Abstract
Background
Little is known about the disparity of choices between three urinary diversions after radical cystectomy, focusing on patient and institutional factors.
Methods
We identified urothelial carcinoma patients who received radical cystectomy with cutaneous ureterostomy, ileal conduit or continent reservoir using the Japanese Diagnosis Procedure Combination database from 2007 to 2012. Data comprised age, sex, comorbidities (converted into the Charlson index), TNM classification (converted into oncological stage), hospitals’ academic status, hospital volume, bed volume and geographical region. Multivariate ordinal logistic regression analyses fitted with the proportional odds model were performed to analyze factors affecting urinary diversion choices. For dependent variables, the three diversions were converted into an ordinal variable in order of complexity: cutaneous ureterostomy (reference), ileal conduit and continent reservoir. Geographical variations were also examined by multivariate logistic regression models.
Results
A total of 4790 patients (1131 cutaneous ureterostomies [23.6 %], 2970 ileal conduits [62.0 %] and 689 continent reservoirs [14.4 %]) were included. Ordinal logistic regression analyses showed that male sex, lower age, lower Charlson index, early tumor stage, higher hospital volume (≥3.4 cases/year) and larger bed volume (≥450 beds) were significantly associated with the preference of more complex urinary diversion. Significant geographical disparity was also found.
Conclusion
Good patient condition and early oncological status, as well as institutional factors, including high hospital volume, large bed volume and specific geographical regions, are independently related to the likelihood of choosing complex diversions. Recognizing this disparity would help reinforce the need for clinical practice uniformity.
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Abbreviations
- CCI:
-
Charlson comorbidity index
- CR:
-
Continent reservoir
- CU:
-
Cutaneous ureterostomy
- DPC:
-
Diagnosis procedure combination
- IC:
-
Ileal conduit
References
Lerner SP, Sternberg CN (2011) Management of metastatic and invasive bladder cancer. In: Wein AJ, Kavoussi LR, Novick AC et al (eds) Campbell-Walsh Urology. Saunders Elsevier, Philadelphia, pp 2355–2374
Hautmann RE, Abol-Enein H, Hafez K et al (2007) Urinary diversion. Urology 69:17–49
Gore JL, Litwin MS (2009) Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy. World J Urol 27:45–50
Gore JL, Saigal CS, Hanley JM et al (2006) Variations in reconstruction after radical cystectomy. Cancer 107:729–737
Gore JL, Yu HY, Setodji C et al (2010) Urinary diversion and morbidity after radical cystectomy for bladder cancer. Cancer 116:331–339
Sugihara T, Yasunaga H, Horiguchi H et al (2013) Comparisons of perioperative outcomes and costs between open and laparoscopic radical prostatectomy: a propensity-score matching analysis based on the Japanese Diagnosis Procedure Combination database. Int J Urol 20:349–353
Sugihara T, Yasunaga H, Horiguchi H et al (2013) Regional, institutional and individual factors affecting selection of minimally invasive nephroureterectomy in Japan: A national database analysis. Int J Urol 20:695–700
Sobin LH, Wittekind C (2002) TNM Classification of Malignant Tumours, 6th edn, Wiley, New York
Quan H, Sundararajan V, Halfon P et al (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139
Sugihara T, Yasunaga H, Horiguchi H et al (2013) Does mechanical bowel preparation improve quality of laparoscopic nephrectomy? Propensity score-matched analysis in Japanese series. Urology 81:74–79
Bender R, Grouven U (1997) Ordinal logistic regression in medical research. J R Coll Physicians Lond 31:546–551
Panageas KS, Schrag D, Riedel E et al (2003) The effect of clustering of outcomes on the association of procedure volume and surgical outcomes. Ann Intern Med 139:658–665
Jahnson S, Damm O, Hellsten S et al (2010) Urinary diversion after cystectomy for bladder cancer: a population-based study in Sweden. Scand J Urol Nephrol 44:69–75
Bjerre BD, Johansen C, Steven K (1995) Health-related quality of life after cystectomy: bladder substitution compared with ileal conduit diversion. A questionnaire survey. Br J Urol 75:200–205
Kitamura H, Miyao N, Yanase M et al (1999) Quality of life in patients having an ileal conduit, continent reservoir or orthotopic neobladder after cystectomy for bladder carcinoma. Int J Urol 6:393–399
Dutta SC, Chang SC, Coffey CS et al (2002) Health related quality of life assessment after radical cystectomy: comparison of ileal conduit with continent orthotopic neobladder. J Urol 168:164–167
The Committee for Establishment of the Clinical Practice Guidelines for the Management of Bladder Cancer and the Japanese Urological Association (2010) Evidence-based clinical practice guidelines for bladder cancer (summary—JUA 2009 Edition). Int J Urol 17:102–124
Hollenbeck BK, Taub DA, Miller DC et al (2005) The regionalization of radical cystectomy to specific medical centers. J Urol 174:1385–1389
Sanchez-Ortiz RF, Huang WC, Mick R et al (2003) An interval longer than 12 weeks between the diagnosis of muscle invasion and cystectomy is associated with worse outcome in bladder carcinoma. J Urol 169:110–115
Kilciler M, Bedir S, Erdemir F et al (2006) Comparison of ileal conduit and transureteroureterostomy with ureterocutaneostomy urinary diversion. Urol Int 77:245–250
MacGregor PS, Montie JE, Straffon RA (1987) Cutaneous ureterostomy as palliative diversion in adults with malignancy. Urology 30:31–34
Deliveliotis C, Papatsoris A, Chrisofos M et al (2005) Urinary diversion in high-risk elderly patients: modified cutaneous ureterostomy or ileal conduit? Urology 66:299–304
Malavaud B, Vaessen C, Mouzin M et al (2001) Complications for radical cystectomy. Impact of the American Society of Anesthesiologists score. Eur Urol 39:79–84
Pycha A, Comploj E, Martini T et al (2008) Comparison of complications in three incontinent urinary diversions. Eur Urol 54:825–832
Hautmann RE, Hautmann SH, Hautmann O (2011) Complications associated with urinary diversion. Nat Rev Urol 8:667–677
Sugihara T, Yasunaga H, Horiguchi H et al (2012) Admissions related to interstitial cystitis in Japan: an estimation based on the Japanese Diagnosis Procedure Combination database. Int J Urol 19:86–89
Acknowledgments
This study was funded by an ITO Genboku and SAGARA Chian Memorial Scholarship from Saga Prefecture, Japan, by a Grant-in-Aid for Research on Policy Planning and Evaluation from the Ministry of Health, Labour and Welfare, Japan (Grant number: H22-Policy-031), by a Grant-in-Aid for Scientific Research B (No. 22390131) from the Ministry of Education, Culture, Sports, Science and Technology and by the Funding Program for World-Leading Innovative R&D on Science and Technology (FIRST program) from the Council for Science and Technology Policy, Japan (Grant number: 0301002001001).
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The authors declare that they have no conflict of interest.
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Sugihara, T., Yasunaga, H., Horiguchi, H. et al. Factors affecting choice between ureterostomy, ileal conduit and continent reservoir after radical cystectomy: Japanese series. Int J Clin Oncol 19, 1098–1104 (2014). https://doi.org/10.1007/s10147-013-0655-1
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DOI: https://doi.org/10.1007/s10147-013-0655-1