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

Unilateral cutaneous ureterostomy with separate stomas versus ileal conduit after radical cystectomy: A prospective non-randomized comparative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unilateral cutaneous ureterostomy with separate stomas versus ileal conduit after radical cystectomy: A prospective non-randomized comparative study Mahmoud Khalil, Mina Hosam Mahdy, Rabea Ahmed Gadelkareem, Ahmed Shahat, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7723501/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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 Bladder cancer Cutaneous ureterostomy Ileal conduit Radical cystectomy Urinary diversion Figures Figure 1 Introduction Radical cystectomy (RC) with pelvic lymph node dissection and appropriate urinary diversion (UD) remain the mainstay of treatment for muscle-invasive bladder cancer (BC) and for high-risk non-muscle invasive disease. UD is a complex surgery that has an impact on different aspects of health, including physical, psychosocial, sexual, activities of daily living, and distress related to body image [ 1 ]. The ideal UD should successfully preserve renal function while managing urinary outflow and minimizing morbidity to the patient [ 2 ]. Although ileal conduit (IC) is considered the standard method for incontinent UD, it is associated with early bowel-related complications, such as bowel obstruction, prolonged ileus, and anastomotic leak. Also, late complications occur in 25–60% of patients, comprising ureteroenteric stricture (UES), urinary fistula, and stomal site complications. The latter include stomal stenosis, retraction, prolapse, and parastomal herniation. Cutaneous ureterostomy (CU) may represent the method of choice for elderly and otherwise morbid patients due to its relatively short duration and fewer bowel and metabolic complications. Still, it has a high rate of stomal stenosis making permanent stenting mandatory [ 3 ]. In poor communities, specialized medical care is not widely available. This study hypothesized that unilateral CU with separate stomas may represent a good alternative to IC without significant unfavorable effects on the quality of life (QoL) and long-term outcomes. We aimed to compare the surgical outcomes and QoL after IC and CU and to identify the factors influencing QoL with these incontinent techniques of UD after RC. Materials and Methods Study design and settings: A prospective study was performed at our hospital from April 2019 to March 2022. This study included patients with BC who underwent RC with IC or unilateral CU with separate stomas. Exclusion criteria were patients with metastases, solitary kidney, RC with unilateral nephroureterectomy, lost-to-follow-up, perioperative death, and refusal of participation in the study. This study was conducted according to the Transparent Reporting of Evaluations with Nonrandomized Designs statement [ 4 ]. Considering the power of the study of 80%, effect size of 0.9, and a probability value of 0.5, the estimated minimum required sample size was 34 patients. The sample size was calculated using G*power software 3.1.9.2., based on the following assumptions: The outcome variable used was the difference in the operative time between IC and CU. Based on a previous study [ 5 ], the IC operative time was 225.8 ± 72.3 minutes compared to 149.5 ± 35.1 minutes in the CU group. Considering 5% for those with lost-to-follow-up, the study included 36 patients. For all patients, a full history was taken for age, smoking, comorbidities (such as hypertension, diabetes mellitus, cardiac, hepatic, or chest diseases), previous transurethral resections of bladder tumors, intravesical BCG, or neoadjuvant chemo- or radiotherapy. A systematic physical examination was performed, including a digital rectal examination for evaluation of the bladder mass. Laboratory workups included complete blood count, serum creatinine (SCr), and random blood sugar. In all cases, imaging studies included ultrasonography, kidney-ureter-bladder radiography, and computed tomography. According to the type of UD, patients were divided into two groups: Group A included patients who had unilateral CU with separate stomas and Group B included patients who had IC. The type of UD was left to the surgeon's preference and intraoperative circumstances. Hence, non-random allocation of the patients was carried out to either of the surgical approaches of UD. Operative technique: The stoma site was defined and marked on the skin for both techniques. Group A : All patients underwent unilateral CU as described in previous studies. 5 However, a technical modification was performed, making two small abdominal wall openings for the ureters on one side. Subcutaneous fat was removed, the fascia was incised, and the muscle and peritoneal layers were perforated with blunt artery forceps. The ureters were brought out through these two separate stomas with skin ridge 0.5–1 cm in between. Ureters were spatulated, fixed to the fascia, and sutured to the skin. Group B : All patients underwent IC, using the Wallace technique for ureteroenteric anastomosis [ 6 ]. The operative time was defined as the time between the start of the skin incision and the finish of skin closure. The time of UD was defined as the time from the start of handling the ureters after completing RC and lymphadenectomy till the end of UD. In addition, the amount of blood loss, blood transfusion, and intraoperative complications were evaluated. Postoperatively, hemoglobin and SCr levels, blood transfusion, hospital stay, hospital readmission, postoperative histopathology, tumor staging, complications, and auxiliary chemotherapy or radiotherapy were evaluated. In addition, the care of stents and collection bag base was studied; the rate of exchange, place, and caregiver personnel. Follow-up was scheduled every three months: SCr, estimated glomerular filtration rate (eGFR), urine analysis, and abdominopelvic ultrasonography were performed. Workups for distant metastasis by computed tomography or magnetic resonance imaging were performed one year after surgery. The QoL was assessed, using the validated Functional Assessment of Cancer Therapy–Bladder (FACT-BL) questionnaire. It includes 27 items divided into 4 domains: physical, social, emotional, and functional well-being. Additional 12 urology-specific items: 10 items related to urinary, gastrointestinal, and sexual symptoms and 2 questions for patients with urostomy appliances. All items are scored on a Likert scale of 0 "not at all" to 4 "very much" with higher scores indicating better QoL [ 7 ]. The study's primary outcome was the difference in the operative time between IC and CU. The secondary outcomes were the complication rates and grades. The early complications (within 90 days) and late complications (after 90 days) were classified according to the modified Clavien-Dindo system [ 8 ], including low (I, II, and IIIa) and high (IIIb, IV, and V) grades. The local ethical committee in our institute approved this study, and the institutional review board approval number is 17101339E/2019. In addition, it was registered in ClinicalTrials: NCT04610385. All procedures performed in this study were in accordance with the Helsinki Declaration and its amendments. Informed consent was obtained from all the participants in the study. Statistical analysis: Statistical analysis was performed using the statistical package for social sciences, version 20.0 (SPSS Inc., Chicago, Illinois, USA). Quantitative data were expressed as median and range and analyzed by the Mann-Whitney U Test. In contrast, qualitative data were expressed by frequency and percentage and analyzed by Fisher's exact test. We compared the two groups regarding preoperative, operative, and postoperative data. Factors affecting the QoL were analyzed using simple linear regression. Kaplan-Meier survival analysis was done for patients in the two groups. A p-value of 0.05 was considered statistically significant. Results The current study included 32 patients who underwent RC. Unintentionally, 16 male patients were included in each Group A (unilateral CU) and Group B (IC). The median age (range) was 61 (48–83) years with a median (range) body mass index of 23.95 (19.2–30.2) kg/m 2 . Transitional cell carcinoma was the histopathology in 19 (59.4%) patients. The operative and postoperative characteristics of all patients are demonstrated in Table 1 . Table 1 Demographic and clinical characteristics of all patients Variables Value Median (range) / Frequency (percentage) Age (years) 61 (48–83) BMI (kg/m 2 ) 23.95 (19.2–30.2) eGFR (ml/min) 97.5 (16–117) Hemoglobin (g/dl) 12.25 (9-16.3) Serum creatinine (mg/dl) 0.9 (0.5–3.9) Smoking 23 (71.9%) Medical comorbidities 12 (37.5%) Tumor stage T 1 8 (25%) T 2 17 (53.1%) T 3 7 (21.9%) Tumor histopathology TCC 19 (59.4%) Squamous cell carcinoma 3 (9.4%) Adenocarcinoma 1 (3.1%) TCC with variants 9 (28.1%) Neoadjuvant therapy Chemotherapy 7 (21.9%) Radiotherapy 2 (6.3%) Intravesical BCG 4 (12.5%) Comorbidities Diabetes 7 (21.9%) Hypertension 5 (15.6%) Cardiac 1 (3.1%) COPD 2 (6.3%) Operative characteristics Operative time (min) 357.5 (250–500) Operative time for shunt (min) 100 (40–165) Blood loss (cc) 925 (600–2000) Blood transfusion (Units per patient) 2 (1–4) Postoperative day-1 hemoglobin level (mg/dl) 10.6 (7.7–13.6) Postoperative day-1 serum creatinine level (mg/dl) 1.1 (0.6–3.3) Number of retrieved lymph nodes 18 (4–39) Incidence of perioperative complications 31 (96.95%) Complication grade Low or no complications 25 (78.1%) High 7 (21.9%) Hospital stay (days) 12 (3–55) Follow-up Duration (months) 10 (6–24) Serum creatinine (mg/dl) 1.1 (0.8–4.1) eGFR (ml/min) 74 (14–101) Interval for bag base exchange (days) 10 (5–25) QoL score 71 (52–103) Febrile UTI 9 (36%) BCG: Bacillus-Calmette-Geurin, BMI: Body mass index, COPD: Chronic obstructive pulmonary disease, eGFR: estimated glomerular filtration rate, QoL: Quality-of-Life, TCC: Transitional cell carcinoma, UTI: Urinary tract infection The most common complication was wound infections documented in 22 (68.8%) patients followed by paralytic ileus in 16 (50%) patients. The rate of mortality was 18.8%, and the main cause was septicemia (Table 2 ). Table 2 Summary of perioperative complications, their grades, and management Complication* Frequency (Percentage) Grade No. Management Rectal injury 1 (3.1%) 3b Intra-operative