Postoperative complications following simple cystectomy for radiation-induced bladder dysfunction compared to radical cystectomy: A matched cohort study.

Abstract

Introduction: Simple cystectomy (SC) for radiation-induced bladder dysfunction (RIBD) is occasionally performed, yet data regarding perioperative outcomes are limited. This study aimed to compare perioperative complications following SC for RIBD with radical cystectomy (RC) for bladder cancer.

Material and methods: We conducted a retrospective single-center analysis of patients who underwent laparoscopic cystectomy with ureterocutaneostomy between 2016 and 2024. Propensity score matching (PSM) was applied separately for cT1-cT2 stage tumors, cT3-cT4 stage tumors, and for SC group vesicoenteric fistula patients. Outcomes were assessed using the Clavien-Dindo (CD) classification at 30 and 90 days.

Results: In total, 257 patients were included in the study: 25 SC for RIBD and 232 RC for BC. Prior to matching, SC patients had significantly higher rates of CD grade ≥3 complications at 30 days (44% vs 22.4%, p <0.001), higher reoperation rates (47.8% vs 11.6%, p <0.001), and prolonged hospital stays (15 vs 9 days, p = 0.002). After matching, SC patients continued to demonstrate more severe complications, especially compared to cT1-T2 RC patients (CD ≥3 complications: 47.1% vs 11.8%, p = 0.057; reoperations: 56.2% vs 5.9%, p = 0.002). In patients with vesicoenteric fistula after matching, CD complication rates at 30 days did not differ significantly between groups (p = 0.130), 90-day complication rates were comparable (p = 0.968), and reoperations occurred significantly more often in the SC group (61.5% vs 6.7%; p = 0.004). Study limitations include the retrospective single-center design, small SC group size and urinary diversion type.

Conclusions: Due to high morbidity, non-oncological cystectomy for RIBD should be limited to selected cases and managed in experienced, multidisciplinary centers. Urinary diversion without cystectomy may be a safer alternative.