title: [Complications after ileal conduit: Urinary diversion-associated complications after radical cystectomy].
abstract: BACKGROUND
  We analyzed complications associated with urinary diversion after radical cystectomy (RC) and ileal conduit (IC) for bladder cancer (BCa).
  
  
  METHODS
  A total of 305 BCa patients after RC with IC were included in the study (June 2003-December 2010). IC complications (peristomal hernia, IC stenosis, stenosis of the ureteral anastomosis, IC bleeding, urolithiasis, urinary infections, and renal insufficiency) were identified according to the Clavien-Dindo classification (CDC). Kaplan-Meier plots were generated. Uni- and multivariable Cox regression analyses with backward selection for prediction of high-grade complications (CDC ≥ III) and IC revision surgery were conducted; covariates included age, previous abdominal/pelvic radiation, body mass index (BMI), previous abdominal/pelvic surgery, comorbidities, and advanced tumor stage.
  
  
  RESULTS
  An IC complication (CDC ≥ I) or a high-grade IC complication (CDC ≥ III) was experienced by 32.7 and 13.4 % of our cohort: 14.8 %, 4.3 %, 4.6 % developed a peristomal hernia, IC stenosis, stenosis of the ureteral anastomosis, respectively. IC revision was required by 10.5 % of patients (median follow-up 19.5 months, IQR 7-47 months). The estimated rate of IC complications at 5 years was 52 % (CDC ≥ I) and 22 % (CDC ≥ III). The final model of the multivariable analysis showed that patients with a history of previous radiation (HR 4.33), a BMI ≥ 30 (HR 2.24), or longer duration of surgery (HR 1.01; all p < 0.05) were at higher risk for IC revision surgery. A BMI ≥ 30 (HR 2.49, p = 0.011) was a risk factor for high-grade complications.
  
  
  CONCLUSIONS
  The risk of experiencing a high-grade IC complication is moderate. Previous radiation, obesity, and comorbidities represent risk factors for IC revision surgery. Moreover, obesity is a risk factor for high-grade complications.
authors.affiliation: Klinik für Urologie, Marien Hospital Herne, Ruhr-Universität Bochum, Widumerstr. 8, 44627, Herne, Deutschland, florian.roghmann@marienhospital-herne.de.
authors.forename: F
authors.initials: F
authors.lastname: Roghmann
authors.forename: M
authors.initials: M
authors.lastname: Gockel
authors.forename: J
authors.initials: J
authors.lastname: Schmidt
authors.forename: J
authors.initials: J
authors.lastname: Hanske
authors.forename: N
authors.initials: N
authors.lastname: von Landenberg
authors.forename: B
authors.initials: B
authors.lastname: Löppenberg
authors.forename: K
authors.initials: K
authors.lastname: Braun
authors.forename: C
authors.initials: C
authors.lastname: von Bodman
authors.forename: J
authors.initials: J
authors.lastname: Pastor
authors.forename: J
authors.initials: J
authors.lastname: Palisaar
authors.forename: J
authors.initials: J
authors.lastname: Noldus
authors.forename: M
authors.initials: M
authors.lastname: Brock
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D015653:Cystectomy / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D017678:Sex Distribution; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D014547:Urinary Diversion / Q000706:statistics & numerical data*