repair Paralytic ileus 16 (50%) 1 2 Five patients underwent conservation 11 patients required medications Severe anemia 7 (21.9%) 2 Blood transfusion Lymphorrhea 5 (15.6%) 1 Conservative management Lymphocele 1 (3.1%) 3a Conservative management Fecal fistula 3 (9.4%) 3b Re-exploration Wound infection 22 (68.8%) 1 Daily dressing with antiseptics Burst abdomen 6 (18.8%) 3b Surgical re-closure Pneumonia 1 (3.1%) 2 Medical treatment Early stent slippage 2 (6.3%) 1 3a One patient had bilateral stent slippage POD 13 and underwent conservation (group B) One patient from group A showed left stent slippage POD 32 which was associated with a burst abdomen and fecal fistula and underwent PCN insertion Anastomotic urine leakage and intestinal obstruction 1 (3.1%) 5 Death Thromboembolism 2 (6.3%) 4a 5 One patient entered in a vegetative state One death CVD 1 (3.1%) 5 Heart failure and death Fecal fistula and burst abdomen 3 (9.3%) 5 Septicemia and death Febrile UTI 1 (3.1%) 5 Septicemia and death *Some patients experienced more than one complication. CVD: Cardiovascular diseases, PCN: Percutaneous nephrostomy, POD: Postoperative day, UTI: Urinary tract infection. In comparison between both groups, the median time of shunt procedure was significantly longer in group B (p < 0.001). Also, the postoperative hemoglobin level (p = 0.029), the interval of exchange of the base of the collecting bag (p < 0.001), the rate of febrile urinary tract infection (UTI) (p = 0.017), and the score of QoL (p = 0.025) were significantly different in both groups (Table 3 ). Before six months of follow-up, seven patients experienced high-grade complications and six of them died (five patients in group A and one patient in group B). The seventh patient was from group B and he developed a fecal fistula and re-explored then developed a cerebrovascular insult after a cardiac arrest ended by a vegetative state. These seven patients were excluded from further analysis. (Table 2 ) Table 3 Comparison between the two groups for the preoperative, operative, and postoperative variables Variables Group A (CU) Group B (IC) p-value Age 62 (48–83) 61 (51–73) 0.590 BMI (kg/m 2 ) 24.65 (19.2–29.5) 23.15 (20.8–30.2) 0.468 eGFR (ml/min) 88.5 (16–113) 98.5 (48–117) 0.287 Hemoglobin (g/dl) 10.7 (9-14.7) 12.85 (10.5–16.3) 0.056 Serum creatinine (mg/dl) 1 (0.5–3.9) 0.85 (0.5–1.6) 0.361 Smoking 13 (81.25%) 10 (62.5%) 0.433 Medical comorbidities 6 (37.5%) 6 (37.5%) > 0.999 Tumor stage T 1 5 (31.25%) 3 (18.75%) 0.445 T 2 5 (31.25%) 12 (75%) T 3 6 (37.5%) 1 (6.25%) Tumor histopathology Urothelial 10 (62.5%) 9 (56.25%) 0.496 Squamous cell carcinoma 2 (12.5%) 1 (6.25%) Adenocarcinoma 1 (6.3%) 0 Urothelial with variant 3 (18.75%) 6 (37.5%) Neoadjuvant chemotherapy 4 (25%) 3 (18.75%) > 0.999 Neoadjuvant radiotherapy 2 (12.5%) 0 0.484 Intravesical BCG 3 (18.8%) 1 (6.3%) 0.6 Operative time (min) 360 (250–480) 350 (270–500) 0.985 Shunt time (min) 60 (40–110) 122.5 (90–165) < 0.001 Estimated blood loss (cc) 950 (800–2000) 900 (600–1600) 0.171 Blood transfusion (units) 2 (2–4) 2 (1–4) 0.184 Postoperative hemoglobin level (g/dl) 10.15 (7.7–12.6) 11.05 (8.9–13.6) 0.029 Postoperative serum creatinine level (mg/dl) 1.2 (0.6–3.3) 1 (0.6–1.8) 0.110 Hospital stay (days) 10 (3–33) 13 (9–55) 0.080 Number of retrieved lymph nodes 15.5 (4–28) 20 (8–39) 0.080 Perioperative complications 15 (93.75%) 16 (100%) > 0.999 Complication grade No or low grades 11 (68.75%) 14 (87.5%) 0.394 High grades 5 (31.25%) 2 (12.5%) Interval for bag base exchange (days) 15 (10–25) 7 (5–15) 0.999 Febrile UTI 7 (63.63%) 2 (14.28%) 0.017 QoL 65.5 (52–92) 78 (56–103) 0.025 After 6 months 68 (52–90) 80.5 (62–103) 0.029 BMI: Body mass index, eGFR: estimated glomerular filtration rate, QoL: Quality of life, UTI: Urinary tract infection The postoperative staging and histopathology of the remaining 25 patients are listed in Table 4 . Seventeen patients received adjuvant chemotherapy, and 10 of them received combined chemotherapy and radiotherapy for cases with T3-4 or positive nodes. However, three patients didn't receive adjuvant therapy due to refusal or unfitness. Eight of these 25 patients developed distant metastasis. Table 4 The postoperative staging, histopathology, and adjuvant therapy for the remaining 25 patients Primary tumor (T) Regional lymph nodes (N) Number of patients Chemotherapy Or Radiotherapy Histopathology* T0 N0 1 - Necrosis T1 N0 1 - UC T2 N0 3 - UC T2 N+ 3 Two patients received chemotherapy UC T3 N0/Nx 7 Chemotherapy (2) (6) UC Combined (4) (1) SCC None (1) T3 N+ 1 Combined UC T4 N0/Nx 2 One received chemotherapy (1) UC (1) SCC T4 N+ 7 Chemotherapy (2) (6) UC Combined (5) (1) adenocarcinoma SCC: squamous cell carcinoma, UC: urothelial carcinoma At 6 months follow-up, the medians of SCr level, eGFR, and interval for bag base exchange were 1.1 (0.8–3.9) mg/dl, 79 (15–103) ml/min, and 10 (3–25) days, respectively. Four patients (16%) developed febrile UTIs. Of the remaining 25 patients who survived, 14 patients belonged to group B and 11 patients belonged to group A. The median QoL score was 71 (52–103); 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) (Table 3 ). Regarding group B, six (42.85%) patients showed UES; one (7.14%) patient had a right-sided UES (developed at 6 months), two (14.28%) patients had a left-sided UES (developed at 6 and 9 months) and three (21.42%) patients had bilateral UES (developed at 6 and 12 months – at 9 and 12 months – at 18 and 24 months) considering that all patients had right-sided stoma. Of these six patients, four patients received postoperative radiotherapy. Most of these patients presented either with infected hydronephrosis or oliguria and raised SCr or both. The initial management was percutaneous nephrostomy insertion as an emergency. One of these patients underwent a trial of retrograde endoscopic treatment but failed due to complete obliteration of the anastomotic site and this patient is scheduled for open repair. Regarding group A, the median interval for ureteric stent exchange was 40 (30–45) days. Four (36.4%) patients were exchanging stents by themselves at home, 4 (36.4%) patients by paramedics at home, one (9.1%) patient at a primary health care center, and only 2 (18.2%) patients were exchanging stents at Assiut University Hospital outpatient clinic according to their preference without any difficulty. There are no patients in group A experienced ureteric stricture that hindered stent exchange. Regarding the factors influencing the QoL, serum creatinine level (p = 0.045), recurrent UTI (p = 0.025), and the number of re-interventions (p = 0.010) had a significant inverse association with QoL. eGFR showed a significant proportional relation (p-value 0.006). Group B showed a significantly higher QoL score than that in group A (p = 0.025) (Table 5 ). Table 5 Multivariate linear regression analysis of factors influencing the quality of life Variables Unstandardized Coefficients Standardized Coefficients (95% confidence interval p-value Age (years) -0.555 -0.288 (-1.351–0.241) 0.162 The interval between bag base exchange (days) -0.889 -0.310 (-2.095–0.316) 0.140 Number of re-interventions -11.386 -0.506 (-19.751 - -3.020) 0.010 Serum creatinine level (mg/dl) -8.148 -0.404 (-16.096 - -0.201) 0.045 eGFR (ml/min) 0.339 0.544 (0.108–0.570) 0.006 Medical comorbidities 11.533 0.394 (-0.068–23.135) 0.051 Postoperative chemotherapy 0.176 0.006 (-13.080–13.433) 0.978 Postoperative radiotherapy -8.967 -0.306 (-20.983–3.050) 0.136 Distant metastatic recurrence -0.743 -0.024 (-13.996–12.511) 0.909 Febrile UTI -13.354 -0.447 (-24.878 - -1.830) 0.025 Type of shunt -12.773 -0.442 (-23.947 - -1.599) 0.027 eGFR: estimated glomerular filtration rate, UTI: Urinary tract infection At the end of the study, 15 of 32 patients (46.87%) died within a median time of 190 (3-491) days. In Kaplan Meier survival analysis and using the Log-Rank test, there was a statistically significant difference between the two groups in the survival rate (p = 0.004) (Fig. 1). Discussion The type of UD after RC is planned according to several factors such as life expectancy, renal function, patient choice, tumor characteristics, medical comorbidities, gastrointestinal tract status, surgeon experience, and center qualifications [ 2 ]. The bilateral CU is considered the simplest shunt with a relatively short time. However, it carries a high complication rate and low scores of QoL. So, there are multiple modifications to this shunt to enhance the QoL such as reimplanting both ureters at one side with single or separate stomas. The common complications of CU are stomal stenosis making ureteral stenting mandatory, recurrent stent slippage, and increased risk of UTI leading eventually to renal impairment [ 9 ]. Although IC is considered the standard method of incontinent UD and as most previous studies conducted CU on elder patients with advanced disease, mostly done as a palliative measure. Unconvinced with others' opinions, we want to give this diversion another chance as we believe that it may be under-rated and can be used with reasonable results regarding the QoL. Previous researchers compared only the total operative time that was significantly longer in patients with IC [ 10 , 11 ]. Our study compared additionally the shunt time, which was significantly longer in the group of IC (p < 0.001). However, the total operative time was nearly equal between the two groups. This finding can be explained by the inherent tendency to perform CU in cases with advanced malignancy, prolonged difficult cystectomy, and LND to avoid more anesthesia time. The possibility of postoperative management of these patients by adjuvant combined chemo and radiotherapy with possible intestinal and anastomotic complications was considered. In the current study, the rate of febrile UTI was significantly higher in the CU group (p = 0.017). However, there was no significant difference regarding the renal function. Clifford et al. [ 12 ] studied UTI rates per type of urinary diversion in the first postoperative 90 days and found no significant differences [ 12 ]. On the other hand, other studies revealed more frequent UTIs in orthotopic bladder substitution (OBS) than in heterotopic diversions [ 13 , 14 ]. The renal function is expected to get worse due to old age, recurrent UTI, use of intestinal segment, and disease recurrence [ 5 ]. While several large-scale reports have compared the postoperative renal function between IC and OBS, few