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Stoma complications and quality of life in patients with Indiana pouch versus appendico/neo-appendico-umbilicostomy urinary diversions

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Abstract

Objectives

To evaluate three subtypes of continent-cutaneous urinary diversion (CCUD); Indiana pouch (IP), right colon pouch with appendico-umbilicostomy (AU), and right colon pouch with neo-appendico-umbilicostomy (NAU), by investigating diversion-specific complications and quality-of-life outcomes.

Materials and methods

A retrospective review of an IRB-approved database was conducted for perioperative and outcome data. The EORTC QLQ-C30 questionnaire was used to assess quality of life; all responses were obtained > 6 months after diversion.

Results

Fifty-eight patients who underwent a CCUD at our institution from 2010 to 2016 (33 IP by two surgeons, 15 AU and ten NAU by third surgeon) were identified for this study. Higher age and Charlson Comorbidity Index (CCI) ≥ 3 were seen in the AU cohort when compared to the IP cohort (P = 0.02 and 0.02, respectively). NAU group were also older when compared to the IP group (P = 0.02). After a median follow-up of 21 months (range: 0.8–81.0), more high-grade diversion-related complications were reported for AU and NAU patients comparing to the IP group (P < 0.01 and P = 0.02, respectively). More stoma complications were also reported for the NAU cohort than the IP cohort (70% vs 30%, P = 0.03). In all groups, > 60% of stoma complications occurred at the skin or fascia level. In the 90-day postoperative period, a higher continence rate was reported for the IP cohort, and this difference was significant when compared to the NAU cohort (P = 0.04). Length of stay after surgery and revision rates were not significantly different. For all groups, the majority of patients reported little-to-no disturbance of daily functions and rated overall quality of life as good-to-excellent.

Conclusion

Urinary diversion using the Indiana pouch and right colon pouch with appendico/neo-appendico-umbilicostomy are all associated with high rates of continence and patient satisfaction. When compared to IP, AU and NAU patients had higher rates of high-grade diversion-related complications and NAU patients had a higher stoma complications with lower 90-day continence rate.

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Authors and Affiliations

  1. USC-Keck School of Medicine, USC Institute of Urology, Los Angeles, CA, USA

    Kai Wen Cheng

  2. USC/Norris Comprehensive Cancer Center, USC Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089, USA

    Wesley Yip, Luis G. Medina, Alireza Ghoreifi, Gus Miranda, Anne Schuckman, Siamak Daneshmand & Hooman Djaladat

  3. Duke University Division of Urology, Durham, NC, USA

    Ankeet Shah

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  1. Kai Wen Cheng
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  2. Wesley Yip
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  4. Luis G. Medina
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  5. Alireza Ghoreifi
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  6. Gus Miranda
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  7. Anne Schuckman
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  8. Siamak Daneshmand
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  9. Hooman Djaladat
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Contributions

KWC: data collection or management, data analysis, and manuscript writing/editing. WY: data analysis and manuscript writing/editing. AS: data analysis and manuscript writing/editing. LGM: data analysis and manuscript writing/editing. AG: data analysis and manuscript writing/editing. GM: data collection or management, critical review, and supervision. AS: protocol/project development and manuscript writing/editing. SD: protocol/project development and manuscript writing/editing. HD: protocol/project development, data analysis, and manuscript writing/editing.

Corresponding author

Correspondence to Hooman Djaladat.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Cheng, K.W., Yip, W., Shah, A. et al. Stoma complications and quality of life in patients with Indiana pouch versus appendico/neo-appendico-umbilicostomy urinary diversions. World J Urol 39, 1521–1529 (2021). https://doi.org/10.1007/s00345-020-03348-z

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  • DOI: https://doi.org/10.1007/s00345-020-03348-z

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