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Comparative Study
. 2024 Oct 23;42(1):591.
doi: 10.1007/s00345-024-05300-x.

Cutaneous ureterostomy following robot-assisted radical cystectomy: a multicenter comparative study of transperitoneal versus retroperitoneal techniques

Yutaro Sasaki #  1 , Yasuyo Yamamoto #  2 , Kyotaro Fukuta  3 , Kazuyoshi Izumi  4 , Fumiya Kadoriku  5 , Kei Daizumoto  2 , Keito Shiozaki  3 , Ryotaro Tomida  2 , Yoshito Kusuhara  2 , Tomoya Fukawa  2 , Yutaka Yanagihara  5 , Kunihisa Yamaguchi  2 , Hirofumi Izaki  3 , Masayuki Takahashi  2 , Kenjiro Okamoto  5 , Masahito Yamanaka  4 , Junya Furukawa  2
Affiliations
Comparative Study

Cutaneous ureterostomy following robot-assisted radical cystectomy: a multicenter comparative study of transperitoneal versus retroperitoneal techniques

Yutaro Sasaki et al. World J Urol. .

Abstract

Background: The aim of this study was to evaluate the differences in perioperative outcomes between transperitoneal and retroperitoneal techniques in cutaneous ureterostomy (CUS).

Methods: Between 2018 and 2023, 55 patients underwent CUS following robot-assisted radical cystectomy. Among the 55 patients, we compared 33 patients who underwent transperitoneal CUS (t-CUS) and 22 who underwent retroperitoneal CUS (r-CUS).

Results: Compared with the r-CUS group, the t-CUS group had significantly shorter operative times (p < 0.001); significantly less estimated blood loss (p < 0.001); and significantly lower incidence of complications (Clavien-Dindo classification grade ≤ 2) within 30 days (p = 0.005). Unexpectedly, the incidence of ileus within 30 days was lower, though the difference was not statistically significant (p = 0.064). During the median follow-up period of 24.3 months, no ileus was observed in either group after 30 days postoperatively. There was no significant difference in the stent-free rate between the groups (p = 0.449). There were also no significant differences in the rates of change in estimated glomerular filtration rate from preoperatively at 3, 6, 12, and 24 months postoperatively between the groups (p = 0.590, p = 0.627, p = 0.741, and p = 0.778, respectively).

Conclusions: Compared with r-CUS, t-CUS was associated with a shorter operative time and lower incidence of perioperative complications, including gastrointestinal complications. We believe that t-CUS can be performed safely and effectively.

Keywords: Bladder cancer; Cutaneous ureterostomy; Retroperitoneal technique; Robot-assisted radical cystectomy; Transperitoneal technique.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Surgical images showing transperitoneal CUS. (a) The patient-side surgeon inserts Pean forceps transperitoneally from the stoma site. (b) The patient-side surgeon retracts the ureter out of the body. CUS, cutaneous ureterostomy
Fig. 2
Fig. 2
Surgical images showing retroperitoneal CUS. (a) The console surgeon expands the retroperitoneal space laterally toward the stoma site. (b) The patient-side surgeon expands the retroperitoneal space near the stoma site using a trocar. (c) The patient-side surgeon then inserts Pean forceps retroperitoneally from the stoma site. (d) The patient-side surgeon retracts the ureter out of the body. (e) The console surgeon checks to make sure the left ureter is not bent. (f) Retroperitonealization of the ureter is completed. CUS, cutaneous ureterostomy
Fig. 3
Fig. 3
The rate of change in eGFR before and after surgery between the transperitoneal CUS and retroperitoneal CUS groups. CUS, cutaneous ureterostomy; t- transperitoneal; r-, retroperitoneal; eGFR, estimated glomerular filtration rate; Preop, preoperatively; POM, postoperative months
See this image and copyright information in PMC

References

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