studies have directly compared the postoperative renal function in IC and CU. Suzuki et al. [ 11 ] documented that recurrent pyelonephritis occurred significantly higher in the CU group than in the IC group, considering it a risk factor for renal deterioration. So, CU was identified as a significant predictor of a ≥ 20% decrease in the eGFR [ 11 ]. Several studies showed insignificant difference in patients developed renal deterioration post RC among the three different UDs (CU, IC and OBS) [ 16 – 18 ]. Selection of the UD type according to baseline serum creatinine is a selection bias which may partially mask any real differences in postoperative renal function. Other various parameters, such as age, hypertension, diabetes, baseline eGFR, urinary tract obstruction and UTI, have been shown to significantly affect postoperative renal function in this category of patients [ 16 ]. The short-term follow-up might be a cause of the absence of significant difference in renal function deterioration between the two groups in our study. One of the complications developed post RC with IC is UES. The risk of UES development ranges from 2.7% to 10% in high volume centers with median time to discovery of 7–18 months after surgery. Ureteral ischemia and inflammation secondary to excessive dissection and intraoperative handling of the ureters and radiotherapy may be the possible factors for benign stricture development [ 19 ]. Nassar and Alsafa [ 20 ], Shah et al. [ 19 ] and Richards et al. [ 21 ] found that strictures are more likely to occur on the left than the right side (66% on the left and 29% on the right) [ 19 ]. Although the anastomotic technique is the same bilaterally, the left ureter is usually tunneled under the mesosigmoid and mobilized more proximally to gain adequate length for anastomosis. This increased dissection and mobilization may play a role in the higher left-sided stricture rates because of increased handling and potential compromise of the vascular supply [ 19 – 21 ]. We found that six (42.85%) patients showed UES with a median time of 12 months before detection. This stricture rate in our study was significantly higher than that reported in the literature with a range of 8.8% − 14%. The Wallace technique could be blamed for these higher rates. Similarly, Shah et al. believed that the Bricker method of ureteroenteric anastomosis could be an important factor in dramatically decreasing the rate of UES. The postoperative radiotherapy in the case of patients with locally advanced disease is mostly accused [ 20 – 24 ]. Arman et al. evaluated the QoL between the two groups using FACT-BL questionnaire with a significantly higher (p = 0.027) median total score of 115.5 (106–123) in IC compared to 108.0 (96–118) in unilateral CU and 101.0 (93–108) in the standard bilateral CU [ 9 ]. Also, Moeen et al. compared QoL after different types of UD (continent and incontinent) using the same questionnaire with a mean total score of 77.9 ± 4.4 in CU and 97.9 ± 5.3 in IC [ 1 ]. In our study, we found that the median total score was 78 (56–103) in IC compared to 65.5 (52–92) in unilateral CU (p = 0.025). Our explanation may be the choice of CU as UD for advanced cases. In the current study, SCr level, febrile UTI, and the number of re-interventions were significantly inversely related to QoL but eGFR showed a significant direct relation. These techniques of incontinent UD imply the use of external urine bags, which can lead to negative effects on QoL. However, each technique has its inherent advantages and disadvantages. CU is the simplest and least invasive form of UD. Moreover, CU does not require intestinal violation and allows a convenient approach to the upper urinary tract. The main drawback of CU is stomal stenosis, which has been observed more often with this procedure than in intestinal stomas and requires lifelong ureteric stenting with recurrent febrile UTI representing a real disadvantage. IC does not require permanent ureteric stenting, but complications related to gastrointestinal tract violation are more frequent. So, high-risk patients with BC undergoing RC have shown better intra- and early postoperative outcomes when a CU with unilateral stomas was performed rather than with IC. The limitations of this study included a lack of randomization, a small sample size, and a relatively short duration of follow-up. However, the prospective nature of the current study with the discussion of an uncommon modification of CU may be considered points of strength. Conclusions Which type of diversion is the best is still a controversial topic. Considering that many patients who belonged to the IC group underwent re-intervention in the form of percutaneous nephrostomy insertion mainly for silent uremia due to lack of medical care with irregular follow-up in developing countries, unilateral CU with separate stomas may represent a good alternative to IC despite the relative better QoL and long-term outcomes of the latter. Abbreviations BC Bladder cancer CU Cutaneous ureterostomy eGFR estimated glomerular filtration rate FACT-BL The Functional Assessment of Cancer Therapy – Bladder IC Ileal conduit OBS Orthotopic bladder substitution QoL Quality of life RC Radical cystectomy SCr Serum creatinine UD Urinary diversion UES Ureteroenteric stricture Declarations Ethics approval The study was approved by the local ethics committee at our university (institutional review board number: 17101339E/2019). This study was conducted following the principles of the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from each participant in this study. Consent to participate Informed consent was obtained from all individual participants included in the study. Funding The authors did not receive support from any organization for the submitted work. Author Contribution MK: contributed to concept design, practical work, data collection, writing, revision, and approval. MHM: contributed to data collection, statistical analysis, writing, and approval.RAG: contributed to practical work, concept design, statistical analysis, writing, revision, and approval. AS: contributed to practical work, concept design, writing, critical revision, supervision, and approval.MAS: contributed to concept design, writing, critical revision, supervision, and approval.MAZ: contributed to concept design, writing, supervision and approval. Data Availability All original data and patients’ consents are available on request. 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Comparison of the Perioperative and Postoperative Outcomes of Ileal Conduit and Cutaneous Ureterostomy: A Propensity Score-Matched Analysis. Urol Int. 2020;104(1–2):48. Clifford TG, Katebian B, Van Horn CM, et al. Urinary tract infections following radical cystectomy and urinary diversion: a review of 1133 patients. World J Urol . 2018;36(5):775. Parker WP, Toussi A, Tollefson MK, et al. Risk Factors and Microbial Distribution of Urinary Tract Infections Following Radical Cystectomy. Urology. 2016;94:96. Ghoreifi A, Van Horn CM, Xu W, et al. Urinary tract infections following radical cystectomy with enhanced recovery protocol: A prospective study. Urol Oncol. 2020;38(3):75.e9. Eisenberg MS, Thompson RH, Frank I, et al. Long-Term Renal Function Outcomes after Radical Cystectomy. J Urol. 2014;191(3):619. Nishikawa M, Miyake H, Yamashita M, Inoue T aki, Fujisawa M. Long-term changes in renal function outcomes following radical cystectomy and urinary diversion. Int J Clin Oncol. 2014;19(6):1105. Jin XD, Roethlisberger S, Burkhard FC, Birkhaeuser F, Thoeny HC, Studer UE. Long-term renal function after urinary diversion by ileal conduit or orthotopic ileal bladder substitution. Eur Urol. 2012;61(3):491. Eisenberg MS, Thompson RH, Frank I, et al. Long-Term Renal Function Outcomes after Radical Cystectomy. J Urol. 2014;191(3):619. Shah SH, Movassaghi K, Skinner D, et al. Ureteroenteric Strictures After Open Radical Cystectomy and Urinary Diversion: The University of Southern California Experience. Urology. 2015;86(1):87. Nassar OAH, Alsafa MES. Experience With Ureteroenteric Strictures After Radical Cystectomy and Diversion: Open Surgical Revision. Urology. 2011;78(2):459. Richards KA, Cohn JA, Large MC, Bales GT, Smith ND, Steinberg GD. The effect of length of ureteral resection on benign ureterointestinal stricture rate in ileal conduit or ileal neobladder urinary diversion following radical cystectomy. Urol Oncol. 2015;33(2):65.e1. Westerman ME, Parker WP, Viers BR, et al. Malignant ureteroenteric anastomotic stricture following radical cystectomy with urinary diversion: Patterns, risk factors, and outcomes. Urol Oncol. 2016;34(11):485.e1. Tal R, Sivan B, Kedar D, Baniel J. Management of Benign Ureteral Strictures Following Radical Cystectomy and Urinary Diversion for Bladder Cancer. J Urol. 2007;178(2):538. Madersbacher S, Schmidt J, Eberle JM, et al. Long-Term Outcome of Ileal Conduit Diversion. J Urol. 2003;169(3):985. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":13957,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure1KaplanMeierSurvival.png","url":"https://assets-eu.researchsquare.com/files/rs-7723501/v1/4c6ff04f7b88d1a5a2d83c72.png"},{"id":94987495,"identity":"44489cb4-e465-4d22-9ea2-1f63e2dd6e3d","added_by":"auto","created_at":"2025-11-03 07:02:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":984780,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7723501/v1/0e48c9b7-3728-453f-b878-c8e27e1376bd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eUnilateral cutaneous ureterostomy with separate stomas versus ileal conduit after radical cystectomy: A prospective non-randomized comparative study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRadical cystectomy (RC) with pelvic lymph node dissection and appropriate urinary diversion (UD) remain the mainstay of treatment for muscle-invasive bladder cancer (BC) and for high-risk non-muscle invasive disease. UD is a complex surgery that has an impact on different aspects of health, including physical, psychosocial, sexual, activities of daily living, and distress related to body image [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The ideal UD should successfully preserve renal function while managing urinary outflow and minimizing morbidity to the patient [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough ileal conduit (IC) is considered the standard method for incontinent UD, it is associated with early bowel-related complications, such as bowel obstruction, prolonged ileus, and anastomotic leak. Also, late complications occur in 25\u0026ndash;60% of patients, comprising ureteroenteric stricture (UES), urinary fistula, and stomal site complications. The latter include stomal stenosis, retraction, prolapse, and parastomal herniation. Cutaneous ureterostomy (CU) may represent the method of choice for elderly and otherwise morbid patients due to its relatively short duration and fewer bowel and metabolic complications. Still, it has a high rate of stomal stenosis making permanent stenting mandatory [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn poor communities, specialized medical care is not widely available. This study hypothesized that unilateral CU with separate stomas may represent a good alternative to IC without significant unfavorable effects on the quality of life (QoL) and long-term outcomes. We aimed to compare the surgical outcomes and QoL after IC and CU and to identify the factors influencing QoL with these incontinent techniques of UD after RC.