- Email: [email protected]
MP38-11 ONCOLOGICAL TRIFECTA AND PENTAFECTA CRITERIA IN A CONTEMPORARY COHORT OF BLADDER CANCER PATIENTS AFTER RADICAL CYSTECTOMY
THE JOURNAL OF UROLOGYâ
e536
gender, histological type, stage, grade, tumor location, presence of Cis, te ro- hydronephrosis, number of previous bladder resection, ureteral ure frozen section analysis and final ureteral analysis. RESULTS: Mean follow-up was 36.2 months [12-255]. Pathological stages were: 91pT2, 163pT3, 73pT4 among which 111 patients were N +. The average age was 65.3 years [35-87]. The ureteral frozen section was proposed for 178 renal units (173 negative and 5 positive). The final review of ureteral section included 566 renal units (24 positive and 542 negative) and has always confirmed the results of the frozen section (sensitivity and specificity of 100%). Cis was associated with bladder tumor in 12% of cases (n ¼ 54). Uretero-hydronephrosis unilateral or bilateral was present in 33.6% of cases (n ¼ 148). In univariate analysis only hydronephrosis (p ¼ 0.002) and the presence of CIS (p ¼ 0.06) were associated with the risk of ureteral recoupes positive. The specificity, sensitivity, NPV and PPV of the uretero-hydronephrosis Cisassociation for the result of the ureteral cuts was 96% respectively 33%, 99% and 14%. In multivariate analysis only the Cis was an independent prognostic factor for ureteral intersects positive (p ¼ 0.02) (OR ¼ 0.26 [0.08 to 0.80]). CONCLUSIONS: The absence of CIS and uretero-hydronephrosis eliminates 99% the risk of ureteral intersects positive and the need for a frozen section. The presence of Cis is the only independent factor overlaps ureteral positive. Source of Funding: none
MP38-09 DOES THE ILEAL LENGTH USED FOR NEOBLADDER RECONSTRUCTION AFTER RADICAL CYSTECTOMY IMPACT ON POSTOPERATIVE BOWEL HABITS ? - A COMPARISON BETWEEN THE STUDER- AND THE I-POUCH Johannes Mischinger*, Tuebingen, Germany; Mohamed Abdelhafez, €fer, Stefan Aufderklamm, Assiut, Egypt; Tilman Todenho Steffen Rausch, Christian Schwentner, Arnulf Stenzl, Georgios Gakis, Tuebingen, Germany INTRODUCTION AND OBJECTIVES: The aim of the study was to investigate whether the length of ileum used for neobladder reconstruction after radical cystectomy (RC) for bladder cancer (60cm vs. 40cm) impacts on postoperative bowel function. METHODS: In this cross sectional study, a total of 56 patients who received an ileal neobladder after RC for BC between 2003 and 2011 were investigated (Studer (S)-Pouch: 23 patients, 19 men, 4 women; I-Pouch: 33 patients; 26 men, 7 women)). Changes perioperative bowel habits were retrospectively evaluated by the validated Gastrotintestinal Quality of Life Index (GIQLI). In addition, preoperative comorbidities were assessed by the Charlson Comobidity Index (CCI) and surgical complications as graded by the Clavien-Dindo classification. RESULTS: I-Pouch patients tended to have a higher CCI compared to S-Pouch patients (defined as CCI>¼3; S-Pouch: 8/23, 34% vs. I-Pouch: 20/33, 61%; p¼0.055). No significant differences were observed for 30-day major- (S: 5/23, 22% vs. I: 4/33, 12%; p¼0.33) and minor (S: 5/23, 22% vs. I: 7/33, 21%; p¼0.96) complication rates as well as 90-day major (S: 2/23, 9%) vs. I: 0/33, 0%; p¼0.08) and minor (S: 2/ 23, 9% vs. I: 0/33, 0%; p¼0.08) complication rates between both types of neobladder. Patients with an S-Pouch reported on higher preoperative stool frequency (S: median 3, IQR 2-4; I: median 4, IQR 3-4; p¼0.035) and urgency (S: median 3, IQR 2.75-4; I: 4, IQR: 3-4; p¼0.032). No significant differences in postoperative bowel disorders were found between both neobladder types (S-Pouch: median: 16, IQR: 14-18.5; I: median: 18, IQR: 14-20; p¼0.50). CONCLUSIONS: In this analysis, I-pouch patients tended to present with more comorbidities prior to RC while S-Pouch suffered more frequently from bowel disorders preoperatively. However, perioperative complication rates and bowel habits were similar between both orthotopic bladder substitutes. These data suggest that the length of ileum used for neobladder reconstruction does not impact per se on bowel function after RC. Source of Funding: none
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
