Rodriguez Peñaranda Natali, Di Bello Francesco, Marmiroli Andrea, Falkenbach Fabian, Longoni Mattia, Le Quynh Chi, Goyal Jordan A, Tian Zhe, Saad Fred, Shariat Shahrokh F, Longo Nicola, De Cobelli Ottavio, Graefen Markus, Briganti Alberto, Chun Felix K H, Puliatti Stefano, Micali Salvatore, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Department of Urology, AOU di Modena, University of Modena and Reggio Emilia, Via Pietro Giardini, Baggiovara, 1355, 41126, Italy.
World J Urol. 2025 Jun 16;43(1):375. doi: 10.1007/s00345-025-05495-7.
To test for differences in adverse in-hospital outcomes between females vs. males after radical cystectomy (RC) according to specific urinary diversion type (neobladder vs. ileal conduit).
Patients were identified within the National Inpatient Sample (NIS 2000-2019). Propensity score matching (PSM, 1:2 ratio) based on sex (female: male) and multivariable logistic regression models (LRMs) were applied separately to the neobladder and ileal conduit cohorts. Complications were assessed as immediate postoperative events recorded during the index hospitalization, as the NIS database does not include data beyond discharge.
Of 1,899 RC patients with neobladder, 209 (11.0%) were female vs. 3,823 (20.3%) were female of 18,777 RC patients with ileal conduit. After 1:2 PSM, 209 of 209 (100%) female neobladder vs. 418 of 1,690 (24.7%) male neobladder patients were included. Within the neobladder cohort, in multivariable LRMs, female sex independently predicted higher rates of blood transfusions (multivariable odds ratio [MOR] 1.7). Conversely, after 1:2 PSM, 3,823 of 3,823 (100%) female ileal conduit vs. 7,646 of 14,954 (51.1%) male ileal conduit patients were included. Within the ileal conduit cohort, in multivariable LRMs, female sex independently predicted higher rates of blood transfusions (MOR 1.5), overall postoperative complications (MOR 1.1), pulmonary complications (MOR 1.1), and hospital stay ≥ 75th percentile (MOR 1.1), but lower rates of wound (MOR 0.7) and gastrointestinal (MOR 0.8) complications.
Female sex affects adverse in-hospital outcomes after RC differently based on urinary diversion type. The adverse effect of female sex is much more pronounced in ileal conduit than in neobladder patients.
根据特定的尿流改道类型（新膀胱与回肠膀胱），测试根治性膀胱切除术后（RC）女性与男性住院不良结局的差异。
在国家住院患者样本（NIS 2000 - 2019）中识别患者。基于性别（女性：男性）的倾向评分匹配（PSM，1:2比例）和多变量逻辑回归模型（LRMs）分别应用于新膀胱和回肠膀胱队列。并发症评估为索引住院期间记录的术后即刻事件，因为NIS数据库不包括出院后的数据。
在1899例接受新膀胱的RC患者中，209例（11.0%）为女性，而在18777例接受回肠膀胱的RC患者中，3823例（20.3%）为女性。经过1:2的PSM后，209例接受新膀胱的女性患者中的209例（100%）与1690例接受新膀胱的男性患者中的418例（24.7%）被纳入。在新膀胱队列中，在多变量LRMs中，女性独立预测输血率更高（多变量优势比[MOR] 1.7）。相反，经过1:2的PSM后，3823例接受回肠膀胱的女性患者中的3823例（100%）与14954例接受回肠膀胱的男性患者中的7646例（51.1%）被纳入。在回肠膀胱队列中，在多变量LRMs中，女性独立预测输血率更高（MOR 1.5）、总体术后并发症（MOR 1.1）、肺部并发症（MOR 1.1）以及住院时间≥第75百分位数（MOR 1.1），但伤口（MOR 0.7）和胃肠道（MOR 0.8）并发症发生率较低。
根据尿流改道类型，女性对根治性膀胱切除术后住院不良结局的影响不同。女性的不良影响在回肠膀胱患者中比在新膀胱患者中更为明显。
