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PURPOSE: Radical cystectomy/urinary diversion (RCUD) is a high-risk procedure. Intraoperative stents (IOS) are commonly utilized to decrease ureteroeneteric anastomosis (UEA) related complications. Institutionally, some surgeons routinely utilize IOS while others don’t, providing an opportunity to compare complication differences. MATERIALS AND METHODS: A prospective database of 283 patients enrolled into a randomized controlled trial evaluating 30-day perioperative complications with goal-directed fluid therapy post open RCUD between 2014–2018 was queried. UEA specific complications (ureteral obstruction, urinary leak, urinary infections/sepsis, and intrabdominal abscess) were compared between groups (IOS vs non-IOS) using Fisher’s exact test and quantified using logistic regression. RESULTS: The non-IOS group (77/283,27%) was older (median 72 vs 69), more likely to receive neoadjuvant chemotherapy (53% vs 40%), have baseline renal insufficiency (43% vs 30%), and undergo an ileal conduit (IC) (92% vs 53%). However, despite higher comorbidity, the non-IOS group had a significantly lower rate of UEA complications (14% vs 32%, p=0.004). Since continent diversions may be associated with higher complications, the non-IOS group with IC was also compared to IOS cohorts with IC, and UEA complications remained lower in the non-IOS group (14% vs 28%, p=0.043). Multivariable logistic regression showed a significantly increased odds of urinary complications with IOS use (OR 3.55; 95% CI, 2.93–4.31, p |
