Bladder Cancer Comparison of Complications in Three Incontinent Urinary Diversions Armin Pycha a, *, Evi Comploj a , Thomas Martini a , Emanuela Trenti a , Christine Mian b , Lukas Lusuardi a , Michele Lodde a , Michael Mian c , Salvatore Palermo a a Department of Urology, General Hospital of Bolzano, Italy b Department of Pathology, General Hospital of Bolzano, Italy c Department of Haematology, General Hospital of Bolzano, Italy european urology 54 (2008) 825–834 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted April 23, 2008 Published online ahead of print on May 7, 2008 Keywords: Cystectomy Bladder cancer Urinary diversion Complications Surgical technique Abstract Background: Few data are available in comparing different incontinent urinary diver- sions (ICUD). Objective: To compare early, short-term, and long-term complications in three differ- ent forms of ICUD. Design, setting, and participants: 130 high-risk patients undergoing radical cystectomy and ICUD were prospectively enrolled at one institution. The patients were divided into three groups: ileal conduit (IC), colon conduit (CC), and ureteroureterocutaneost- omy (UUCS). Intervention: All patients underwent radical cystectomy and one form of ICUD. Measurements: The complications observed were prospectively listed and subse- quently compared. Statistical analysis was performed using the Pearson’s chi-square test. A p-value  0.05 was considered statistically significant. Results and limitations: 130 patients with a median age of 71.0 yr (range 46–81) under- went radical cystoprostatectomy (RCP): n = 95 (73%) or anterior pelvic exenteration (APE) n = 35 (27%) with lymphadenectomy. An IC was performed in 55, a CC in 34, and a UUCS in 41 patients, respectively. A high comorbidity, mainly diabetes, arteriosclero- sis, pulmonary insufficiency, and borderline renal function (creatinine > 1.5 mg%) was found in 12.7% of group 1, in 35.2% of group 2, and in 48.9% of group 3. Overall median follow-up was 16 mo (range 5–84). Perioperative mortality occurred in 1.5%. The overall perioperative diversion-unre- lated complication rate was 23.6%. IC showed the lowest rate with 18.1%, followed by CC with 26.4%, and UUCS with 32%, respectively. In contrast, major diversion-related complications occurred in 18.1% of IC, in 5.8% of CC, and none in UUCS. The same was true for late surgical reintervention, with 20% for IC, 5.8% for CC, and 2.4% for UUCS. Conclusions: Complications are closely related to the method selected. The IC had the highest rate of severe complications as well as surgical reinterventions and late complications in the intestinal tract. # 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Department of Urology, General Hospital of Bolzano, L. Boehler St. 5, Bolzano, 39100, Italy. Tel. +39 0471 908686; Fax: +39 0471 909738. E-mail address: a_pycha@hotmail.com (A. Pycha). 0302-2838/$ – see back matter # 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2008.04.068