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Factors affecting choice between ureterostomy, ileal conduit and continent reservoir after radical cystectomy: Japanese series

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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

  1. 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

    Google Scholar 

  2. Hautmann RE, Abol-Enein H, Hafez K et al (2007) Urinary diversion. Urology 69:17–49

    Article  PubMed  Google Scholar 

  3. Gore JL, Litwin MS (2009) Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy. World J Urol 27:45–50

    Article  PubMed Central  PubMed  Google Scholar 

  4. Gore JL, Saigal CS, Hanley JM et al (2006) Variations in reconstruction after radical cystectomy. Cancer 107:729–737

    Article  PubMed Central  PubMed  Google Scholar 

  5. Gore JL, Yu HY, Setodji C et al (2010) Urinary diversion and morbidity after radical cystectomy for bladder cancer. Cancer 116:331–339

    Article  PubMed Central  PubMed  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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

    Google Scholar 

  8. Sobin LH, Wittekind C (2002) TNM Classification of Malignant Tumours, 6th edn, Wiley, New York

  9. 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

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. Bender R, Grouven U (1997) Ordinal logistic regression in medical research. J R Coll Physicians Lond 31:546–551

    CAS  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  CAS  PubMed  Google Scholar 

  15. 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

    Article  CAS  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    Article  Google Scholar 

  18. Hollenbeck BK, Taub DA, Miller DC et al (2005) The regionalization of radical cystectomy to specific medical centers. J Urol 174:1385–1389

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. Kilciler M, Bedir S, Erdemir F et al (2006) Comparison of ileal conduit and transureteroureterostomy with ureterocutaneostomy urinary diversion. Urol Int 77:245–250

    Article  PubMed  Google Scholar 

  21. MacGregor PS, Montie JE, Straffon RA (1987) Cutaneous ureterostomy as palliative diversion in adults with malignancy. Urology 30:31–34

    Article  CAS  PubMed  Google Scholar 

  22. 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

    Article  CAS  PubMed  Google Scholar 

  23. 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

    Article  CAS  PubMed  Google Scholar 

  24. Pycha A, Comploj E, Martini T et al (2008) Comparison of complications in three incontinent urinary diversions. Eur Urol 54:825–832

    Article  PubMed  Google Scholar 

  25. Hautmann RE, Hautmann SH, Hautmann O (2011) Complications associated with urinary diversion. Nat Rev Urol 8:667–677

    PubMed  Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

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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).

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to Toru Sugihara.

Appendix

Appendix

See Table 4.

Table 4 Classification of Japanese Prefectures into eight regions

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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

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