Delayed complications of radical cystectomy considering urinary diversion methods: non-muscle-invasive bladder cancer and cancer with minimal muscle invasion

Introduction. Radical cystectomy (RC) effectively controls bladder cancer but carries a > 50% 90-day complication rate, 15 – 20% severe complications, and 2% mortality. Most short- and long-term complications relate to urinary diversion rather than RC itself.

Objective. To evaluate the incidence and profile of delayed postoperative complications following RC by urinary diversion method in non-muscle-invasive bladder cancer (NMIBC) and minimal intradetrusor-invasive muscle-invasive bladder cancer (MIBC).

Materials & methods. This study included 49 patients with high-risk progressive NMIBC (group 1) and 102 with MIBC exhibiting minimal intradetrusor invasion (group 2) who underwent RC.

Results. Delayed complications occurred in 10.9 ± 4.9 (group 1) versus 12.1 ± 3.5 cases per 100 patients (group 2; no significant difference). Diversion-related complications were 5.5 times more frequent than non-diversion-related ones. Proportions of affected patients were similar (39.1% vs 39.4%), but case prevalence was higher in group 2 (71.7 ± 8.5 vs 60.9 ± 11.5 per 100; p > 0.05). Internal diversion showed the highest risk (266.7 ± 66.7 per 100), while inverted ileocystoplasty was most favourable (34.8 ± 12.3 per 100). Bricker diversion had the lowest corrective surgery rate (6.3 ± 4.4 per 100).

Conclusion. Delayed diversion-related and urological complications were more prevalent in minimal MIBC, with higher corrective surgeries in NMIBC. Internal diversion performed poorly, whereas orthotopic inverted ileocystoplasty offered optimal outcomes.

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