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Evidence from the ‘PROspective MulticEnTer RadIcal Cystectomy Series 2011 (PROMETRICS 2011)’ Study: How are Preoperative Patient Characteristics Associated with Urinary Diversion Type After Radical Cystectomy for Bladder Cancer?

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to examine preoperative patients’ characteristics associated with the urinary diversion (UD) type (continent vs. incontinent) after radical cystectomy (RC) and UD-associated postoperative complications.

Materials

In 2011, 679 bladder cancer patients underwent RC at 18 European tertiary care centers. Data were prospectively collected within the ‘PROspective MulticEnTer RadIcal Cystectomy Series 2011’ (PROMETRICS 2011). Logistic regression models assessed the impact of preoperative characteristics on UD type and evaluated diversion-related complication rates.

Results

Of 570 eligible patients, 28.8, 2.6, 59.3, and 9.3 % received orthotopic neobladders, continent cutaneous pouches, ileal conduits, and ureterocutaneostomies, respectively. In multivariable analyses, female sex (odds ratio [OR] 3.9; p = 0.002), American Society of Anesthesiologists score ≥3 (OR 2.3; p = 0.02), an age-adjusted Charlson Comorbidity Index ≥3 (OR 4.1; p < 0.001), and a positive biopsy of the prostatic urethra in the last transurethral resection of the bladder prior to RC (OR 4.9; p = 0.03) were independently associated with incontinent UD. There were no significant differences in 30- and/or 90-day complication rates between the UD types. Perioperative transfusion rates and 90-day mortality were significantly associated with incontinent UD (p < 0.001, respectively). Limitations included the small sample size and a certain level of heterogeneity in the application of clinical pathways between the different participating centers.

Conclusions

Within this prospective contemporary cohort of European RC patients treated at tertiary care centers, the majority of patients received an incontinent UD. Female sex and pre-existing comorbidities were associated with receiving an incontinent UD. The risk of overall complications did not vary according to UD type.

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Acknowledgment

The authors would like to thank their colleagues for their valuable effort in the acquisition of data within our collaborative research group, PROMETRICS 2011.

Disclosure

Marianne Schmid certifies that there are no conflicts of interest, including specific financial interests and relationships and affiliations, relevant to the subject matter or materials discussed in the manuscript (e.g. employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending).

Author information

Authors and Affiliations

  1. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Marianne Schmid MD, Michael Rink MD, Miriam Traumann MD, Margit Fisch MD & Felix K.H. Chun MD

  2. Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Marianne Schmid MD & Quoc-Dien Trinh MD

  3. Department of Urology, Paracelsus Medical Center Golzheim, Düsseldorf, Germany

    Patrick J. Bastian MD

  4. Department of Urology, Goethe University, Frankfurt am Main, Germany

    Georg Bartsch MD & Axel Haferkamp MD

  5. Department of Urology, University of Bonn, Bonn, Germany

    Jörg Ellinger MD

  6. Department of Urology, University of Jena, Jena, Germany

    Marc-Oliver Grimm MD & Florian Hartmann MD

  7. Department of Urology, University of Heidelberg, Heidelberg, Germany

    Boris Hadaschik MD, Markus Hohenfellner MD & Sasc ha Pahernik MD

  8. Department of Urology, University of Rostock, Rostock, Germany

    Oliver W. Hakenberg MD & Chris Protzel MD

  9. Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany

    Atiqullah Aziz MD & Michael Gierth MD

  10. Department of Urology, University of Münster, Münster, Germany

    Edwin Herrmann MD

  11. Department of Urology, Paracelsus Medical University, Salzburg, Austria

    Günter Janetschek MD & Lukas Lusuardi MD

  12. Department of Urology, Vivantes Kliniken Am Urban und Im Friedrichshain Berlin, Berlin, Germany

    Jan Roigas MD & Murat Gördük MD

  13. Department of Urology, St. Elisabeth Medical Center, Straubing, Germany

    Matthias May MD

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  1. Marianne Schmid MD
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Consortia

PROMETRICS 2011 Research Group

Corresponding author

Correspondence to Marianne Schmid MD.

Additional information

Marianne Schmid and Michael Rink contributed equally to this article.

PROMETRICS 2011 Research Group: The PROMETRICS 2011 Research Group: Hans Martin Fritsche, Maximilian Burger, Roman Mayr (Regensburg); Rein-Jüri Palisaar, Joachim Noldus, Florian Roghmann (Herne); Christian Bolenz, Thomas Martini, Maurice Stephan Michel (Mannheim); Armin Pycha (Bozen); Christian Seitz (Wien); Manfred Wirth, Vladimir Novotny, Michael Fröhner (Dresden); Sabine Brookman-May, Christian G. Stief, Philipp Nuhn, Alexander Buchner (LMU München); Melanie Durschnabel, Florian Wagenlehner, Wolfgang Weidner (Gießen); Lothar Hertle, Rudolf Moritz (Münster); Bastian Keck, Bernd Wullich (Erlangen); Stefan Vallo (Frankfurt); Nicole Kraischits (Salzburg); Annerose Krausse (Jena); Stefan C. Müller, Isabella Syring, Jörg Ellinger (Bonn).

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Schmid, M., Rink, M., Traumann, M. et al. Evidence from the ‘PROspective MulticEnTer RadIcal Cystectomy Series 2011 (PROMETRICS 2011)’ Study: How are Preoperative Patient Characteristics Associated with Urinary Diversion Type After Radical Cystectomy for Bladder Cancer?. Ann Surg Oncol 22, 1032–1042 (2015). https://doi.org/10.1245/s10434-014-4029-3

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