MP38-10 CYSTECTOMY ASSOCIATED WITH IMPROVED OVERALL SURVIVAL IN VERY ELDERLY PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER; RESULTS FROM THE NATIONAL CANCER DATA BASE Bream Matthew*, Matthew Maurice, Simon Kim, Hui Zhu, Robert Abouassaly, Cleveland, OH INTRODUCTION AND OBJECTIVES: Cystectomy offers a survival advantage for muscle invasive bladder cancer (MIBC), but it is unclear if the very elderly receive this benefit given the competing risks of death, and morbidity of major surgical intervention in this population. We sought to assess overall survival (OS) in elderly patients with MIBC by treatment type. METHODS: From the National Cancer Data Base (NCDB), we selected a cohort of patients age 75 and older, diagnosed with T2-T4, non-metastatic urothelial bladder cancer from 2003 to 2012 who received cystectomy, primary chemoradiation, or non-standard treatment (neither cystectomy nor chemoradiation). The effect of treatment on overall survival (OS) was determined unadjusted using Kaplan-Meier analysis and the log-rank test, and adjusted using a Cox proportional hazards model. RESULTS: Of a total of 18,945 patients with MIBC, 3898 (21%) received cystectomy, 2482 (13%) received chemoradiation therapy, and the remaining 12,565 (66%) received non-standard treatment. Median OS for the entire cohort was 14.7 months. Median OS (95% CI) was 26.5 months (23.1-28.9) for cystectomy, 22.1 months (20.1-24.2) for chemoradiation, and 12.0 months (11.3-12.7) for non-standard treatment (p<0.0001, Figure 1). A survival benefit for cystectomy over non-standard treatment was seen in all Charlson comorbidity groups. In the Cox proportional hazards model, the hazard ratio for death when compared to non-standard treatment was 0.69 (95% CI 0.63-0.75, p<0.0001) for cystectomy and 0.75 (95% CI 0.70-0.82, p<0.0001) for chemoradiation. CONCLUSIONS: Cystectomy confers an OS benefit on very elderly patients with MIBC that persists when accounting for competing risks of death. These data support the continued use of cystectomy in appropriately selected elderly patients.
Source of Funding: None
MP38-11 ONCOLOGICAL TRIFECTA AND PENTAFECTA CRITERIA IN A CONTEMPORARY COHORT OF BLADDER CANCER PATIENTS AFTER RADICAL CYSTECTOMY Julian Hanske*, Nicolas von Landenberg, Sebastian Berg, €ri Palisaar, Jana Schmidt, Marko Brock, Christian von Bodman, Ju Florian Roghmann, Joachim Noldus, Herne, Germany INTRODUCTION AND OBJECTIVES: To assess the rate and readily available preoperative predictors of trifecta and pentafecta
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
criteria in bladder cancer (BCa) patients that underwent radical cystectomy (RC). The criteria were taken from a recent expert survey. METHODS: Overall, 177 consecutive BCa patients that underwent RC with urinary diversion at a single institution from 2009 to 2012 were retrospectively included in the study cohort. Trifecta criteria comprised negative tissue surgical margins, lymph node dissection of ¼16 nodes, and absence of major complications (CD III-V) according to Clavien-Dindo. In addition, pentafecta criteria include time from diagnosis to RC of <3 months and absence of local bladder cancer recurrence within one year after surgery. Descriptive statistics of categorical variables comprised frequencies and proportions whereas medians and interquartile ranges were reported for continuous variables. Multivariable analyses were performed for predicting the risk of mismatching trifecta and pentafecta criteria, respectively. Covariates included Body Mass Index (BMI), Charlson Comorbidity Index (CCI), age, gender, American Society of Anesthesiologists Score (ASA), neoadjuvant chemotherapy, prior abdominal or pelvic surgery, organ-defined tumor. RESULTS: The majority of the study population was male (135/ 177; 76.3%), had a BMI ¼30 (n¼137), and organ defined tumor (117/ 177; 66.1%). In total, 68/177 patients (38.4%) failed to meet trifecta whereas 70/177 patients (39.5%) missed pentafecta. Those patients, who failed to meet trifecta were more likely to have a higher ASA score (OR: 2.72; 95%CI: 1.37-5.43) and at higher likelihood to have a history of prior abdominal/pelvic surgery (OR: 2.65; 95%CI: 1.37-5.12, both p<0.004). Multivariable analyses of pentafecta did not reveal any significant differences. CONCLUSIONS: The risk of trifecta and pentafecta failure after RC is moderate. ASA and a history of prior abdominal/pelvic surgery may help to identify patients at risk for Trifecta failure. Our results emphasize the importance of these criteria in patient counseling prior surgical treatment.
e537
MP38-12 PROPHYLACTIC ANTIBIOTICS IN THE FIRST 30 DAYS FOLLOWING RADICAL CYSTECTOMY WITH URINARY DIVERSION LEADS TO FEWER URINARY TRACT INFECTIONS Ryan Werntz*, Theresa Koppie, Brian Junio, Christopher Amling, Portland, OR INTRODUCTION AND OBJECTIVES: Urinary tract infections and sepsis from a urinary source contribute significantly to the morbidity associated with cystectomy and urinary diversion. Many of these urinary tract infections and readmissions for urosepsis occur in the first 30 days following surgery and around the time of ureteral stent removal. The purpose of this study was to determine if prophylactic antibiotics decreases urinary tract infections in the first 30 days following radical cystectomy. METHODS: From 2014-2015, 84 consecutive patients who underwent a radical cystectomy with urinary diversion for bladder cancer were included in the study. The ureteral stents were left in place for 3 weeks in both groups. The first 42 patients did not receive daily antibiotics. The next group received a urine culture on discharge followed by 4 weeks of daily oral antibiotics. We evaluated for urinary tract infections in the first 30 days following surgery. A urinary tract infection was defined as clinical symptoms or signs and a documented culture positive organism. Simple T tests were used to determine the association between 4 weeks of postoperative antibiotics and 30 day risk of urinary tract infection. RESULTS: There was no difference in age, BMI, or stage between the two groups. A total of 10% in the prophylactic antibiotic group had a documented urinary tract infection, whereas 31% in the no antibiotic group had a urinary tract infection (p<0.01). The RRR was 97% and the NNT to prevent 1 UTI was 4.7. A total of 1 (2%) patient in the antibiotic group was readmitted for urosepsis whereas 7 (17%) patients in the no antibiotic group were readmitted for urosepsis. Not receiving antibiotics was significantly associated with admission for urosepsis (P¼0.02). The relative risk reduction was 86% and the NNT to prevent 1 readmission for urosepsis was 6.7. In the patients receiving antibiotics, 8 patients had positive urine cultures and only 1 patient had a symptomatic urinary tract infection. There was no association noted between urine culture at discharge and the development of UTI in the 30 day post discharge period (p¼0.75). CONCLUSIONS: Prophylactic antibiotics in the 4 weeks following radical cystectomy is associated with a significant decrease in urinary traction infections in the 30 days after surgery. Discharge positive urine culture was not associated with the development of a urinary tract infection. Patients not receiving prophylactic antibiotics were associated with a high readmission rate for urosepsis. Source of Funding: none
MP38-13 LONG-TERM 10-YEAR HEALTH-RELATED QUALITY OF LIFE OUTCOMES FOLLOWING RADICAL CYSTECTOMY Paul Gellhaus*, K. Clint Cary, Cindy Johnson, M. Francesca Monn, Hristos Kaimakliotis, Michael Weiner, Michael Koch, Richard Bihrle, Indianapolis, IN
Source of Funding: “none”
INTRODUCTION AND OBJECTIVES: Ileal conduit (IC), neobladder (NB) and Indiana pouch (IP) urinary diversions (UD) are offered after radical cystectomy (RC). Current literature has conflicting and inconclusive results regarding a superior diversion. We evaluate longterm (>10 years) health-related quality of life (HRQOL) outcomes following radical cystectomy, comparing IC, NB and IP. METHODS: Our RC database was queried to identify patients who RC for bladder cancer between 1991-2009. Approximately 300 living patients were sent a survey that consisted of the validated Bladder Cancer Index (BCI) instrument. RESULTS: Total of 128 (42.7%) patients completed the survey. When adjusted for gender, age at surgery, and time post-surgery, there were significant differences between UD and urinary function. IC and IP
e536
gender, histological type, stage, grade, tumor location, presence of Cis, te ro- hydronephrosis, number of previous bladder resection, ureteral ure frozen section analysis and final ureteral analysis. RESULTS: Mean follow-up was 36.2 months [12-255]. Pathological stages were: 91pT2, 163pT3, 73pT4 among which 111 patients were N +. The average age was 65.3 years [35-87]. The ureteral frozen section was proposed for 178 renal units (173 negative and 5 positive). The final review of ureteral section included 566 renal units (24 positive and 542 negative) and has always confirmed the results of the frozen section (sensitivity and specificity of 100%). Cis was associated with bladder tumor in 12% of cases (n ¼ 54). Uretero-hydronephrosis unilateral or bilateral was present in 33.6% of cases (n ¼ 148). In univariate analysis only hydronephrosis (p ¼ 0.002) and the presence of CIS (p ¼ 0.06) were associated with the risk of ureteral recoupes positive. The specificity, sensitivity, NPV and PPV of the uretero-hydronephrosis Cisassociation for the result of the ureteral cuts was 96% respectively 33%, 99% and 14%. In multivariate analysis only the Cis was an independent prognostic factor for ureteral intersects positive (p ¼ 0.02) (OR ¼ 0.26 [0.08 to 0.80]). CONCLUSIONS: The absence of CIS and uretero-hydronephrosis eliminates 99% the risk of ureteral intersects positive and the need for a frozen section. The presence of Cis is the only independent factor overlaps ureteral positive. Source of Funding: none
MP38-09 DOES THE ILEAL LENGTH USED FOR NEOBLADDER RECONSTRUCTION AFTER RADICAL CYSTECTOMY IMPACT ON POSTOPERATIVE BOWEL HABITS ? - A COMPARISON BETWEEN THE STUDER- AND THE I-POUCH Johannes Mischinger*, Tuebingen, Germany; Mohamed Abdelhafez, €fer, Stefan Aufderklamm, Assiut, Egypt; Tilman Todenho Steffen Rausch, Christian Schwentner, Arnulf Stenzl, Georgios Gakis, Tuebingen, Germany INTRODUCTION AND OBJECTIVES: The aim of the study was to investigate whether the length of ileum used for neobladder reconstruction after radical cystectomy (RC) for bladder cancer (60cm vs. 40cm) impacts on postoperative bowel function. METHODS: In this cross sectional study, a total of 56 patients who received an ileal neobladder after RC for BC between 2003 and 2011 were investigated (Studer (S)-Pouch: 23 patients, 19 men, 4 women; I-Pouch: 33 patients; 26 men, 7 women)). Changes perioperative bowel habits were retrospectively evaluated by the validated Gastrotintestinal Quality of Life Index (GIQLI). In addition, preoperative comorbidities were assessed by the Charlson Comobidity Index (CCI) and surgical complications as graded by the Clavien-Dindo classification. RESULTS: I-Pouch patients tended to have a higher CCI compared to S-Pouch patients (defined as CCI>¼3; S-Pouch: 8/23, 34% vs. I-Pouch: 20/33, 61%; p¼0.055). No significant differences were observed for 30-day major- (S: 5/23, 22% vs. I: 4/33, 12%; p¼0.33) and minor (S: 5/23, 22% vs. I: 7/33, 21%; p¼0.96) complication rates as well as 90-day major (S: 2/23, 9%) vs. I: 0/33, 0%; p¼0.08) and minor (S: 2/ 23, 9% vs. I: 0/33, 0%; p¼0.08) complication rates between both types of neobladder. Patients with an S-Pouch reported on higher preoperative stool frequency (S: median 3, IQR 2-4; I: median 4, IQR 3-4; p¼0.035) and urgency (S: median 3, IQR 2.75-4; I: 4, IQR: 3-4; p¼0.032). No significant differences in postoperative bowel disorders were found between both neobladder types (S-Pouch: median: 16, IQR: 14-18.5; I: median: 18, IQR: 14-20; p¼0.50). CONCLUSIONS: In this analysis, I-pouch patients tended to present with more comorbidities prior to RC while S-Pouch suffered more frequently from bowel disorders preoperatively. However, perioperative complication rates and bowel habits were similar between both orthotopic bladder substitutes. These data suggest that the length of ileum used for neobladder reconstruction does not impact per se on bowel function after RC. Source of Funding: none
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
MP38-10 CYSTECTOMY ASSOCIATED WITH IMPROVED OVERALL SURVIVAL IN VERY ELDERLY PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER; RESULTS FROM THE NATIONAL CANCER DATA BASE Bream Matthew*, Matthew Maurice, Simon Kim, Hui Zhu, Robert Abouassaly, Cleveland, OH INTRODUCTION AND OBJECTIVES: Cystectomy offers a survival advantage for muscle invasive bladder cancer (MIBC), but it is unclear if the very elderly receive this benefit given the competing risks of death, and morbidity of major surgical intervention in this population. We sought to assess overall survival (OS) in elderly patients with MIBC by treatment type. METHODS: From the National Cancer Data Base (NCDB), we selected a cohort of patients age 75 and older, diagnosed with T2-T4, non-metastatic urothelial bladder cancer from 2003 to 2012 who received cystectomy, primary chemoradiation, or non-standard treatment (neither cystectomy nor chemoradiation). The effect of treatment on overall survival (OS) was determined unadjusted using Kaplan-Meier analysis and the log-rank test, and adjusted using a Cox proportional hazards model. RESULTS: Of a total of 18,945 patients with MIBC, 3898 (21%) received cystectomy, 2482 (13%) received chemoradiation therapy, and the remaining 12,565 (66%) received non-standard treatment. Median OS for the entire cohort was 14.7 months. Median OS (95% CI) was 26.5 months (23.1-28.9) for cystectomy, 22.1 months (20.1-24.2) for chemoradiation, and 12.0 months (11.3-12.7) for non-standard treatment (p<0.0001, Figure 1). A survival benefit for cystectomy over non-standard treatment was seen in all Charlson comorbidity groups. In the Cox proportional hazards model, the hazard ratio for death when compared to non-standard treatment was 0.69 (95% CI 0.63-0.75, p<0.0001) for cystectomy and 0.75 (95% CI 0.70-0.82, p<0.0001) for chemoradiation. CONCLUSIONS: Cystectomy confers an OS benefit on very elderly patients with MIBC that persists when accounting for competing risks of death. These data support the continued use of cystectomy in appropriately selected elderly patients.
Source of Funding: None
MP38-11 ONCOLOGICAL TRIFECTA AND PENTAFECTA CRITERIA IN A CONTEMPORARY COHORT OF BLADDER CANCER PATIENTS AFTER RADICAL CYSTECTOMY Julian Hanske*, Nicolas von Landenberg, Sebastian Berg, €ri Palisaar, Jana Schmidt, Marko Brock, Christian von Bodman, Ju Florian Roghmann, Joachim Noldus, Herne, Germany INTRODUCTION AND OBJECTIVES: To assess the rate and readily available preoperative predictors of trifecta and pentafecta
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
criteria in bladder cancer (BCa) patients that underwent radical cystectomy (RC). The criteria were taken from a recent expert survey. METHODS: Overall, 177 consecutive BCa patients that underwent RC with urinary diversion at a single institution from 2009 to 2012 were retrospectively included in the study cohort. Trifecta criteria comprised negative tissue surgical margins, lymph node dissection of ¼16 nodes, and absence of major complications (CD III-V) according to Clavien-Dindo. In addition, pentafecta criteria include time from diagnosis to RC of <3 months and absence of local bladder cancer recurrence within one year after surgery. Descriptive statistics of categorical variables comprised frequencies and proportions whereas medians and interquartile ranges were reported for continuous variables. Multivariable analyses were performed for predicting the risk of mismatching trifecta and pentafecta criteria, respectively. Covariates included Body Mass Index (BMI), Charlson Comorbidity Index (CCI), age, gender, American Society of Anesthesiologists Score (ASA), neoadjuvant chemotherapy, prior abdominal or pelvic surgery, organ-defined tumor. RESULTS: The majority of the study population was male (135/ 177; 76.3%), had a BMI ¼30 (n¼137), and organ defined tumor (117/ 177; 66.1%). In total, 68/177 patients (38.4%) failed to meet trifecta whereas 70/177 patients (39.5%) missed pentafecta. Those patients, who failed to meet trifecta were more likely to have a higher ASA score (OR: 2.72; 95%CI: 1.37-5.43) and at higher likelihood to have a history of prior abdominal/pelvic surgery (OR: 2.65; 95%CI: 1.37-5.12, both p<0.004). Multivariable analyses of pentafecta did not reveal any significant differences. CONCLUSIONS: The risk of trifecta and pentafecta failure after RC is moderate. ASA and a history of prior abdominal/pelvic surgery may help to identify patients at risk for Trifecta failure. Our results emphasize the importance of these criteria in patient counseling prior surgical treatment.
e537
MP38-12 PROPHYLACTIC ANTIBIOTICS IN THE FIRST 30 DAYS FOLLOWING RADICAL CYSTECTOMY WITH URINARY DIVERSION LEADS TO FEWER URINARY TRACT INFECTIONS Ryan Werntz*, Theresa Koppie, Brian Junio, Christopher Amling, Portland, OR INTRODUCTION AND OBJECTIVES: Urinary tract infections and sepsis from a urinary source contribute significantly to the morbidity associated with cystectomy and urinary diversion. Many of these urinary tract infections and readmissions for urosepsis occur in the first 30 days following surgery and around the time of ureteral stent removal. The purpose of this study was to determine if prophylactic antibiotics decreases urinary tract infections in the first 30 days following radical cystectomy. METHODS: From 2014-2015, 84 consecutive patients who underwent a radical cystectomy with urinary diversion for bladder cancer were included in the study. The ureteral stents were left in place for 3 weeks in both groups. The first 42 patients did not receive daily antibiotics. The next group received a urine culture on discharge followed by 4 weeks of daily oral antibiotics. We evaluated for urinary tract infections in the first 30 days following surgery. A urinary tract infection was defined as clinical symptoms or signs and a documented culture positive organism. Simple T tests were used to determine the association between 4 weeks of postoperative antibiotics and 30 day risk of urinary tract infection. RESULTS: There was no difference in age, BMI, or stage between the two groups. A total of 10% in the prophylactic antibiotic group had a documented urinary tract infection, whereas 31% in the no antibiotic group had a urinary tract infection (p<0.01). The RRR was 97% and the NNT to prevent 1 UTI was 4.7. A total of 1 (2%) patient in the antibiotic group was readmitted for urosepsis whereas 7 (17%) patients in the no antibiotic group were readmitted for urosepsis. Not receiving antibiotics was significantly associated with admission for urosepsis (P¼0.02). The relative risk reduction was 86% and the NNT to prevent 1 readmission for urosepsis was 6.7. In the patients receiving antibiotics, 8 patients had positive urine cultures and only 1 patient had a symptomatic urinary tract infection. There was no association noted between urine culture at discharge and the development of UTI in the 30 day post discharge period (p¼0.75). CONCLUSIONS: Prophylactic antibiotics in the 4 weeks following radical cystectomy is associated with a significant decrease in urinary traction infections in the 30 days after surgery. Discharge positive urine culture was not associated with the development of a urinary tract infection. Patients not receiving prophylactic antibiotics were associated with a high readmission rate for urosepsis. Source of Funding: none
MP38-13 LONG-TERM 10-YEAR HEALTH-RELATED QUALITY OF LIFE OUTCOMES FOLLOWING RADICAL CYSTECTOMY Paul Gellhaus*, K. Clint Cary, Cindy Johnson, M. Francesca Monn, Hristos Kaimakliotis, Michael Weiner, Michael Koch, Richard Bihrle, Indianapolis, IN
Source of Funding: “none”
INTRODUCTION AND OBJECTIVES: Ileal conduit (IC), neobladder (NB) and Indiana pouch (IP) urinary diversions (UD) are offered after radical cystectomy (RC). Current literature has conflicting and inconclusive results regarding a superior diversion. We evaluate longterm (>10 years) health-related quality of life (HRQOL) outcomes following radical cystectomy, comparing IC, NB and IP. METHODS: Our RC database was queried to identify patients who RC for bladder cancer between 1991-2009. Approximately 300 living patients were sent a survey that consisted of the validated Bladder Cancer Index (BCI) instrument. RESULTS: Total of 128 (42.7%) patients completed the survey. When adjusted for gender, age at surgery, and time post-surgery, there were significant differences between UD and urinary function. IC and IP