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and settings:\u003c/h2\u003e\u003cp\u003eA prospective study was performed at our hospital from April 2019 to March 2022. This study included patients with BC who underwent RC with IC or unilateral CU with separate stomas. Exclusion criteria were patients with metastases, solitary kidney, RC with unilateral nephroureterectomy, lost-to-follow-up, perioperative death, and refusal of participation in the study. This study was conducted according to the Transparent Reporting of Evaluations with Nonrandomized Designs statement [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConsidering the power of the study of 80%, effect size of 0.9, and a probability value of 0.5, the estimated minimum required sample size was 34 patients. The sample size was calculated using G*power software 3.1.9.2., based on the following assumptions: The outcome variable used was the difference in the operative time between IC and CU. Based on a previous study [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], the IC operative time was 225.8\u0026thinsp;\u0026plusmn;\u0026thinsp;72.3 minutes compared to 149.5\u0026thinsp;\u0026plusmn;\u0026thinsp;35.1 minutes in the CU group. Considering 5% for those with lost-to-follow-up, the study included 36 patients.\u003c/p\u003e\u003cp\u003eFor all patients, a full history was taken for age, smoking, comorbidities (such as hypertension, diabetes mellitus, cardiac, hepatic, or chest diseases), previous transurethral resections of bladder tumors, intravesical BCG, or neoadjuvant chemo- or radiotherapy.\u003c/p\u003e\u003cp\u003eA systematic physical examination was performed, including a digital rectal examination for evaluation of the bladder mass. Laboratory workups included complete blood count, serum creatinine (SCr), and random blood sugar. In all cases, imaging studies included ultrasonography, kidney-ureter-bladder radiography, and computed tomography.\u003c/p\u003e\u003cp\u003eAccording to the type of UD, patients were divided into two groups: Group A included patients who had unilateral CU with separate stomas and Group B included patients who had IC. The type of UD was left to the surgeon's preference and intraoperative circumstances. Hence, non-random allocation of the patients was carried out to either of the surgical approaches of UD.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eOperative technique:\u003c/h3\u003e\n\u003cp\u003eThe stoma site was defined and marked on the skin for both techniques. \u003cb\u003eGroup A\u003c/b\u003e: All patients underwent unilateral CU as described in previous studies.\u003csup\u003e5\u003c/sup\u003e However, a technical modification was performed, making two small abdominal wall openings for the ureters on one side. Subcutaneous fat was removed, the fascia was incised, and the muscle and peritoneal layers were perforated with blunt artery forceps. The ureters were brought out through these two separate stomas with skin ridge 0.5\u0026ndash;1 cm in between. Ureters were spatulated, fixed to the fascia, and sutured to the skin. \u003cb\u003eGroup B\u003c/b\u003e: All patients underwent IC, using the Wallace technique for ureteroenteric anastomosis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe operative time was defined as the time between the start of the skin incision and the finish of skin closure. The time of UD was defined as the time from the start of handling the ureters after completing RC and lymphadenectomy till the end of UD. In addition, the amount of blood loss, blood transfusion, and intraoperative complications were evaluated.\u003c/p\u003e\u003cp\u003ePostoperatively, hemoglobin and SCr levels, blood transfusion, hospital stay, hospital readmission, postoperative histopathology, tumor staging, complications, and auxiliary chemotherapy or radiotherapy were evaluated. In addition, the care of stents and collection bag base was studied; the rate of exchange, place, and caregiver personnel.\u003c/p\u003e\u003cp\u003eFollow-up was scheduled every three months: SCr, estimated glomerular filtration rate (eGFR), urine analysis, and abdominopelvic ultrasonography were performed. Workups for distant metastasis by computed tomography or magnetic resonance imaging were performed one year after surgery.\u003c/p\u003e\u003cp\u003eThe QoL was assessed, using the validated Functional Assessment of Cancer Therapy\u0026ndash;Bladder (FACT-BL) questionnaire. It includes 27 items divided into 4 domains: physical, social, emotional, and functional well-being. Additional 12 urology-specific items: 10 items related to urinary, gastrointestinal, and sexual symptoms and 2 questions for patients with urostomy appliances. All items are scored on a Likert scale of 0 \"not at all\" to 4 \"very much\" with higher scores indicating better QoL [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe study's primary outcome was the difference in the operative time between IC and CU. The secondary outcomes were the complication rates and grades. The early complications (within 90 days) and late complications (after 90 days) were classified according to the modified Clavien-Dindo system [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], including low (I, II, and IIIa) and high (IIIb, IV, and V) grades.\u003c/p\u003e\u003cp\u003e The local ethical committee in our institute approved this study, and the institutional review board approval number is 17101339E/2019. In addition, it was registered in ClinicalTrials: NCT04610385. All procedures performed in this study were in accordance with the Helsinki Declaration and its amendments. Informed consent was obtained from all the participants in the study.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\u003cp\u003eStatistical analysis was performed using the statistical package for social sciences, version 20.0 (SPSS Inc., Chicago, Illinois, USA). Quantitative data were expressed as median and range and analyzed by the Mann-Whitney U Test. In contrast, qualitative data were expressed by frequency and percentage and analyzed by Fisher's exact test. We compared the two groups regarding preoperative, operative, and postoperative data. Factors affecting the QoL were analyzed using simple linear regression. Kaplan-Meier survival analysis was done for patients in the two groups. A p-value of 0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe current study included 32 patients who underwent RC. Unintentionally, 16 male patients were included in each Group A (unilateral CU) and Group B (IC). The median age (range) was 61 (48\u0026ndash;83) years with a median (range) body mass index of 23.95 (19.2\u0026ndash;30.2) kg/m\u003csup\u003e2\u003c/sup\u003e. Transitional cell carcinoma was the histopathology in 19 (59.4%) patients. The operative and postoperative characteristics of all patients are demonstrated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and clinical characteristics of all patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian (range) / Frequency (percentage)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (48\u0026ndash;83)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.95 (19.2\u0026ndash;30.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eeGFR (ml/min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97.5 (16\u0026ndash;117)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin (g/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.25 (9-16.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSerum creatinine (mg/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.9 (0.5\u0026ndash;3.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (71.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical comorbidities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (37.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (25%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (53.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (21.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor histopathology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTCC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (59.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSquamous cell carcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (9.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdenocarcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (3.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTCC with variants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (28.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeoadjuvant therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (21.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadiotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (6.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntravesical BCG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComorbidities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (21.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (15.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCardiac\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (3.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCOPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (6.