Comparison between cutaneous ureterostomy and the ileal conduit in patients with urothelial bladder carcinoma undergoing radical cystectomy: Expanding eligibility for the gold standard treatment

• Both cutaneous ureterostomy (CU) and ileal conduit (IC) are feasible diversion options after radical cystectomy (RC). • CU enabled RC in higher-risk patients without more major perioperative morbidity. • CU was associated with a more favorable perioperative course, including shorter operative time, earlier oral intake, reduced length of hospital stay, and more days out of hospital within the first 90 postoperative days. • A standardized CU protocol may expand access to curative RC for frail or high-risk bladder cancer patients, particularly in real-world, resource-limited settings. To compare outcomes of cutaneous ureterostomy (CU) and ileal conduit (IC) after radical cystectomy (RC), evaluating whether CU may expand surgical eligibility for frail patients with bladder cancer. This longitudinal study, incorporating both prospective and retrospective data, included patients with urothelial carcinoma of the bladder who underwent radical cystectomy (RC) between January 2013 and June 2020. The clinical characteristics, surgical outcomes, complication rates, and mortality at 90 days and 365 days were analyzed and compared according to the type of urinary diversion. A total of 127 patients were included: 70 (55%) underwent IC and 57 (45%) CU, all with a single stoma. CU patients were significantly older ( P < 0.01), had higher ASA scores ( P = 0.008), and showed a trend toward more advanced tumor staging ( P = 0.051). Despite their poorer clinical status, CU patients demonstrated complication and mortality rates at 90 and 365 days, which were comparable to those of the IC group ( P = 0.12, 0.28, and 0.62, respectively). CU was also associated with a shorter length of hospital stay ( P < 0.01), earlier diet resumption ( P < 0.01), and more days out of hospital within the first 90 days ( P = 0.04). A standardized CU technique represents a viable option for frail patients undergoing cystectomy, offering morbidity and mortality outcomes comparable to those of IC and potentially expanding surgical eligibility in high-risk populations.