Hydroureter and Hidronephrosis after Radical Cystectomy with Ileal Conduit Urinary Diversion vs TUUC

Ardika Satria Kusuma, Dr. dr. Danarto, Sp.B, Sp.U(K); Dr. dr. Ahmad Zulfan Hendri, Sp.U(K)

2026 | Tesis-Spesialis | SP UROLOGI

Latar Belakang: Radikal sistektomi dengan diversi urin non-kontinen, terutama ileal conduit (IC) dan transuretero-ureterocutaneostomy (TUUC), merupakan standar tatalaksana pada pasien kanker kandung kemih invasif yang memerlukan pengangkatan kandung kemih, namun keduanya berpotensi menimbulkan hidroureter dan hidronefrosis yang dapat mempercepat penurunan fungsi ginjal. Penelitian ini bertujuan membandingkan kejadian hidroureter dan hidronefrosis pada pasien pasca radikal sistektomi dengan IC dibandingkan TUUC.

Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien kanker kandung kemih yang menjalani radikal sistektomi dengan diversi urin IC atau TUUC di RSUP Dr. Sardjito Yogyakarta periode Desember 2018 hingga Januari 2026. Data dikumpulkan dari rekam medis, meliputi karakteristik demografis, jenis diversi urin, dan temuan radiologis hidroureter dan hidronefrosis pasca operasi. Analisis komparatif antara kelompok IC dan TUUC dilakukan menggunakan uji Chi-square dengan tingkat kemaknaan p < 0>

Hasil: Sejumlah 134 pasien memenuhi kriteria inklusi, terdiri dari 31 pasien (23,1%) pada kelompok IC dan 103 pasien (76,9%) pada kelompok TUUC. Prevalensi hidronefrosis pasca operasi secara keseluruhan adalah 26,9% (36 pasien). Kejadian hidronefrosis pada kelompok IC sebesar 29% (9 dari 31 pasien) dibandingkan 26,2% (27 dari 103 pasien) pada kelompok TUUC. Hasil uji Chi-square menunjukkan nilai p = 0,756 (Fisher’s Exact Test p = 0,818), yang mengindikasikan tidak terdapat perbedaan signifikan secara statistik dalam frekuensi kejadian hidronefrosis antara kedua teknik diversi urin.

Kesimpulan: Diversi urin dengan IC dan TUUC menunjukkan risiko kejadian hidronefrosis yang setara secara statistik setelah radikal sistektomi. Pemilihan teknik diversi urin perlu mempertimbangkan faktor lain seperti kondisi komorbiditas pasien, ketersediaan sumber daya bedah, dan risiko komplikasi perioperatif, mengingat tidak ada perbedaan bermakna dalam kejadian hidronefrosis antara kedua teknik.

Kata Kunci: radikal sistektomi, ileal conduit, transuretero-ureterocutaneostomy, hidroureter, hidronefrosis, fungsi ginjal.

Background: Radical cystectomy with non-continent urinary diversion, particularly ileal conduit (IC) and transuretero-ureterocutaneostomy (TUUC), is the standard surgical treatment for muscle-invasive bladder cancer requiring bladder removal, but both techniques may lead to hydroureter and hydronephrosis that can accelerate renal function decline. This study aimed to compare the incidence of hydroureter and hydronephrosis in patients undergoing radical cystectomy with IC versus TUUC.

Methods: This was a retrospective cohort study including bladder cancer patients who underwent radical cystectomy with IC or TUUC urinary diversion at Dr. Sardjito General Hospital, Yogyakarta, between December 2018 and January 2026. Data were collected from medical records, including demographic characteristics, type of urinary diversion, and postoperative radiologic findings of hydroureter and hydronephrosis. Comparative analyses between IC and TUUC groups were performed using Chi-square test, with statistical significance set at p < 0>

Results: A total of 134 patients met the inclusion criteria, consisting of 31 patients (23.1%) in the IC group and 103 patients (76.9%) in the TUUC group. The overall prevalence of postoperative hydronephrosis was 26.9% (36 patients). The incidence of hydronephrosis in the IC group was 29% (9 of 31 patients) compared with 26.2% (27 of 103 patients) in the TUUC group. Chi-square test results showed p = 0.756 (Fisher’s Exact Test p = 0.818), indicating no statistically significant difference in the frequency of hydronephrosis between the two urinary diversion techniques.

Conclusion: Urinary diversion with IC and TUUC showed a statistically equivalent risk of hydronephrosis after radical cystectomy. The choice of urinary diversion technique should consider other factors such as patient comorbidities, availability of surgical resources, and risk of perioperative complications, given the absence of significant difference in hydronephrosis incidence between the two techniques.

Keywords: radical cystectomy, ileal conduit, transuretero-ureterocutaneostomy, hydroureter, hydronephrosis, renal function.

Kata Kunci : radikal sistektomi, ileal conduit, transuretero-ureterocutaneostomy, hidroureter, hidronefrosis, fungsi ginjal