title: Comparison of 90-day complications between ileal conduit and neobladder reconstruction after radical cystectomy: a retrospective multi-institutional study in Japan.
abstract: OBJECTIVE
  To determine the differences in the type, incidence, and severity of 90-day morbidity after radical cystectomy between two different methods of urinary diversion, ileal conduit and neobladder.
  
  
  METHODS
  We carried out a retrospective multi-institutional study by reviewing the records of 668 patients treated with open radical cystectomy, and ileal conduit (n = 493) or neobladder substitution (n = 175) between 1997 and 2010. All complications within 90 days after surgery were divided into 11 specific categories as reported by the Memorial-Sloan Kettering Cancer Center, and graded according to the modified Clavien system. Type, incidence and severity of the 90-day morbidity between the two different types of urinary diversions were compared.
  
  
  RESULTS
  There was no significant difference in the overall complication rates between the two groups (ileal conduit: 72% [353/493], neobladder: 74% [129/175], P = 0.5909), whereas the neobladder group had fewer major (grade 3 or more) complications (13 vs 20%, respectively, P = 0.0271). The neobladder group had more infectious complications (43 vs 31%, respectively, P = 0.0037), mainly as a result of urinary tract infection, whereas the ileal conduit group had more wound-related complications (24 vs 14%, respectively, P = 0.0068), mainly as a result of surgical site infection. The 90-day mortality rates were 1.1% (2/175) in the neobladder group and 1.6% (8/493) in the ileal conduit group (P = 0.6441).
  
  
  CONCLUSIONS
  There was no significant difference in the overall complication rates between the two methods, and patients with neobladder had fewer major complications. The neobladder group had more infectious complications, whereas the ileal conduit group had more wound-related complications.
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Takashige
authors.initials: T
authors.lastname: Abe
authors.forename: Norikata
authors.initials: N
authors.lastname: Takada
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.forename: Ryuji
authors.initials: R
authors.lastname: Matsumoto
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Murai
authors.forename: Ataru
authors.initials: A
authors.lastname: Sazawa
authors.forename: Satoru
authors.initials: S
authors.lastname: Maruyama
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Tsuchiya
authors.forename: Shino
authors.initials: S
authors.lastname: Kanzaki
authors.forename: Katsuya
authors.initials: K
authors.lastname: Nonomura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects*
keywords: complication; cystectomy; ileal conduit; morbidity; mortality; neobladder