Extracorporeal vs. intracorporeal urinary diversion at robot-assisted radical cystectomy: adverse in-hospital outcomes

The advantage of intracorporeal (ICUD) over extracorporeal urinary diversion (ECUD) at robot-assisted radical cystectomy (RARC) regarding adverse in-hospital outcomes is still under debate. We addressed these knowledge gap in the National Inpatient Sample (2016–2019). RARC patients receiving either ileal conduit or neobladder were stratified according to UD technique (ECUD vs. ICUD). Propensity score matching (PSM), univariable and multivariable logistic and Poisson regression models were used to test differences in adverse in-hospital outcomes rates. Subgroups analyses focused on specific population: female patients, patients receiving neobladder, patients treated in low volume hospitals. Of 1747 RARC patients, 462 (26.4%) underwent ECUD vs. 1285 (73.6%) underwent ICUD. ECUD patients were more frequently treated in low volume hospitals (72.3 vs. 66.2%, p = 0.02) and more frequently received neobladder than their ICUD counterparts (10.2 vs. 4.7%, p < 0.001). The proportions of ECUD and ICUD significantly differed within United States regions (p = 0.001). After one-to-one PSM between ECUD and ICUD patient, 444 (96.1%) ECUD patients and 444 (34.6%) ICUD patients were compared. After separate univariable and multivariable logistic and Poisson regression models, ECUD was not an independent predictor of adverse in-hospital outcome in 13 examined-categories. Similarly, no differences in adverse in-hospital outcomes were identified between ECUD vs. ICUD within the three examined subgroups. The current data indicates no differences between ECUD and ICUD when adverse in-hospital outcomes represent the endpoint of interest. In consequence, surgical expertise with one or the other technique within individual Institutions might represent the most relevant factor to guide choice between ECUD and ICUD.