Outcomes After Colon Conduit Urinary Diversion: A Multi-Institutional Retrospective Study From the Reconstruction and Diversion: Improving Outcomes Group.

Abstract

To assess outcomes after colon conduit urinary diversion (CCUD) with and without concurrent colon anastomosis. Patients who underwent CCUD were retrospectively identified at 4 institutions. Primary outcomes included 0- to 90-day high-grade complications, 30-day readmission, and late interventions. Secondary outcomes included high-grade complications and their association with concurrent colonic anastomosis, prior radiation, and hypoalbuminemia. The cohort was substratified into (1) CCUD with colonic anastomosis, (2) CCUD with colostomy, and (3) colostomy switch. Patient characteristics, perioperative variables, and outcomes were compared between groups using descriptive, univariable, and multivariable statistics. One hundred seventy-nine patients, median age 61 years, underwent CCUD between 1990 and 2022. Prior radiation therapy (63.7%), genitourinary surgery (54%), and abdominal surgery (72%) were common within the cohort. Outcomes included 30-day high-grade complications (28.5%), 30- to 90-day high-grade complications (14.5%), and 90-day mortality (4.5%). Ninety-day reintervention (surgical or procedural) was 30.2%. The most common late complication was need for ureteral stent or nephrostomy tube (16.8%). Preoperative albumin ≥ 3.2 was associated with reduced 30- to 90-day high-grade complications (HR 0.18). Development of high-grade complication during postoperative day 0 to 30 was associated with an increased likelihood of developing a secondary high-grade complication between postoperative day 30 and 90 (HR 2.85). The presence of a colonic anastomosis at the time of colon conduit urinary was not associated with worse 30-day outcomes. Hypoalbuminemia was associated with an increased likelihood of 30- to 90-day high-grade complications. Use of colon remains an important option for urinary diversion surgery when ileum is not clinically feasible.