Purpose: Radical cystectomy with continent diversion is the standard treatment for muscle-invasive bladder cancer. Evidence supporting the necessity of ureteral stent use after this procedure is limited. This study compares 30-day postoperative outcomes of radical cystectomy with continent diversion using neobladder reconstruction in patients managed with and without ureteral stents.

Methods: A retrospective cohort study using the 2019-2022 ACS-NSQIP database included 1,318 patients who underwent radical cystectomy with continent diversion using neobladder reconstruction. We compared baseline characteristics and perioperative factors between the stented (n = 1,216) and stentless group (n = 102). Univariate and multivariate analyses assessed the relationship between stent use and perioperative outcomes, as well as 1:1 propensity score matching.

Results: Patient demographics and comorbidities were comparable between the two groups. Similarly, preoperative and intraoperative factors showed no significant differences, except for a higher drain placement rate in the stented group (98.6% vs. 89.2%, p < 0.001). Postoperatively, the stented cohort exhibited higher odds of minor complications (CD grade 1-2; OR 1.66, p = 0.018), and an increased incidence of progressive renal insufficiency (8.7% vs. 1.3%, p = 0.024) and bleeding requiring transfusion (29.8% vs. 19.6%, p = 0.030). Ureteral obstruction, urinary leak, anastomotic leak rates, hospital stay, and readmission and reoperation rates remained similar between the two groups. Propensity score matching (1:1) for patients with and without stents supported the results of the multivariate logistic regression.

Conclusion: Stent omission after radical cystectomy with continent diversion using neobladder reconstruction was not associated with significant differences in major complications, ureteral obstruction, readmission, or reoperation rates. It is potentially a safe alternative associated with fewer minor complications.

Keywords: Complication; Continent diversion; Radical cystectomy; Ureteral stent; Urinary diversion.

© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

目的： 根治性膀胱切除术结合大陆式尿流改道是治疗肌层浸润性膀胱癌的标准治疗方法。支持术后使用输尿管支架的证据有限。本研究比较了接受新膀胱重建进行根治性膀胱切除术和大陆式尿流改道患者在有或没有输尿管支架的情况下30天内的术后结果。

方法： 该研究使用2019-2022年ACS-NSQIP数据库进行回顾性队列分析，纳入了1,318名接受新膀胱重建根治性膀胱切除术和大陆式尿流改道的患者。我们比较了置管组（n=1,216）与无置管组（n=102）在基线特征和围手术期因素方面的差异，并通过单变量分析及多变量分析评估输尿管支架使用情况与围手术期结果的关系，以及进行了一对一倾向性评分匹配。

结果： 两组患者的人口统计学数据和合并症相似。除置管组（98.6% vs 89.2%，p

结论： 在根治性膀胱切除术结合新膀胱重建进行大陆式尿流改道后，不放置输尿管支架与主要并发症、输尿管梗阻、再入院或再次手术率无显著差异。这可能是一种较为安全的替代方案，并且可以减少轻微并发症的发生。

关键词： 并发症；大陆式尿流改道；根治性膀胱切除术；输尿管支架；尿流改道。