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Tinoco et al. Mini-invasive Surg 2021;5:28 https://dx.doi.org/10.20517/2574-1225.2021.35 Page 3 of 11

Table 1. Overall complication rates reported by the cited articles
General complications Specific complications
Early (90 days) Ileal conduit
Ileus 12%-23% Parastomal hernia 11%-17.1%
Urinary tract infection 5.7%-44% Conduit deformities
Urinary leakage Strictures 2.4%
Uretero-ileal 2%-5.5% Neobladder
Urethral < 25.3% Rupture < 1%
Late Fistula
Renal failure 19% Neobladder-enteric < 2%
Metabolic abnormalities < 50% Neobladder-vaginal 2.7%-8.8%
Acidosis 10.2%-33% Hypercontinence
B12 deficiency 3% Male 4%-8%
Urolithiasis 3.5%-15.3% Female 24%-62.5%
Ureteroenteric stricture 1.3%-10% Incontinence
Daytime 3%-43%
Nightime < 54.7%

food by post-operative day 5, the need to place a nasogastric tube (NGT), or the need to stop oral intake due
to abdominal distension, nausea, or emesis”. In a study by Shabsigh et al. , 23% of patients suffered from
[3]
[4]
ileus by this definition. Hautmann et al. also used this definition to report an ileus rate of 12% in a large
neobladder series of 1013 patients. In the RAZOR trial, the rate of ileus in open and robotic cystectomy was
similar, 20% and 22%, respectively . A comparison between extracorporeal and intracorporeal approaches
[6]
showed less time to return of bowel activity in intracorporeal robot-assisted diversions, which the authors
attribute to less pain and analgesic use and faster return to normal activity due to smaller and less painful
incisions and to less ambient air exposure of the peritoneum and abdominal viscera .
[8]

Enhanced recovery after surgery (ERAS) protocols for cystectomy play an important role in reducing post-
operative ileus, with a multimodal approach to prevent this complication which frequently prolongs
hospitalization. Chewing gum and post-operative nasogastric tube avoidance, for example, seem to be
effective in reducing ileus [9,10] .

Urinary tract infection
Urinary tract infections (UTIs) are a common complication causing readmission in many cystectomized
patients. Early post-operative UTI rates range from 5.7% to 44%, but a lack of standardization is evident,
and the rates greatly depend on the UTI definition. Diagnosing a UTI in a patient with a urinary diversion
requires a high level of suspicion because of its vague presentation, ranging from abdominal discomfort and
changes in urine’s smell to septic shock. Most often UTIs occur before stent removal, and their higher
frequency in the early vs. late post-operative period also suggests an important role of these foreign bodies
in UTI pathogenesis. Antibiotic treatment should be directed to cultured microorganisms as soon as
possible [11-13] .

Clifford et al. reported a global rate of 11% patients develop UTIs in the first 90 days post-operatively,
[11]
predominantly by Gram-negative rods; 17% of those patients had recurrent infections and 20% had
urosepsis. They studied UTI rate by type of urinary diversion and found no significative difference between
diversion types (orthotopic neobladder, continent cutaneous diversion, and ileal conduit) . On the other
[11]
hand, other studies found UTIs to be more frequent in orthotopic neobladder than in heterotopic