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. 2025 Oct 6.
doi: 10.1111/bju.70018. Online ahead of print.

Temporal trends and clinical determinants of urinary diversion after radical cystectomy

Francesco Pellegrino  1   2 , Mario de Angelis  2   3   4 , Pietro Scilipoti  2   3   5 , Mattia Longoni  2   3 , José Daniel Subiela  6 , Roberto Contieri  7 , Luca Afferi  8   9 , Stefania Zamboni  10 , Nazareno Suardi  10 , Gennaro Musi  11   12 , Stefano Luzzago  11   12 , David D'Andrea  13 , Ekaterina Laukhtina  13 , Francesco Soria  14 , Paolo Gontero  14 , Francesco Del Giudice  15 , Giuseppe Fallara  1   11 , Morgan Roupret  5 , Elisabeth Grobet-Jeandin  16 , Arthur Baudewyns  17 , Hajime Tanaka  18 , Shunya Matsumoto  18 , Yasuhisa Fujii  18 , Flavia Proietti  19 , Giuseppe Simone  19 , Gerald Bastian Schulz  20 , Nikolaos Pyrgidis  20 , Guillaume Ploussard  21 , Alessandro Antonelli  22 , Riccardo Bertolo  22 , Mathieu Roumiguie  23 , Anne-Sophie Bajeot  23 , Stefano Resca  4 , Edoardo Beatrici  4 , Edward Lambert  4 , Alexandre Mottrie  4 , Maria Carme Mir  24 , Paolo Umari  25 , Jeremy Teoh  26 , Chris Wong  26 , Laura S Mertens  27 , Renate Pichler  28 , Keiichiro Mori  29 , Aleksander Ślusarczyk  30 , Cédric Poyet  31 , Simone Albisinni  32 , Atiqullah Aziz  33   34 , Alessandro Volpe  35 , Shahrokh Shariat  17   36   37   38 , Benjamin Pradere  39 , Pierre Karakiewicz  40 , Andrea Necchi  2   3 , Matteo Ferro  1   12 , Francesco Montorsi  2   3 , Alberto Briganti  2   3 , Marco Moschini  2   3 ; European Association of Urology–Young Academic Urologists Urothelial Carcinoma Working Group (EAU‐YAU)
Affiliations

Temporal trends and clinical determinants of urinary diversion after radical cystectomy

Francesco Pellegrino et al. BJU Int. .

Abstract

Objectives: To evaluate the temporal trends in types of urinary diversion (UD) used after radical cystectomy (RC) in a large, multicentre, international cohort over the past two decades.

Materials and methods: We analysed 6469 patients who underwent RC between 2004 and 2024 at 23 international tertiary referral centres. Trends in UD type (cutaneous ureterostomy [UCS], ileal conduit [IC], and neobladder) were assessed using estimated annual percentage change (EAPC). Multivariable analysis (MVA) models identified preoperative predictors of UD type. EAPC was applied to evaluate temporal changes in the patient characteristics associated with UD type.

Results: Overall, 882 (14%), 3611 (56%) and 1976 patients (31%) underwent UCS, IC, and neobladder procedures, respectively. IC remained the most common UD, without significant temporal change (P = 0.1). UCS use increased from 2% to 22% (EAPC 9.9%; P < 0.001), while neobladder use declined from 41% to 19% (EAPC -2%; P = 0.009). MVA showed that older age, comorbidities, and advanced disease were associated with higher rates of UCS and lower rates of neobladder use (all P < 0.005). Neoadjuvant chemotherapy (NAC) was inversely linked to UCS, while robot-assisted RC and male sex favoured neobladder use (all P < 0.005). EAPC showed rising proportions of male patients (EAPC 6.7%), patients aged >70 years (1.2%), patients with a Charlson Comorbidity Index ≥3 (8.3%), patients who received NAC (10.4%) and patients with cT2-cN0 disease (0.5%; all P < 0.05).

Conclusion: Over two decades, a marked increase in UCS use has been observed, alongside a decline in neobladder reconstruction. These trends coincided with a shift toward older, more comorbid patients undergoing RC. Evolving patient profiles and surgical practices underscore the need for tailored UD strategies and optimised peri-operative management.

Keywords: bladder cancer; radical cystectomy; robotic surgery; urinary diversion; urothelial cancer.

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