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Tinoco et al. Mini-invasive Surg 2021;5:28 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.35

Review Open Access

Urinary diversions for radical cystectomy: a review

of complications and their management

1
Catarina Laranjo Tinoco , Estevão Lima 2,3
1
Urology Department, Hospital de Braga, Braga 4710-243, Portugal.
2
Life and Health Sciences Research Institute, ICVS/3B's - Associate Lab, School of Medicine - University of Minho, Braga 4710-
057, Portugal.
3
CUF Urology, CUF Hospital, Lisbon 1350-352, Portugal.
Correspondence to: Dr. Catarina Laranjo Tinoco, Urology Department, Hospital de Braga, Sete Fontes - São Victor , Braga 4710-
243, Portugal. E-mail: cat.tinoco@gmail.com
How to cite this article: Tinoco CL, Lima E. Urinary diversions for radical cystectomy: a review of complications and their
management. Mini-invasive Surg 2021;5:28. https://dx.doi.org/10.20517/2574-1225.2021.35

Received: 14 Mar 2021 First Decision: 22 Mar 2021 Revised: 28 Mar 2021 Accepted: 12 Apr 2021 Available online: 6 Jun 2021
Academic Editor: Giulio Belli Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Radical cystectomy involves a urinary diversion, the most used being the ileal conduit and the orthotopic
neobladder. This review focuses on the complications associated with these procedures, dividing them into general
and diversion related complications, as well as their management. We conducted a search on PubMed and Scopus
to identify eligible articles on complications of urinary diversions. Randomized controlled trials and systematic
reviews with meta-analysis were preferred when available. Early complications occur in the first 90 days after
surgery. The most common is post-operative ileus, followed by urinary tract infections and urinary leakage. Most
complications occur in the late post-operative setting, being related to the type of urinary diversion. Some of these
complications are renal failure, metabolic abnormalities, infections, urolithiasis, and ureteroenteric strictures, each
with particular management options. Specific ileal conduit complications are conduit deformities and parastomal
hernias. Neobladder patients can have continence problems, like incontinence or urinary retention, but also fistulas
and dehiscence. Standardization of complications’ definitions and time-dependent reporting are crucial to better
understand and manage these complications. Complication rates are similar between open and robot-assisted
procedures and between intracorporeal and extracorporeal diversion. Radical cystectomy with urinary diversion is
the most difficult surgical procedure in urology with high early and late complication rates. There is an urgent need
of standardizing complication reporting to better compare different procedures.

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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