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Annals of Surgical Oncology

, Volume 22, Issue 3, pp 1032–1042 | Cite as

Evidence from the ‘PROspective MulticEnTer RadIcal Cystectomy Series 2011 (PROMETRICS 2011)’ Study: How are Preoperative Patient Characteristics Associated with Urinary Diversion Type After Radical Cystectomy for Bladder Cancer?

  • Marianne Schmid
  • Michael Rink
  • Miriam Traumann
  • Patrick J. Bastian
  • Georg Bartsch
  • Jörg Ellinger
  • Marc-Oliver Grimm
  • Boris Hadaschik
  • Axel Haferkamp
  • Oliver W. Hakenberg
  • Atiqullah Aziz
  • Florian Hartmann
  • Edwin Herrmann
  • Markus Hohenfellner
  • Günter Janetschek
  • Michael Gierth
  • Sasc ha Pahernik
  • Chris Protzel
  • Jan Roigas
  • Murat Gördük
  • Lukas Lusuardi
  • Matthias May
  • Quoc-Dien Trinh
  • Margit Fisch
  • Felix K.H. Chun
  • PROMETRICS 2011 Research Group
Urologic Oncology

Abstract

Purpose

The aim of this study was to examine preoperative patients’ characteristics associated with the urinary diversion (UD) type (continent vs. incontinent) after radical cystectomy (RC) and UD-associated postoperative complications.

Materials

In 2011, 679 bladder cancer patients underwent RC at 18 European tertiary care centers. Data were prospectively collected within the ‘PROspective MulticEnTer RadIcal Cystectomy Series 2011’ (PROMETRICS 2011). Logistic regression models assessed the impact of preoperative characteristics on UD type and evaluated diversion-related complication rates.

Results

Of 570 eligible patients, 28.8, 2.6, 59.3, and 9.3 % received orthotopic neobladders, continent cutaneous pouches, ileal conduits, and ureterocutaneostomies, respectively. In multivariable analyses, female sex (odds ratio [OR] 3.9; p = 0.002), American Society of Anesthesiologists score ≥3 (OR 2.3; p = 0.02), an age-adjusted Charlson Comorbidity Index ≥3 (OR 4.1; p < 0.001), and a positive biopsy of the prostatic urethra in the last transurethral resection of the bladder prior to RC (OR 4.9; p = 0.03) were independently associated with incontinent UD. There were no significant differences in 30- and/or 90-day complication rates between the UD types. Perioperative transfusion rates and 90-day mortality were significantly associated with incontinent UD (p < 0.001, respectively). Limitations included the small sample size and a certain level of heterogeneity in the application of clinical pathways between the different participating centers.

Conclusions

Within this prospective contemporary cohort of European RC patients treated at tertiary care centers, the majority of patients received an incontinent UD. Female sex and pre-existing comorbidities were associated with receiving an incontinent UD. The risk of overall complications did not vary according to UD type.

Keywords

Radical Cystectomy Urinary Diversion Multivariable Logistic Regression Analysis Prostatic Urethra MIBC 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors would like to thank their colleagues for their valuable effort in the acquisition of data within our collaborative research group, PROMETRICS 2011.

Disclosure

Marianne Schmid certifies that there are no conflicts of interest, including specific financial interests and relationships and affiliations, relevant to the subject matter or materials discussed in the manuscript (e.g. employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending).

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Marianne Schmid
    • 1
    • 2
  • Michael Rink
    • 1
  • Miriam Traumann
    • 1
  • Patrick J. Bastian
    • 3
  • Georg Bartsch
    • 4
  • Jörg Ellinger
    • 5
  • Marc-Oliver Grimm
    • 6
  • Boris Hadaschik
    • 7
  • Axel Haferkamp
    • 4
  • Oliver W. Hakenberg
    • 8
  • Atiqullah Aziz
    • 9
  • Florian Hartmann
    • 6
  • Edwin Herrmann
    • 10
  • Markus Hohenfellner
    • 7
  • Günter Janetschek
    • 11
  • Michael Gierth
    • 9
  • Sasc ha Pahernik
    • 7
  • Chris Protzel
    • 8
  • Jan Roigas
    • 12
  • Murat Gördük
    • 12
  • Lukas Lusuardi
    • 11
  • Matthias May
    • 13
  • Quoc-Dien Trinh
    • 2
  • Margit Fisch
    • 1
  • Felix K.H. Chun
    • 1
  • PROMETRICS 2011 Research Group
  1. 1.Department of UrologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Center for Surgery and Public Health and Division of Urologic SurgeryBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Department of UrologyParacelsus Medical Center GolzheimDüsseldorfGermany
  4. 4.Department of UrologyGoethe UniversityFrankfurt am MainGermany
  5. 5.Department of UrologyUniversity of BonnBonnGermany
  6. 6.Department of UrologyUniversity of JenaJenaGermany
  7. 7.Department of UrologyUniversity of HeidelbergHeidelbergGermany
  8. 8.Department of UrologyUniversity of RostockRostockGermany
  9. 9.Department of Urology, Caritas St. Josef Medical CenterUniversity of RegensburgRegensburgGermany
  10. 10.Department of UrologyUniversity of MünsterMünsterGermany
  11. 11.Department of UrologyParacelsus Medical UniversitySalzburgAustria
  12. 12.Department of UrologyVivantes Kliniken Am Urban und Im Friedrichshain BerlinBerlinGermany
  13. 13.Department of UrologySt. Elisabeth Medical CenterStraubingGermany

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