Introduction

The decision to perform continent orthotopic neobladder (NB) versus non-continent ileal conduit (IC) or continent cutaneous diversion (CCD) at the time of radical cystectomy requires thorough preoperative planning and counseling. Still, preconceived plans may change due to unforeseen intraoperative challenges. Herein, we investigate factors that contribute to this change in plan.

Methods

Using an IRB approved, prospectively maintained database, we identified 711 patients with bladder cancer who underwent radical cystectomy from 2002 to 2015. Of these, 392 were consented on the day of surgery to NB as their first choice of urinary diversion. 348 patients ultimately received NB while 38 received IC and 6 CCD. We compared those who received NB after being offered such on initial consultation with those who received either IC or CCD to determine factors that may have been involved in the decision.

Results

Factors for intraoperative change in plan are listed in Table 1. On statistical analysis, patients who ultimately received NB were significantly more likely to have organ confined disease (p=0.005), lower ASA score (p=0.006) and to undergo an open surgical approach (p=0.011) (Table 2).

Conclusions

The factors influencing the choice of urinary diversion in patients undergoing radical cystectomy are complex. Oncologic, metabolic, and technical factors must be weighed along with patient preference on initial consultation. We found that amongst those consented for NB, those with organ confined disease, lower ASA score and those undergoing an open approach, were more likely to ultimately receive a NB. As plans may require change intraoperatively, a more clear understanding of the factors involved will improve shared decision making in the future.

Funding

None