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperative characteristics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperative time (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e357.5 (250\u0026ndash;500)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperative time for shunt (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100 (40\u0026ndash;165)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood loss (cc)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e925 (600\u0026ndash;2000)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood transfusion (Units per patient)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative day-1 hemoglobin level (mg/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.6 (7.7\u0026ndash;13.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative day-1 serum creatinine level (mg/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.1 (0.6\u0026ndash;3.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of retrieved lymph nodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (4\u0026ndash;39)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncidence of perioperative complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (96.95%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplication grade\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow or no complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (78.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (21.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital stay (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (3\u0026ndash;55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFollow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration (months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (6\u0026ndash;24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSerum creatinine (mg/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.1 (0.8\u0026ndash;4.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eeGFR (ml/min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74 (14\u0026ndash;101)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInterval for bag base exchange (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (5\u0026ndash;25)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQoL score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71 (52\u0026ndash;103)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFebrile UTI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (36%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eBCG: Bacillus-Calmette-Geurin, BMI: Body mass index, COPD: Chronic obstructive pulmonary disease, eGFR: estimated glomerular filtration rate, QoL: Quality-of-Life, TCC: Transitional cell carcinoma, UTI: Urinary tract infection\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe most common complication was wound infections documented in 22 (68.8%) patients followed by paralytic ileus in 16 (50%) patients. The rate of mortality was 18.8%, and the main cause was septicemia (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of perioperative complications, their grades, and management\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplication*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (Percentage)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGrade No.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eManagement\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRectal injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (3.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3b\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIntra-operative repair\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParalytic ileus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFive patients underwent conservation\u003c/p\u003e\u003cp\u003e11 patients required medications\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere anemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (21.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBlood transfusion\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphorrhea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (15.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eConservative management\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphocele\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (3.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eConservative management\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFecal fistula\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (9.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3b\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRe-exploration\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWound infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (68.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDaily dressing with antiseptics\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBurst abdomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (18.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3b\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSurgical re-closure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePneumonia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (3.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedical treatment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly stent slippage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e3a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOne patient had bilateral stent slippage POD 13 and underwent conservation (group B)\u003c/p\u003e\u003cp\u003eOne patient from group A showed left stent slippage POD 32 which was associated with a burst abdomen and fecal fistula and underwent PCN insertion\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnastomotic urine leakage and intestinal obstruction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (3.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThromboembolism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4a\u003c/p\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOne patient entered in a vegetative state\u003c/p\u003e\u003cp\u003eOne death\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCVD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (3.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHeart failure and death\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFecal fistula and burst abdomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (9.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSepticemia and death\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFebrile UTI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (3.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSepticemia and death\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Some patients experienced more than one complication.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eCVD: Cardiovascular diseases, PCN: Percutaneous nephrostomy, POD: Postoperative day, UTI: Urinary tract infection.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn comparison between both groups, the median time of shunt procedure was significantly longer in group B (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Also, the postoperative hemoglobin level (p\u0026thinsp;=\u0026thinsp;0.029), the interval of exchange of the base of the collecting bag (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), the rate of febrile urinary tract infection (UTI) (p\u0026thinsp;=\u0026thinsp;0.017), and the score of QoL (p\u0026thinsp;=\u0026thinsp;0.025) were significantly different in both groups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Before six months of follow-up, seven patients experienced high-grade complications and six of them died (five patients in group A and one patient in group B). The seventh patient was from group B and he developed a fecal fistula and re-explored then developed a cerebrovascular insult after a cardiac arrest ended by a vegetative state. These seven patients were excluded from further analysis. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison between the two groups for the preoperative, operative, and postoperative variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup A (CU)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGroup B (IC)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62 (48\u0026ndash;83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61 (51\u0026ndash;73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.590\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.65 (19.2\u0026ndash;29.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.15 (20.8\u0026ndash;30.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.468\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eeGFR (ml/min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.5 (16\u0026ndash;113)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.5 (48\u0026ndash;117)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.287\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHemoglobin (g/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.7 (9-14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.85 (10.5\u0026ndash;16.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSerum creatinine (mg/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5\u0026ndash;3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.85 (0.5\u0026ndash;1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.361\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (81.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (62.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.433\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMedical comorbidities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (37.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (37.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTumor stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (31.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (18.75%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.445\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (31.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (75%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (37.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (6.25%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eTumor histopathology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrothelial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (62.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (56.