title: Factors associated with non-orthotopic urinary diversion after radical cystectomy.
abstract: BACKGROUND
  Preoperative factors favoring the performance of non-orthotopic bladder substitution (OBS) after radical cystectomy for muscle-invasive bladder cancer were identified.
  
  
  METHODS
  We retrospectively reviewed the medical records of 730 patients who underwent radical cystectomy for urothelial carcinoma of the bladder. After excluding 75 patients who were unable to undergo OBS due to the tumor location or elevated serum creatinine level, we assessed the preoperative factors in the remaining 655 patients. Multivariate logistic regression analysis was performed to identify the independent preoperative predictors of type of urinary diversion.
  
  
  RESULTS
  Of the 655 patients, 171 (26.1%) underwent non-OBS. Patients who underwent non-OBS were more likely to be older and females, to have a lower educational status, non-organ confined disease, more comorbid medical conditions, more impaired performance status, lower body mass index, anemia, azotemia, and hypoalbuminemia, and to be treated by less-experienced surgeons (P < 0.05 each). After adjusting for provider-based factors, multivariate analysis showed that factors independently associated with non-OBS included advanced age (odds ratio [OR] 4.10, P < 0.001), female gender (OR 2.08, P = 0.027), ECOG performance status (≥ 1 vs 0, OR 5.20, P < 0.001), low educational status (OR 1.59, P = 0.042), clinically node-positive disease (OR 2.36, P = 0.003), anemia (OR 1.67, P = 0.041), azotemia (OR 3.97, P < 0.001), and hypoalbuminemia (OR 1.84, P = 0.046).
  
  
  CONCLUSIONS
  Several patient-based as well as provider-based factors were associated with the type of urinary diversion after radical cystectomy. Advanced age, female gender, low performance status, low education level, clinically node-positive disease, anemia, hypoalbuminemia, and azotemia were associated with non-OBS, as surgery was performed by relatively inexperienced surgeons.
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2 dong, Songpa-gu, Seoul 138-736, Korea.
authors.forename: In Gab
authors.initials: IG
authors.lastname: Jeong
authors.forename: Dalsan
authors.initials: D
authors.lastname: You
authors.forename: Jongwon
authors.initials: J
authors.lastname: Kim
authors.forename: Seong Cheol
authors.initials: SC
authors.lastname: Kim
authors.forename: Jun Hyuk
authors.initials: JH
authors.lastname: Hong
authors.forename: Hanjong
authors.initials: H
authors.lastname: Ahn
authors.forename: Choung-Soo
authors.initials: CS
authors.lastname: Kim
mesh_terms: D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000453:epidemiology*; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D015897:Comorbidity; D000075202:Contraindications; D003404:Creatinine / Q000097:blood; D015653:Cystectomy / Q000379:methods*; D004522:Educational Status; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012737:Sex Factors; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D014547:Urinary Diversion; D016476:Urinary Reservoirs, Continent; D019459:Urothelium / Q000473:pathology
chemical_list: D003404:Creatinine