Continent Diversion After Bladder Cancer Surgery on the Decline

Use of continent diversion procedures peaked in 2008, and has been decreasing since.
Use of continent diversion procedures peaked in 2008, and has been decreasing since.
The following article is part of conference coverage from the 2017 American Urological Association meeting in Boston. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2017. 

BOSTON — Use of continent diversion (CD) with orthotopic neobladder after radical cystecomy has been decreasing in recent years, despite the benefit to bladder cancer patients of an internal reservoir for urine, researchers reported at the American Urological Association 2017 annual meeting.

Use of CD declined from a peak of about 11% of cases in 2008 to slightly above 8% in 2012, according to investigators.

“Continent diversions may allow better quality of life and body image perceptions over ileal conduits in selected patients,” lead investigator Robert Weiss, MD, of Rutgers Cancer Institute of New Jersey in New Brunswick told Renal & Urology News. “The youngest patients may be the best candidates. We are concerned that urologists may not be adequately discussing the option of continent diversions, especially with younger patients.”

Using data from the National Inpatient Sample from 2001–2012, the largest all-payer inpatient care database in the United States, the team calculated and compared urinary diversion rates using ICD-9 codes for CD with orthotopic neobladder versus ileal conduit (IC) in male patients with bladder cancer.

From 2001 to 2012, 69,049 ICs and 6991 CDs were performed. In a reversal of the rise observed from 2001 to 2008, CD usage declined every year after 2008. Across all age groups, IC was performed more frequently, including in the youngest subgroups of patients, aged 40–59 and 60-69.

CD and IC showed similar rates of surgical site complications and in-hospital mortality. Surgical site infections occurred in 3.7% and 3.4% of IC and CD patients, respectively. In-hospital mortality occurred in 2.2% and 0.7% of patients, respectively. Length of hospital stay was 8 days for both groups. Complications overall occurred in more frequently among IC than CD patients (52.8% vs 44.7%).

Factors associated with higher usage of CD included being male and white, residing in the western United States, and receiving treatment at a large hospital and/or urban teaching center.

“Possible reasons for declining incidence of continent diversions might include physician reimbursement, length of surgical time, higher incidence of robotic surgery, and physician counseling of patients regarding diversion options,” Dr Weiss stated.

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Reference

Farber N, Faiena I, Dombrovskiy V, et al.  Declining use of continent diversions for bladder cancer. [abstract] J Urol 2017;197(4S):e29. Poster presented at the American Urological Association 2017 annual meeting in Boston on May 12. Poster MP04-05.

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