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.496\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSquamous cell carcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (6.25%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdenocarcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrothelial with variant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (18.75%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (37.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNeoadjuvant chemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (18.75%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNeoadjuvant radiotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.484\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eIntravesical BCG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (18.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eOperative time (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e360 (250\u0026ndash;480)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e350 (270\u0026ndash;500)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.985\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eShunt time (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (40\u0026ndash;110)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e122.5 (90\u0026ndash;165)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEstimated blood loss (cc)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e950 (800\u0026ndash;2000)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e900 (600\u0026ndash;1600)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.171\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eBlood transfusion (units)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (2\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.184\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePostoperative hemoglobin level (g/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.15 (7.7\u0026ndash;12.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.05 (8.9\u0026ndash;13.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePostoperative serum creatinine level (mg/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2 (0.6\u0026ndash;3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.6\u0026ndash;1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.110\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHospital stay (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (3\u0026ndash;33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (9\u0026ndash;55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.080\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNumber of retrieved lymph nodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.5 (4\u0026ndash;28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (8\u0026ndash;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.080\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePerioperative complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (93.75%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eComplication grade\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNo or low grades\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (68.75%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (87.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.394\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHigh grades\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (31.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eInterval for bag base exchange (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (10\u0026ndash;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (5\u0026ndash;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSerum creatinine level (mg/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.15 (0.9\u0026ndash;4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.1 (0.8\u0026ndash;2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.120\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eeGFR (ml/min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70 (14\u0026ndash;100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 (33\u0026ndash;101)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.186\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eIncidence of re-intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.4 (0.699)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.46 (0.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFebrile UTI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (63.63%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (14.28%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eQoL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.5 (52\u0026ndash;92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 (56\u0026ndash;103)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAfter 6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (52\u0026ndash;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80.5 (62\u0026ndash;103)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eBMI: Body mass index, eGFR: estimated glomerular filtration rate, QoL: Quality of life, UTI: Urinary tract infection\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe postoperative staging and histopathology of the remaining 25 patients are listed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Seventeen patients received adjuvant chemotherapy, and 10 of them received combined chemotherapy and radiotherapy for cases with T3-4 or positive nodes. However, three patients didn't receive adjuvant therapy due to refusal or unfitness. Eight of these 25 patients developed distant metastasis.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe postoperative staging, histopathology, and adjuvant therapy for the remaining 25 patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary tumor (T)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegional lymph nodes (N)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of patients\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eChemotherapy\u003c/p\u003e\u003cp\u003eOr\u003c/p\u003e\u003cp\u003eRadiotherapy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHistopathology*\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNecrosis\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUC\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUC\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTwo patients received chemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUC\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eT3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eN0/Nx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eChemotherapy (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(6) UC\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCombined (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e(1) SCC\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNone (1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCombined\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUC\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eT4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eN0/Nx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOne received chemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1) UC\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1) SCC\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eT4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eN+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eChemotherapy (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(6) UC\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCombined (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1) adenocarcinoma\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eSCC: squamous cell carcinoma, UC: urothelial carcinoma\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAt 6 months follow-up, the medians of SCr level, eGFR, and interval for bag base exchange were 1.1 (0.8\u0026ndash;3.9) mg/dl, 79 (15\u0026ndash;103) ml/min, and 10 (3\u0026ndash;25) days, respectively. Four patients (16%) developed febrile UTIs. Of the remaining 25 patients who survived, 14 patients belonged to group B and 11 patients belonged to group A. The median QoL score was 71 (52\u0026ndash;103); the median QoL score for group A was 68 (52\u0026ndash;90) while the median QoL score for group B was 80.50 (62\u0026ndash;103) (p\u0026thinsp;=\u0026thinsp;0.029) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegarding group B, six (42.85%) patients showed UES; one (7.14%) patient had a right-sided UES (developed at 6 months), two (14.28%) patients had a left-sided UES (developed at 6 and 9 months) and three (21.42%) patients had bilateral UES (developed at 6 and 12 months \u0026ndash; at 9 and 12 months \u0026ndash; at 18 and 24 months) considering that all patients had right-sided stoma. Of these six patients, four patients received postoperative radiotherapy. Most of these patients presented either with infected hydronephrosis or oliguria and raised SCr or both. The initial management was percutaneous nephrostomy insertion as an emergency. One of these patients underwent a trial of retrograde endoscopic treatment but failed due to complete obliteration of the anastomotic site and this patient is scheduled for open repair.\u003c/p\u003e\u003cp\u003eRegarding group A, the median interval for ureteric stent exchange was 40 (30\u0026ndash;45) days. Four (36.4%) patients were exchanging stents by themselves at home, 4 (36.4%) patients by paramedics at home, one (9.1%) patient at a primary health care center, and only 2 (18.2%) patients were exchanging stents at Assiut University Hospital outpatient clinic according to their preference without any difficulty. There are no patients in group A experienced ureteric stricture that hindered stent exchange.