Outcomes of radical cystectomy in a resource-limited setting: a pilot study

Abstract

BACKGROUND: Radical cystectomy is a cornerstone treatment for muscle-invasive bladder cancer, but its implementation in resource-limited settings is challenged by limited access to trained professionals and inadequate healthcare infrastructure. This pilot study aims to analyze perioperative complications and mortality associated with radical cystectomy and urinary diversion at Gezira Hospital for Renal Diseases and Surgery (GHRDS) in Sudan. These findings reflect the outcomes of an in-country training program established by the Society of International Urology (SIU) to address surgical capacity gaps in resource-limited settings. METHODS: We conducted a retrospective analysis of patient who underwent radical cystectomy with ileal conduit urinary diversion between January 2015 and December 2019. Data were collected from medical records, including demographic details, perioperative complications classified by the modified Clavien-Dindo system, and histopathological findings. RESULTS: A total of 30 patients were included in the study. The median age was 65 years, and 77% were male. The majority of patients (76%) had transitional cell carcinoma, followed by squamous cell carcinoma (17%) and adenocarcinoma (7%). The clinical stage at presentation were T1 N0 M0 (23%) and T2 N0 M0 (77%). A total of 32 complications were observed, with 91% classified as low-grade. Infectious complications were the most common (50%), followed by gastrointestinal and respiratory issues. Severe complications occurred in 13% of cases, and in-hospital mortality was 3%. CONCLUSION: This study demonstrates the feasibility of performing radical cystectomy in a resource-constrained environment, supported by a collaborative training program involving international expertise and local participants. While outcomes were encouraging, key areas for improvement include infection control, critical care capacity, and early detection of bladder cancer. These findings underscore the importance of sustainable in-service training programs in building surgical capacity in resource-limited settings. Future research should focus on long-term outcomes and strategies to reduce complications.