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. 2024 Oct;31(10):7220-7228.
doi: 10.1245/s10434-024-15730-x. Epub 2024 Jul 5.

Temporal Trends in Urinary Diversion among Patients Undergoing Radical Cystectomy Between 1986 and 2022: Experience at the University Medical Center Mainz with 2224 Cases

Gregor Duwe  1 , Mohamed M Kamal  2 , Crispin Wiesmann  2 , Katarzyna E Banasiewicz  2 , Isabel Wagner  2 , Nikita Dhruva Fischer  2 , Maximilian Haack  2 , Lisa Johanna Frey  2 , Rene Mager  2 , Thomas Höfner  3 , Peter Sparwasser  4 , Igor Tsaur  4 , Christoph Wiesner  5 , Christian Thomas  6 , Joachim Wolfgang Thüroff  2 , Rudolf Hohenfellner  2 , Maximilian Peter Brandt #  2 , Axel Haferkamp #  2
Affiliations

Temporal Trends in Urinary Diversion among Patients Undergoing Radical Cystectomy Between 1986 and 2022: Experience at the University Medical Center Mainz with 2224 Cases

Gregor Duwe et al. Ann Surg Oncol. 2024 Oct.

Abstract

Background: Analysis of temporal trends of urinary diversion (UD) and identification of predictive factors for continent urinary diversion (CUD) in patients with bladder cancer (BC) is scarce and data on large cohorts are missing. We aimed to describe longitudinal temporal trends and predictive factors for UD among patients with BC receiving radical cystectomy (RC).

Patients and methods: We retrospectively analysed institutional data collected from patients undergoing RC from 1986 to 2022 to describe changes in patients' characteristics and UD. Primary end points were patients' characteristics associated with type of UD. Logistic regression analysis was used to determine predictive factors for CUD.

Results: In total, 2224 patients (77.16% male, 22.84% female) with a mean age of 66 years [standard deviation (SD), 10.64 years] were included. We observed an increase in mean age from 59.86 (10.8) years (1986-1990) to 69.85 (9.99) years (2016-2022) (p < 0.001). The proportion of CUD gradually declined from 43.72% (94/215; 1986-1990) to 18.38% (86/468; 2016-2022). Patients who were male [odds ratio (OR): 1.92, 95% confidence interval (CI): 1.43-2.57, p < 0.001), younger (OR: 0.88, 95% CI: 0.87-0.89, p < 0.001) and had no hydronephrosis prior to RC (OR: 2.2, 95% CI: 1.66-2.92, p < 0.001) were more likely to receive CUD.

Conclusions: We report the largest European single-center cohort of UD after RC, demonstrating a significant shift from CUD to IUD, accompanied by an increasing age. Finally, our data mirrors the development and extensive experience with the Mainz Pouch-I in the 1980's and 1990's together with other colon pouches.

Keywords: Bladder cancer; Continent urinary diversion; Incontinent urinary diversion; Radical cystectomy; Time trends; Urinary diversion; Urothelial cell cancer.

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Figures

Fig. 1
Fig. 1
Temporal trends in mean age of patients undergoing radical cystectomy, n = 2224
Fig. 2
Fig. 2
Temporal trends in urinary diversion in patients undergoing radical cystectomy, n = 2182, n = 42 were excluded owing to insufficient data on UD
Fig. 3
Fig. 3
Mean age of patients with continent urinary diversions versus incontinent urinary diversions from 1986 to 2022, n = 2182, n = 42 were excluded due to insufficient data on UD
See this image and copyright information in PMC

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