Unilateral cutaneous ureterostomy with separate stomas versus ileal conduit after radical cystectomy: A prospective non-randomized comparative study

Background: Urinary diversion after radical cystectomy (RC) is a complex surgery that has effects on different patient aspects. The aim was to compare the surgical outcomes and to identify the factors influencing quality-of-life (QoL) after RC with cutaneous ureterostomy (CU) or ileal conduit (IC). Methods: A prospective non-randomized study was performed on patients who underwent RC from April 2019 to March 2022. The demographic and clinical characteristics and QoL were compared in patients with IC and unilateral CU. The primary outcome was the difference in the operative time between patients underwent CU (group A) and IC (group B). Results: This study included 32 patients with median age (range) of 61 (48-83) years and median (range) body mass index of 23.95 (19.2-30.2) kg/m ² . Urinary tract infections (UTI; 68.8%) patients and paralytic ileus (50%) were the commonest complications. The mortality rate was 18.8%, and the main cause was septicemia. The median time of shunt procedure was significantly longer in group B (p<0.001). Also, the postoperative anemia (p=0.029), the interval of exchange of the base of the collecting bag (p<0.001), and the rate of febrile UTI (p=0.017) were higher in group A. However, the score of QoL (p=0.025) and survival rate (p=0.004) were significantly better in group B than in group A. The median QoL score for group A was 68 (52-90) while the median QoL score for group B was 80.50 (62-103) (p=0.029). Serum creatinine level (p=0.045), recurrent UTI (p=0.025), and the number of re-interventions (p=0.010) had significant inverse association with QoL. However, the eGFR showed a significant proportional relation (p-value 0.006). Conclusions: Considering the need for re-intervention in patients in the IC group, unilateral CU with separate stomas may represent a good alternative to IC despite the relatively better QoL and long-term outcomes of the latter. Trial registration : NCT04610385