\u003c/p\u003e\u003cp\u003eRegarding the factors influencing the QoL, serum creatinine level (p\u0026thinsp;=\u0026thinsp;0.045), recurrent UTI (p\u0026thinsp;=\u0026thinsp;0.025), and the number of re-interventions (p\u0026thinsp;=\u0026thinsp;0.010) had a significant inverse association with QoL. eGFR showed a significant proportional relation (p-value 0.006). Group B showed a significantly higher QoL score than that in group A (p\u0026thinsp;=\u0026thinsp;0.025) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate linear regression analysis of factors influencing the quality of life\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnstandardized Coefficients\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandardized Coefficients\u003c/p\u003e\u003cp\u003e(95% confidence interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.555\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.288 (-1.351\u0026ndash;0.241)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.162\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe interval between bag base exchange (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.889\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.310 (-2.095\u0026ndash;0.316)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.140\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of re-interventions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-11.386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.506 (-19.751 - -3.020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSerum creatinine level (mg/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-8.148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.404 (-16.096 - -0.201)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.045\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eeGFR (ml/min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.339\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.544 (0.108\u0026ndash;0.570)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical comorbidities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.394 (-0.068\u0026ndash;23.135)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative chemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.006 (-13.080\u0026ndash;13.433)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.978\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative radiotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-8.967\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.306 (-20.983\u0026ndash;3.050)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.136\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistant metastatic recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.743\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.024 (-13.996\u0026ndash;12.511)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.909\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFebrile UTI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-13.354\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.447 (-24.878 - -1.830)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of shunt\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-12.773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.442 (-23.947 - -1.599)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eeGFR: estimated glomerular filtration rate, UTI: Urinary tract infection\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAt the end of the study, 15 of 32 patients (46.87%) died within a median time of 190 (3-491) days. In Kaplan Meier survival analysis and using the Log-Rank test, there was a statistically significant difference between the two groups in the survival rate (p\u0026thinsp;=\u0026thinsp;0.004) (Fig.\u0026nbsp;1).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe type of UD after RC is planned according to several factors such as life expectancy, renal function, patient choice, tumor characteristics, medical comorbidities, gastrointestinal tract status, surgeon experience, and center qualifications [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The bilateral CU is considered the simplest shunt with a relatively short time. However, it carries a high complication rate and low scores of QoL. So, there are multiple modifications to this shunt to enhance the QoL such as reimplanting both ureters at one side with single or separate stomas. The common complications of CU are stomal stenosis making ureteral stenting mandatory, recurrent stent slippage, and increased risk of UTI leading eventually to renal impairment [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough IC is considered the standard method of incontinent UD and as most previous studies conducted CU on elder patients with advanced disease, mostly done as a palliative measure. Unconvinced with others' opinions, we want to give this diversion another chance as we believe that it may be under-rated and can be used with reasonable results regarding the QoL.\u003c/p\u003e\u003cp\u003ePrevious researchers compared only the total operative time that was significantly longer in patients with IC [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Our study compared additionally the shunt time, which was significantly longer in the group of IC (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, the total operative time was nearly equal between the two groups. This finding can be explained by the inherent tendency to perform CU in cases with advanced malignancy, prolonged difficult cystectomy, and LND to avoid more anesthesia time. The possibility of postoperative management of these patients by adjuvant combined chemo and radiotherapy with possible intestinal and anastomotic complications was considered.\u003c/p\u003e\u003cp\u003eIn the current study, the rate of febrile UTI was significantly higher in the CU group (p\u0026thinsp;=\u0026thinsp;0.017). However, there was no significant difference regarding the renal function. Clifford et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] studied UTI rates per type of urinary diversion in the first postoperative 90 days and found no significant differences [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. On the other hand, other studies revealed more frequent UTIs in orthotopic bladder substitution (OBS) than in heterotopic diversions [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe renal function is expected to get worse due to old age, recurrent UTI, use of intestinal segment, and disease recurrence [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While several large-scale reports have compared the postoperative renal function between IC and OBS, few studies have directly compared the postoperative renal function in IC and CU. Suzuki et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] documented that recurrent pyelonephritis occurred significantly higher in the CU group than in the IC group, considering it a risk factor for renal deterioration. So, CU was identified as a significant predictor of a\u0026thinsp;\u0026ge;\u0026thinsp;20% decrease in the eGFR [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Several studies showed insignificant difference in patients developed renal deterioration post RC among the three different UDs (CU, IC and OBS) [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Selection of the UD type according to baseline serum creatinine is a selection bias which may partially mask any real differences in postoperative renal function. Other various parameters, such as age, hypertension, diabetes, baseline eGFR, urinary tract obstruction and UTI, have been shown to significantly affect postoperative renal function in this category of patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The short-term follow-up might be a cause of the absence of significant difference in renal function deterioration between the two groups in our study.\u003c/p\u003e\u003cp\u003eOne of the complications developed post RC with IC is UES. The risk of UES development ranges from 2.7% to 10% in high volume centers with median time to discovery of 7\u0026ndash;18 months after surgery. Ureteral ischemia and inflammation secondary to excessive dissection and intraoperative handling of the ureters and radiotherapy may be the possible factors for benign stricture development [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Nassar and Alsafa [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], Shah et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and Richards et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] found that strictures are more likely to occur on the left than the right side (66% on the left and 29% on the right) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Although the anastomotic technique is the same bilaterally, the left ureter is usually tunneled under the mesosigmoid and mobilized more proximally to gain adequate length for anastomosis. This increased dissection and mobilization may play a role in the higher left-sided stricture rates because of increased handling and potential compromise of the vascular supply [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. We found that six (42.85%) patients showed UES with a median time of 12 months before detection. This stricture rate in our study was significantly higher than that reported in the literature with a range of 8.8% \u0026minus;\u0026thinsp;14%. The Wallace technique could be blamed for these higher rates. Similarly, Shah et al. believed that the Bricker method of ureteroenteric anastomosis could be an important factor in dramatically decreasing the rate of UES. The postoperative radiotherapy in the case of patients with locally advanced disease is mostly accused [\u003cspan additionalcitationids=\"CR21 CR22 CR23\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eArman et al. evaluated the QoL between the two groups using FACT-BL questionnaire with a significantly higher (p\u0026thinsp;=\u0026thinsp;0.027) median total score of 115.5 (106\u0026ndash;123) in IC compared to 108.0 (96\u0026ndash;118) in unilateral CU and 101.0 (93\u0026ndash;108) in the standard bilateral CU [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Also, Moeen et al. compared QoL after different types of UD (continent and incontinent) using the same questionnaire with a mean total score of 77.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 in CU and 97.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 in IC [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In our study, we found that the median total score was 78 (56\u0026ndash;103) in IC compared to 65.5 (52\u0026ndash;92) in unilateral CU (p\u0026thinsp;=\u0026thinsp;0.025). Our explanation may be the choice of CU as UD for advanced cases. In the current study, SCr level, febrile UTI, and the number of re-interventions were significantly inversely related to QoL but eGFR showed a significant direct relation.