Does colonic anastomosis in CCUD lead to worse 30-day outcomes?

The presence of a colonic anastomosis during colon conduit urinary diversion (CCUD) does not appear to result in poor outcomes within 30 days, according to a study. However, hypoalbuminemia may contribute to a higher likelihood of 30- to 90-day high-grade complications.

A team of investigators retrospectively identified 179 patients (median age 61 years) who underwent CCUD between 1990 and 2022. They stratified the participants into CCUD with colonic anastomosis, CCUD with colostomy, and colostomy switch. Descriptive, univariable, and multivariable statistics were used to compare patient characteristics, perioperative variables, and outcomes between groups.

Of the patients, 63.7 percent had prior radiation therapy, 54 percent genitourinary surgery, and 72 percent abdominal surgery.

High-grade complications at 30 days occurred in 28.5 percent of patients, while 30- to 90-day high-grade complications occurred in 14.5 percent. In addition, 4.5 percent of patients died within 90 days. About a third (30.2 percent) of the participants also had surgical or procedural reintervention within 90 days.

The need for ureteral stent or nephrostomy tube (16.8 percent) was the most common late complication. Preoperative albumin ≥3.2 showed a significant association with fewer 30- to 90-day high-grade complications (hazard ratio [HR], 0.18).

Furthermore, high-grade complications that occurred during postoperative day 0 to 30 contributed to an increased likelihood of developing a secondary high-grade complication between postoperative day 30 and 90 (HR, 2.85).

“Use of colon remains an important option for urinary diversion surgery when ileum is not clinically feasible,” the investigators said.