Comparing the outcome of ileal conduit and transuretero-cutaneostomy urinary diversion after radical cystectomy: a retrospective cohort study

Abstract
Background
Most of the outcomes after radical cystectomy (RC) are directly associated with the type of urinary diversion. This study sets out to evaluate the outcomes of ileal conduit (IC) and transuretero-cutaneostomy (TUC) urinary diversion after RC.

Methods
This retrospective study included 52 patients (IC, n = 30; TUC, n = 22) at Dr. Sardjito Hospital between January 2014 and December 2019. The clinical outcomes were compared using Chi-squared tests and independent t tests. Multivariable logistic regression analysis was performed to determine the odds of developing related complications.

Results
Demographically, both groups were similar in terms of age, gender, ASA score, staging, body mass index, and comorbidities. IC was associated with a high incidence of postoperative complications than TUC (56.7% vs. 27.3%; p = 0.035). Long-term postoperative complications stoma stenosis was more common in the TUC than IC (p = 0.010). Multivariate analysis showed TUC was a significant predictor for stoma stenotic with odds ratio of 1.29 (95% confidence interval, 1.03–1.62; p = 0.006). Meanwhile, metabolic change was found higher in IC (p = 0.047). No difference between the rate of required blood transfusion, postoperative ileus, re-operation, and anastomotic stricture in both groups. Operative time (p = 0.000) and length of stay (p = 0.002) were lower in patients who underwent TUC. The hospitalized cost was also lower in TUC ($ 2311.8 ± 1448 for IC vs. $ 1844.2 ± 948.8 for TUC; p = 0.005). Nonetheless, the follow-up cost was higher in the TUC but not statistically significant. Additionally, there was no difference between the overall satisfaction and diversion-related symptoms scores in both groups. The psychological score was better in IC groups.

Conclusions
Both of these techniques can be an option in a urinary diversion after RC with various advantages and disadvantages. TUC provides reduced complication rates, operative time, shorter length of stay, and hospitalized costs, but IC may reduce postoperative stoma stenosis complications and better psychological function.