\u003c/p\u003e\u003cp\u003eThese techniques of incontinent UD imply the use of external urine bags, which can lead to negative effects on QoL. However, each technique has its inherent advantages and disadvantages. CU is the simplest and least invasive form of UD. Moreover, CU does not require intestinal violation and allows a convenient approach to the upper urinary tract. The main drawback of CU is stomal stenosis, which has been observed more often with this procedure than in intestinal stomas and requires lifelong ureteric stenting with recurrent febrile UTI representing a real disadvantage. IC does not require permanent ureteric stenting, but complications related to gastrointestinal tract violation are more frequent. So, high-risk patients with BC undergoing RC have shown better intra- and early postoperative outcomes when a CU with unilateral stomas was performed rather than with IC.\u003c/p\u003e\u003cp\u003eThe limitations of this study included a lack of randomization, a small sample size, and a relatively short duration of follow-up. However, the prospective nature of the current study with the discussion of an uncommon modification of CU may be considered points of strength.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWhich type of diversion is the best is still a controversial topic. Considering that many patients who belonged to the IC group underwent re-intervention in the form of percutaneous nephrostomy insertion mainly for silent uremia due to lack of medical care with irregular follow-up in developing countries, unilateral CU with separate stomas may represent a good alternative to IC despite the relative better QoL and long-term outcomes of the latter.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBC\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 522px;\"\u003e\n \u003cp\u003eBladder cancer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 522px;\"\u003e\n \u003cp\u003eCutaneous ureterostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eeGFR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 522px;\"\u003e\n \u003cp\u003eestimated glomerular filtration rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFACT-BL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 522px;\"\u003e\n \u003cp\u003eThe Functional Assessment of Cancer Therapy \u0026ndash; Bladder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIC\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 522px;\"\u003e\n \u003cp\u003eIleal conduit\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOBS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 522px;\"\u003e\n \u003cp\u003eOrthotopic bladder substitution\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQoL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 522px;\"\u003e\n \u003cp\u003eQuality of life\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 522px;\"\u003e\n \u003cp\u003eRadical cystectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSCr\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 522px;\"\u003e\n \u003cp\u003eSerum creatinine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 522px;\"\u003e\n \u003cp\u003eUrinary diversion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 522px;\"\u003e\n \u003cp\u003eUreteroenteric stricture\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the local ethics committee at our university (institutional review board number: 17101339E/2019). This study was conducted following the principles of the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from each participant in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive support from any organization for the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMK: contributed to concept design, practical work, data collection, writing, revision, and approval. MHM: contributed to data collection, statistical analysis, writing, and approval.RAG: contributed to practical work, concept design, statistical analysis, writing, revision, and approval. AS: contributed to practical work, concept design, writing, critical revision, supervision, and approval.MAS: contributed to concept design, writing, critical revision, supervision, and approval.MAZ: contributed to concept design, writing, supervision and approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll original data and patients\u0026rsquo; consents are available on request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMoeen AM, Safwat AS, Gadelmoula MM, et al (2018) Health related quality of life after urinary diversion. Which technique is better? \u003cem\u003eJ Egypt Natl Canc Inst.\u003c/em\u003e 30(3):93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee RK, Abol-Enein H, Artibani W, et al. 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An audit of early complications of radical cystectomy using Clavien-Dindo classification. \u003cem\u003eIndian J Urol.\u003c/em\u003e 2016;32(4):282.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArman T, Mher B, Varujan S, Sergey F, Ashot T. Health-related quality of life in patients undergoing radical cystectomy with modified single stoma cutaneous ureterostomy, bilateral cutaneous ureterostomy and ileal conduit. \u003cem\u003eInt Urol Nephrol.\u003c/em\u003e 2020;52(9):1683.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDeliveliotis C, Papatsoris A, Chrisofos M, Dellis A, Liakouras C, Skolarikos A. Urinary diversion in high-risk elderly patients: Modified cutaneous ureterostomy or ileal conduit? \u003cem\u003eUrology.\u003c/em\u003e 2005;66(2):299.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSuzuki K, Hinata N, Inoue TA, Nakamura I, Nakano Y, Fujisawa M. Comparison of the Perioperative and Postoperative Outcomes of Ileal Conduit and Cutaneous Ureterostomy: A Propensity Score-Matched Analysis. \u003cem\u003eUrol Int.\u003c/em\u003e 2020;104(1\u0026ndash;2):48.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eClifford TG, Katebian B, Van Horn CM, et al. Urinary tract infections following radical cystectomy and urinary diversion: a review of 1133 patients. \u003cem\u003eWorld J Urol\u003c/em\u003e. 2018;36(5):775.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eParker WP, Toussi A, Tollefson MK, et al. Risk Factors and Microbial Distribution of Urinary Tract Infections Following Radical Cystectomy. \u003cem\u003eUrology.\u003c/em\u003e 2016;94:96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhoreifi A, Van Horn CM, Xu W, et al. Urinary tract infections following radical cystectomy with enhanced recovery protocol: A prospective study. \u003cem\u003eUrol Oncol.\u003c/em\u003e 2020;38(3):75.e9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEisenberg MS, Thompson RH, Frank I, et al. Long-Term Renal Function Outcomes after Radical Cystectomy. \u003cem\u003eJ Urol.\u003c/em\u003e 2014;191(3):619.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNishikawa M, Miyake H, Yamashita M, Inoue T aki, Fujisawa M. Long-term changes in renal function outcomes following radical cystectomy and urinary diversion. \u003cem\u003eInt J Clin Oncol.\u003c/em\u003e 2014;19(6):1105.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJin XD, Roethlisberger S, Burkhard FC, Birkhaeuser F, Thoeny HC, Studer UE. Long-term renal function after urinary diversion by ileal conduit or orthotopic ileal bladder substitution. \u003cem\u003eEur Urol.\u003c/em\u003e 2012;61(3):491.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEisenberg MS, Thompson RH, Frank I, et al. Long-Term Renal Function Outcomes after Radical Cystectomy. \u003cem\u003eJ Urol.\u003c/em\u003e 2014;191(3):619.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah SH, Movassaghi K, Skinner D, et al. Ureteroenteric Strictures After Open Radical Cystectomy and Urinary Diversion: The University of Southern California Experience. \u003cem\u003eUrology.\u003c/em\u003e 2015;86(1):87.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNassar OAH, Alsafa MES. Experience With Ureteroenteric Strictures After Radical Cystectomy and Diversion: Open Surgical Revision. \u003cem\u003eUrology.\u003c/em\u003e 2011;78(2):459.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRichards KA, Cohn JA, Large MC, Bales GT, Smith ND, Steinberg GD. The effect of length of ureteral resection on benign ureterointestinal stricture rate in ileal conduit or ileal neobladder urinary diversion following radical cystectomy. \u003cem\u003eUrol Oncol.\u003c/em\u003e 2015;33(2):65.e1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWesterman ME, Parker WP, Viers BR, et al. Malignant ureteroenteric anastomotic stricture following radical cystectomy with urinary diversion: Patterns, risk factors, and outcomes. \u003cem\u003eUrol Oncol.\u003c/em\u003e 2016;34(11):485.e1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTal R, Sivan B, Kedar D, Baniel J. Management of Benign Ureteral Strictures Following Radical Cystectomy and Urinary Diversion for Bladder Cancer. \u003cem\u003eJ Urol.\u003c/em\u003e 2007;178(2):538.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMadersbacher S, Schmidt J, Eberle JM, et al. Long-Term Outcome of Ileal Conduit Diversion. \u003cem\u003eJ Urol.\u003c/em\u003e 2003;169(3):985.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bladder cancer, Cutaneous ureterostomy, Ileal conduit, Radical cystectomy, Urinary diversion","lastPublishedDoi":"10.21203/rs.3.rs-7723501/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7723501/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e 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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 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\u003csup\u003e2\u003c/sup\u003e. 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\u0026lt;0.001). Also, the postoperative anemia (p=0.029), the interval of exchange of the base of the collecting bag (p\u0026lt;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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e: NCT04610385\u003c/p\u003e","manuscriptTitle":"Unilateral cutaneous ureterostomy with separate stomas versus ileal conduit after radical cystectomy: A prospective non-randomized comparative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 04:43:12","doi":"10.21203/rs.3.rs-7723501/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4db2501d-0054-46c9-b41c-6a99da5da5d9","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-01T10:23:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-29 04:43:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7723501","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7723501","identity":"rs-7723501","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}