Urinary Diversion for Severe Urinary Adverse Events of Prostate Radiation: Results from a Multi-Institutional Study.
We evaluated the short and long-term surgical outcomes of urinary diversion done for urinary adverse events arising from prostate radiation therapy. We hypothesized that patient characteristics are associated with complications after urinary diversion.



We performed a retrospective cohort study of 100 men who underwent urinary diversion (urinary conduit or continent catheterizable pouch) due to urinary adverse events after prostate radiotherapy from 2007 to 2016 from 9 academic centers in the United States. Outcome measurements included predictors of short and long-term complications, and readmission after urinary diversion of patients who had prostate cancer treated with radiotherapy. The data were summarized using descriptive statistics and univariate associations with complications were identified with logistic regression controlling for center.



Mean patient age was 71 years and median time from radiotherapy to urinary diversion was 8 years. Overall 81 (81%) patients had combined modality therapy (radical prostatectomy plus radiotherapy or various combinations of radiotherapy). Grade 3a or greater Clavien-Dindo complications occurred in 31 (35%) men, including 4 deaths (4.5%). Normal weight men had more short-term complications compared to overweight (OR 4.9, 95% CI 1.3-23.1, p=0.02) and obese men (OR 6.3, 95% CI 1.6-31.1, p=0.009). Hospital readmission within 6 weeks of surgery occurred for 35 (38%) men. Surgery was needed to treat long-term complications after urinary diversion in 19 (22%) patients with a median followup of 16.3 months.



Urinary diversion after prostate radiotherapy has a considerable short and long-term surgical complication rate. Urinary diversion most often cannot be avoided in these patients but appreciation of the risks allows for informed shared decision making between surgeons and patients.
Center for Reconstructive Urology, Department of Surgery, University of Utah, Salt Lake City, Utah. Electronic address: mitchell.bassett@hsc.utah.edu.
Mitchell R
MR
Bassett
Department of Urology, University of Michigan, Ann Arbor, Michigan.
Yahir
Y
Santiago-Lastra
Department of Urology, University of Michigan, Ann Arbor, Michigan.
John T
JT
Stoffel
Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Robert
R
Goldfarb
Department of Urology, University of Minnesota, Minneapolis, Minnesota.
Sean P
SP
Elliott
Department of Urology, University of Kansas, Kansas City, Kansas.
Scott C
SC
Pate
Department of Urology, University of Kansas, Kansas City, Kansas.
Joshua A
JA
Broghammer
Department of Urology, and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
Thomas
T
Gaither
Department of Urology, and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
Benjamin N
BN
Breyer
Department of Urology, Lahey Clinic and Medical Center, Burlington, Massachusetts.
Alex J
AJ
Vanni
Department of Urology, University of Washington, Seattle, Washington.
Bryan B
BB
Voelzke
Department of Urology, University of Iowa, Iowa City, Iowa.
Bradley A
BA
Erickson
Department of Urology, University of Ohio, Columbus, Ohio.
Christopher D
CD
McClung
Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah.
Angela P
AP
Presson
Department of Radiation Oncology and the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
Jonathan D
JD
Tward
Center for Reconstructive Urology, Department of Surgery, University of Utah, Salt Lake City, Utah.
Jeremy B
JB
Myers
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014547:Urinary Diversion; D014555:Urination Disorders / Q000209:etiology* / Q000601:surgery*
complications; prostatic neoplasms; radiation; urinary diversion