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Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium.
J Urol 2018; 199(5):1302-1311JU

Abstract

PURPOSE

This study aimed to provide an update and compare perioperative outcomes and complications of intracorporeal and extracorporeal urinary diversion following robot-assisted radical cystectomy using data from the multi-institutional, prospectively maintained International Robotic Cystectomy Consortium database.

MATERIALS AND METHODS

We retrospectively reviewed the records of 2,125 patients from a total of 26 institutions. Intracorporeal urinary diversion was compared with extracorporeal urinary diversion. Multivariate logistic regression models using stepwise variable selection were fit to evaluate preoperative, operative and postoperative predictors of intracorporeal urinary diversion, operative time, high grade complications and 90-day hospital readmissions after robot-assisted radical cystectomy.

RESULTS

In our cohort 1,094 patients (51%) underwent intracorporeal urinary diversion. These patients demonstrated shorter operative time (357 vs 400 minutes), less blood loss (300 vs 350 ml) and fewer blood transfusions (4% vs 19%, all p <0.001). They experienced more high grade complications (13% vs 10%, p = 0.02). Intracorporeal urinary diversion use increased from 9% of all urinary diversions in 2005 to 97% in 2015. Complications after this procedure decreased significantly with time (p <0.001). On multivariable analysis higher annual cystectomy volume (OR 1.02, 95% CI 1.01-1.03, p <0.002), year of robot-assisted radical cystectomy (2013-2016 OR 68, 95% CI 44-105, p <0.001) and American Society of Anesthesiologists® score less than 3 (OR 1.75, 95% CI 1.38-2.22, p <0.001) were associated with undergoing intracorporeal urinary diversion. The procedure was associated with a shorter operative time of 27 minutes (p = 0.001).

CONCLUSIONS

The use of intracorporeal urinary diversion has increased in the last decade. A higher annual institutional volume of robot-assisted radical cystectomy was associated with intracorporeal urinary diversion as well as with shorter operative time. Although intracorporeal urinary diversion was associated with higher grade complications than extracorporeal urinary diversion, they decreased with time.

Authors+Show Affiliations

Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina. Electronic address: Khurshid.guru@roswellpark.org.Roswell Park Cancer Institute (AAH, PRM, ZJ, YEA, KAG), Buffalo, New York; Cairo University (AAH), Cairo, Egypt; Rijnstate Hospital (CJW), Arnhem, The Netherlands; Ankara Ataturk Training and Research Hospital (AEC), Yildirim Beyazit University, Ankara, Turkey; Guy's Hospital and King's College London School of Medicine (PD, MSK), London, United Kingdom; Division of Surgery and Interventional Science, University College London (JKe), London, United Kingdom; Henry Ford Health System (MM, JOP), Detroit, Michigan; Karolinska University Hospital (AHo), Stockholm, Sweden; Onze-Lieve-Vrouw Ziekenhuis (AM), Aalast, Belgium; Glickman Urological and Kidney Institute (JKa), Cleveland Clinic, Ohio; Wake Forest University Baptist Medical Center (AHe), Winston-Salem, North Carolina.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

29275112

Citation

Hussein, Ahmed A., et al. "Outcomes of Intracorporeal Urinary Diversion After Robot-Assisted Radical Cystectomy: Results From the International Robotic Cystectomy Consortium." The Journal of Urology, vol. 199, no. 5, 2018, pp. 1302-1311.
Hussein AA, May PR, Jing Z, et al. Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium. J Urol. 2018;199(5):1302-1311.
Hussein, A. A., May, P. R., Jing, Z., Ahmed, Y. E., Wijburg, C. J., Canda, A. E., ... Guru, K. A. (2018). Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium. The Journal of Urology, 199(5), pp. 1302-1311. doi:10.1016/j.juro.2017.12.045.
Hussein AA, et al. Outcomes of Intracorporeal Urinary Diversion After Robot-Assisted Radical Cystectomy: Results From the International Robotic Cystectomy Consortium. J Urol. 2018;199(5):1302-1311. PubMed PMID: 29275112.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium. AU - Hussein,Ahmed A, AU - May,Paul R, AU - Jing,Zhe, AU - Ahmed,Youssef E, AU - Wijburg,Carl J, AU - Canda,Abdulla Erdem, AU - Dasgupta,Prokar, AU - Shamim Khan,Mohammad, AU - Menon,Mani, AU - Peabody,James O, AU - Hosseini,Abolfazl, AU - Kelly,John, AU - Mottrie,Alexandre, AU - Kaouk,Jihad, AU - Hemal,Ashok, AU - Wiklund,Peter, AU - Guru,Khurshid A, AU - ,, Y1 - 2017/12/21/ PY - 2017/12/07/accepted PY - 2017/12/25/pubmed PY - 2019/6/7/medline PY - 2017/12/25/entrez KW - cystectomy KW - outcome and process assessment (health care) KW - robotic surgical procedures KW - urinary bladder KW - urinary diversion SP - 1302 EP - 1311 JF - The Journal of urology JO - J. Urol. VL - 199 IS - 5 N2 - PURPOSE: This study aimed to provide an update and compare perioperative outcomes and complications of intracorporeal and extracorporeal urinary diversion following robot-assisted radical cystectomy using data from the multi-institutional, prospectively maintained International Robotic Cystectomy Consortium database. MATERIALS AND METHODS: We retrospectively reviewed the records of 2,125 patients from a total of 26 institutions. Intracorporeal urinary diversion was compared with extracorporeal urinary diversion. Multivariate logistic regression models using stepwise variable selection were fit to evaluate preoperative, operative and postoperative predictors of intracorporeal urinary diversion, operative time, high grade complications and 90-day hospital readmissions after robot-assisted radical cystectomy. RESULTS: In our cohort 1,094 patients (51%) underwent intracorporeal urinary diversion. These patients demonstrated shorter operative time (357 vs 400 minutes), less blood loss (300 vs 350 ml) and fewer blood transfusions (4% vs 19%, all p <0.001). They experienced more high grade complications (13% vs 10%, p = 0.02). Intracorporeal urinary diversion use increased from 9% of all urinary diversions in 2005 to 97% in 2015. Complications after this procedure decreased significantly with time (p <0.001). On multivariable analysis higher annual cystectomy volume (OR 1.02, 95% CI 1.01-1.03, p <0.002), year of robot-assisted radical cystectomy (2013-2016 OR 68, 95% CI 44-105, p <0.001) and American Society of Anesthesiologists® score less than 3 (OR 1.75, 95% CI 1.38-2.22, p <0.001) were associated with undergoing intracorporeal urinary diversion. The procedure was associated with a shorter operative time of 27 minutes (p = 0.001). CONCLUSIONS: The use of intracorporeal urinary diversion has increased in the last decade. A higher annual institutional volume of robot-assisted radical cystectomy was associated with intracorporeal urinary diversion as well as with shorter operative time. Although intracorporeal urinary diversion was associated with higher grade complications than extracorporeal urinary diversion, they decreased with time. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/29275112/Outcomes_of_Intracorporeal_Urinary_Diversion_after_Robot_Assisted_Radical_Cystectomy:_Results_from_the_International_Robotic_Cystectomy_Consortium_ L2 - https://www.jurology.com/doi/full/10.1016/j.juro.2017.12.045?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -