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.
| Original language | English |
|---|---|
| Pages (from-to) | 1302-1311 |
| Number of pages | 10 |
| Journal | Journal of Urology |
| Volume | 199 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 2018 May |
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All Science Journal Classification (ASJC) codes
- Urology
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Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy : Results from the International Robotic Cystectomy Consortium. / Collaborators.
In: Journal of Urology, Vol. 199, No. 5, 05.2018, p. 1302-1311.Research output: Contribution to journal › Article
TY - JOUR
T1 - Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy
T2 - Results from the International Robotic Cystectomy Consortium
AU - Collaborators
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 - Wagner, Andrew
AU - Saar, Matthias
AU - Stockle, Michael
AU - Redorta, Joan Palou
AU - Richstone, Lee
AU - Badani, Ketan
AU - Scherr, Douglas
AU - Khan, Hijab
AU - Gaboardi, Franco
AU - Rha, Koon Ho
AU - Kawa, Omar
AU - Tan, Wei Shen
AU - Schanne, Francis
AU - Polakis, Vassilis
AU - Weizer, Alon
AU - Maatman, Thomas J.
AU - Pini, Giovannalberto
AU - Peak, Taylor C.
AU - Kibel, Adam
AU - Yuh, Bertram
PY - 2018/5
Y1 - 2018/5
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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85044619628&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044619628&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2017.12.045
DO - 10.1016/j.juro.2017.12.045
M3 - Article
C2 - 29275112
AN - SCOPUS:85044619628
VL - 199
SP - 1302
EP - 1311
JO - Journal of Urology
JF - Journal of Urology
SN - 0022-5347
IS - 5
ER -