Two Cases of Revisional Urinary Diversion from Ureterocutaneostomy to Ileal Conduit: A Staged Urinary Diversion Strategy for Patients with Bladder Cancer in the Targeted and Immunotherapy Era.

Abstract

BACKGROUND Cutaneous ureterostomy (CU) is a commonly used urinary diversion procedure, particularly for patients with poor prognosis, such as those with advanced cancer, a single kidney, or older age. CU is technically easier and faster to perform than other procedures, such as ileal conduit and ileal neobladder, as it does not involve the intestines, thus reducing the risk of postoperative intestinal complications and metabolic abnormalities. However, CU has several drawbacks, including difficulty in achieving a catheter-free status, frequent urinary tract infections, and concerns about long-term renal function, which can negatively impact a patient's quality of life. Recent advancements in the treatment of advanced metastatic urothelial cancer, particularly with immune checkpoint inhibitors and antibody-drug conjugates, have significantly improved the prognosis of patients with urothelial carcinoma. As a result, some patients who underwent CU and were initially considered to have poor prognosis achieved long-term remission. For these patients, the next goal is to establish a stable urinary diversion method that minimizes management effort and reduces the risk of infection and renal dysfunction. CASE REPORT This report presents 2 cases of revisional urinary diversion from CU to ileal conduit in patients with locally advanced bladder cancer who initially underwent CU and achieved long-term remission with pembrolizumab. Both patients achieved catheter-free status and preserved renal function postoperatively. CONCLUSIONS These cases highlight the potential benefits of staged urinary diversion in improving the quality of life of bladder cancer survivors in an era of targeted immunotherapy.