title: Complications and quality of life in elderly patients with several comorbidities undergoing cutaneous ureterostomy with single stoma or ileal conduit after radical cystectomy.
abstract: OBJECTIVE
  To compare peri-operative outcomes and quality of life (QoL) in a series of elderly patients with high comorbidity status who underwent single stoma cutaneous ureterostomy (CU) or ileal conduit (IC) after radical cystectomy (RC).
  
  
  METHODS
  The clinical records of patients aged >75 years with an American Society of Anesthesiologists (ASA) score >2 who underwent RC at a single institution between March 2009 and March 2014 were retrospectively analysed. After RC, all patients included in the study received an IC urinary diversion or a CU with single stoma urinary diversion. Preoperative clinical characteristics as well as intra- and postoperative outcomes were evaluated and compared between the two groups. In addition, the Bladder Cancer Index (BCI) was used to assess QoL.
  
  
  RESULTS
  A total of 70 patients were included in the final comparative analyses. Of these, 35 underwent IC diversion and 35 CU single stoma diversion. The two groups were similar with regard to age, gender, ASA score, type of indication and pathological features. Operating times (P < 0.001), estimated blood loss (P < 0.001), need for intensive care unit stay (P = 0.01), time to drain removal (P < 0.001) and length of hospital stay (P < 0.001) were significantly higher in patients undergoing IC diversion. The number of patients with intra- (P = 0.04) and early postoperative (P = 0.02) complications was also significantly higher among those undergoing IC diversion. Interestingly, the mean BCI scores were overlapping in the two groups.
  
  
  CONCLUSIONS
  The present results show that CU with a single stoma can represent a valid alternative to IC in elderly patients with relevant comorbidities, reducing peri-operative complications without a significant impairment of QoL.
authors.affiliation: Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University Federico II of Naples, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Longo
authors.affiliation: Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University Federico II of Naples, Naples, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Imbimbo
authors.affiliation: Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University Federico II of Naples, Naples, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Fusco
authors.affiliation: Urology Department, University of Udine, Udine, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.affiliation: Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University Federico II of Naples, Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mangiapia
authors.affiliation: Oncology Department, University Federico II of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Lorenzo
authors.affiliation: Urology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy. m.creta1@gmail.com.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Creta
authors.affiliation: Urology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Imperatore
authors.affiliation: Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University Federico II of Naples, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011788:Quality of Life; D012189:Retrospective Studies; D014519:Ureterostomy / Q000009:adverse effects*; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects*
keywords: bladder cancer; cutaneous ureterostomy; ileal conduit; radical cystectomy