title: Factors affecting choice between ureterostomy, ileal conduit and continent reservoir after radical cystectomy: Japanese series.
abstract: BACKGROUND
  Little is known about the disparity of choices between three urinary diversions after radical cystectomy, focusing on patient and institutional factors.
  
  
  METHODS
  We identified urothelial carcinoma patients who received radical cystectomy with cutaneous ureterostomy, ileal conduit or continent reservoir using the Japanese Diagnosis Procedure Combination database from 2007 to 2012. Data comprised age, sex, comorbidities (converted into the Charlson index), TNM classification (converted into oncological stage), hospitals' academic status, hospital volume, bed volume and geographical region. Multivariate ordinal logistic regression analyses fitted with the proportional odds model were performed to analyze factors affecting urinary diversion choices. For dependent variables, the three diversions were converted into an ordinal variable in order of complexity: cutaneous ureterostomy (reference), ileal conduit and continent reservoir. Geographical variations were also examined by multivariate logistic regression models.
  
  
  RESULTS
  A total of 4790 patients (1131 cutaneous ureterostomies [23.6 %], 2970 ileal conduits [62.0 %] and 689 continent reservoirs [14.4 %]) were included. Ordinal logistic regression analyses showed that male sex, lower age, lower Charlson index, early tumor stage, higher hospital volume (≥3.4 cases/year) and larger bed volume (≥450 beds) were significantly associated with the preference of more complex urinary diversion. Significant geographical disparity was also found.
  
  
  CONCLUSIONS
  Good patient condition and early oncological status, as well as institutional factors, including high hospital volume, large bed volume and specific geographical regions, are independently related to the likelihood of choosing complex diversions. Recognizing this disparity would help reinforce the need for clinical practice uniformity.
authors.affiliation: The Department of Quantitative Health Sciences, Cleveland Clinic foundation, Cleveland Clinic Main Campus, Mail code JJN3-282 9500, Euclid Avenue, Cleveland, OH, 44195, USA, ezy04707@nifty.com.
authors.forename: Toru
authors.initials: T
authors.lastname: Sugihara
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fujimura
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Changhong
authors.initials: C
authors.lastname: Yu
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014519:Ureterostomy / Q000379:methods; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods