- Design
- Single-centre cohort with propensity score matching
- Population
- 208 matched patients after open radical cystectomy with neobladder
- Primary outcome
- Diversion-specific complications within 3 years
- Effect
- No significant difference; outlet obstruction OR 2.99 (1.15–8.78) with Studer
A high-volume German centre compared 161 Hautmann and 179 modified Studer orthotopic neobladders after open radical cystectomy, then matched 104 pairs by propensity score and followed them for a median of three years.
Diversion-related complications — upper tract strictures, anastomotic leak and infection — did not differ, nor did major complications, short-term mortality, quality of life or decision regret. In exploratory analysis, the modified Studer was associated with more outlet obstruction (OR 2.99, 95% CI 1.15 to 8.78) and 90-day readmission (OR 1.87), while Studer patients who self-catheterised found it easier.
The choice between the two remains a matter of surgeon experience. The outlet obstruction signal is worth knowing about when following Studer patients but needs confirming elsewhere.
- Either neobladder configuration is reasonable; choose the one your team performs regularly.
- In Studer neobladder patients with rising residuals or retention, look for outlet obstruction.
- Teach self-catheterisation before discharge to all neobladder patients who may need it.
- Follow upper tracts with imaging and renal function regardless of configuration.
Why it matters
It suggests the configuration matters less than once thought, apart from one specific complication.
Don't overread it
A single-centre retrospective comparison; the outlet obstruction finding was exploratory.
The statistics, in plain English
An OR of 2.99 for outlet obstruction means about three times the odds with Studer, but the interval (1.15 to 8.78) is wide and the analysis was exploratory, so the true effect could be much smaller.
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