Reoperation rate in patients with a continent urinary diversion or neobladder is influenced by the oncological or functional indication for cystectomy

Bart B. Nieuwkamer, Rob F.M. Bevers, Henk W. Elzevier, Nico J.D. Nagelkerke, Ron Wolterbeek, Guus A.B. Lycklama À Nijeholt

Research output: Contribution to journalArticlepeer-review


Purpose: Continent urinary diversion following a cystectomy has become a standard procedure in suitable patients, because of its potentially favorable aspects. Reports concerning long-term complications necessitating reoperation are mainly based on patients with cystectomy for carcinoma. We reviewed the reoperation rate in patients with a continent diversion for both oncological and interstitial cystitis. Materials and Methods: A retrospective study was performed at our department on 63 patients in whom a continent diversion was created in the period from 1984 to 2002. Mean follow-up period was 73.9 months. Statistical analysis for the postoperative complication rate was performed using a multivariate linear stepwise regression, and Cox proportional hazard model. Results: Mean patient-age for the whole group was 53.8 years. Types of diversion used were Indiana (n = 31), Hautmann (n = 21) and Kock (n = 11). The group with an oncological indication for cystectomy consisted of 40 patients (31 male, 9 female) with a mean age of 58.5 years. Reasons for cystectomy were transitional cell carcinoma of the bladder (n = 39) and clear cell vaginal carcinoma (n = 1). The cystitis group was comprised of 23 patients (2 male, 21 female) with a mean age of 45.7 years. Cystectomy was performed for interstitial cystitis (n = 20) and chronic cystitis (n = 3). Multivariate linear stepwise regression of the summed side-effect score yielded a significant association, with the oncological group having less postoperative complications. The Cox proportional hazard model yielded a highly significant difference in revision of the urinary diversion. Reoperation rate in functional patients was 78.3 vs. 22.5% in oncological patients (p < 0.001). Conclusions: Postoperative complication and reoperation rates of continent diversion (or orthotopic neobladder) were significantly higher in patients with non-oncological indications for cystectomy. Therefore, results of continent diversion based on studies with oncological patients should not be used in counselling patients who may need a urinary diversion because of functional reasons such as interstitial cystitis.

Original languageEnglish
Pages (from-to)9-14
Number of pages6
JournalCurrent Urology
Issue number1
Publication statusPublished - May 2009
Externally publishedYes


  • Bladder neoplasms
  • Cystectomy
  • Interstitial cystitis
  • Postoperative complications
  • Urinary Diversion

ASJC Scopus subject areas

  • Reproductive Medicine
  • Oncology
  • Urology


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