mp60-15 patterns of urinary diversion after radical cystectomy over the past 20 years: a...

e638 THE JOURNAL OF UROLOGY� Vol. 191, No. 4S, Supplement, Monday, May 19, 2014

MP60-14TRENDS IN URINARY DIVERSION AMONG PATIENTSUNDERGOING RADICAL CYSTECTOMY: A CONTEMPORARYPOPULATION-BASED ANALYSIS

Jeffrey Leow*, Joaquim Bellmunt, Boston, MA; Benjamin Chung,Stanford, CA; Steven Chang, Boston, MA

INTRODUCTION AND OBJECTIVES: The type of urinarydiversion performed after radical cystectomy (RC) depends on a varietyof factors including tumor location, performance status, patient prefer-ences, and surgeon competence. We aim to describe contemporarytrends in urinary diversion among RC patients in the United States.

METHODS: Using the Premier Comparative Database (Pre-mier, Inc., Charlotte, NC), which collects data from over 600 non-federal hospitals throughout the US, we captured all patients whounderwent a RC (ICD-9 code 57.71). Continent neobladder recon-struction was captured using ICD-9 code 57.87 and incontinent ileal/colonic conduit using 56.51, 56.61 and 56.71. Utilization of continentdiversion was trended by year. Multivariable analyses incorporatingrelevant patient, hospital and surgical factors were performed afteradjusting for survey weighting and clustering to evaluate the rela-tionship between hospital and patient characteristics and the use ofcontinent urinary diversion.

RESULTS: The final cohort had 42635 RCs, of which 2627(6.2%) and 40009 (93.8%) were continent and incontinent urinary di-versions. There was no significant increase in use of continent diversionfrom 2003 (5.6%) to 2010 (5.3%). Predictors of receipt of continentdiversion include private insurance (OR: 2.01, p<0.01), receipt of pelviclymphadenectomy (OR: 2.07, p<0.01), and higher surgeon volume(OR: 2.27, p<0.01). Patients who are older, female, and have worseCharlson comorbidity scores are less likely to have continent diversions(Table 1). The use of robotic surgery had no association with the type ofurinary diversion.

CONCLUSIONS: The use of continent diversion appears tohave remained stable at about 6% in recent years. Significant vari-ations in urinary diversion appear to exist by insurance status andsurgeon volume/technique. No hospital factors nor the adoption ofrobotic radical cystectomy has altered the use of continent uri-nary diversion.

Source of Funding: none

MP60-15PATTERNS OF URINARY DIVERSION AFTER RADICALCYSTECTOMY OVER THE PAST 20 YEARS: A POPULATION-BASED ANALYSIS

Dustin Hyatt, Oklahoma City, OK; Oluwakayode Adejoro, Minneapolis,MN; Sean Elliott, Oklahoma City, MN; Joel Slaton*, Oklahoma City, OK

INTRODUCTION AND OBJECTIVES: Over the past twentyyears, there has been a large push within the urological communitytowards the greater use of catheterizable urinary pouches and neo-bladders when compared to ileal conduits. We performed a population-based analysis to determine current patterns of use and factorsassociated with choice of specific urinary diversions.

METHODS: We interrogated the SEER-Medicare Databasefrom the years 1992-2009 to identify all patients undergoing radicalcystectomy for urothelial cancer and for specific choice of urinarydiversion used. Parameters including age, race, gender, income, edu-cation, and stage of cancer were correlated with choice of uri-nary diversion.

RESULTS: Among the 5892 cystectomy and urinary diversionsthat were performed, Continent urinary diversion (CUD) vs ileal di-versions were performed in 14% in 1992. This percentage rose to 23-25% for the rest of the 1990’s but has gradually fallen off to 16-18% inthe 2000’s. Receiving a CUD had a significant effect (Tis, Ta, T1 e

27%; T2 -21%; 19%) As might be expected the percentage of patientsundergo a CUD decreased with age (65-69, 29%; 70-74, 22%; 75-79,14%; and >80, 9%). With respect to gender, 21% of men had a CUDand 14% of women with the number in the latter group rising over thepast 20 years. Race played a minimal part in decision making(Caucasian 18% vs nonwhite 22%). Regionally, the West perform 50%higher number of CD. The patients with the highest income (22% vs13%), higher education (26% vs 17%) and lower Charlson score (0 vs 1,21% vs 15%)had a higher change of obtaining a CUD.

CONCLUSIONS: Despite a large push among the urologiccommunity over the past two decades, continent diversions appear tohave peaked in the 1990’s and modestly fell off into the 2000’s. Patientsreceiving CUD were more likely to be male, young, better education,and higher income.

Source of Funding: none

MP60-16THREE-MONTH PATIENT-REPORTED OUTCOMES AFTER OPENVERSUS ROBOTIC RADICAL CYSTECTOMY: A RANDOMIZEDCLINICAL TRIAL

Michael Feuerstein*, Michael Goltzman, Bradley Morganstern,Nicole Roberts, Sara Blass, Ahmad Shabsigh, Yuelin Li,Jonathan Coleman, S. Machele Donat, Harry Herr, Guido Dalbagni,Vincent Laudone, New York, NY; Bruce Rapkin, Bronx, NY;Bernard Bochner, New York, NY

INTRODUCTION AND OBJECTIVES: Radical cystectomy canhave a profound quality of life impact for patients. Prior studies of thepurported differences between open and robotic cystectomy techniqueshave primarily been retrospective, heavily based upon surgical out-comes, and with potential for several major biases. We provide ourprospective data evaluating short-term, patient-reported outcomes(PRO) obtained during a randomized clinical trial of open versus roboticradical cystectomy.

METHODS: Prior to radical cystectomy, patients at our institu-tion were recruited for two concurrent, prospective studies, a longitu-dinal PRO study and a randomized trial comparing open versus roboticradical cystectomy with extracorporeal urinary diversion. We conducteda post-hoc comparison of PRO outcomes in 110 patients enrolled inboth studies using the EORTC QLQ-C30, a validated, cancer-relatedPRO instrument that measures general quality-of-life, functioning and