Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct:144:225-229.
doi: 10.1016/j.urology.2018.06.024. Epub 2018 Jun 30.

Predictors of Benign Ureteroenteric Anastomotic Strictures After Radical Cystectomy and Urinary Diversion

Katherine A Amin  1 , Emily A Vertosick  2 , Gillian Stearns  2 , Ali Fathollahi  2 , Daniel D Sjoberg  2 , Machele S Donat  2 , Harry Herr  2 , Bernard Bochner  2 , Guido Dalbagni  2 , Jaspreet S Sandhu  3
Affiliations

Predictors of Benign Ureteroenteric Anastomotic Strictures After Radical Cystectomy and Urinary Diversion

Katherine A Amin et al. Urology. 2020 Oct.

Abstract

Objective: To determine predictors of symptomatic ureteroenteric anastomotic strictures (UAS) formation following radical cystectomy (RC) and urinary diversion (UD).

Materials and methods: A total of 2,888 consecutive patients who underwent open RC at our institution from 1995 to 2014 were included for analysis. Data were collected from institutional databases and individual medical records. Symptomatic benign UAS was defined as percutaneous nephrostomy tube insertion for rising creatinine or unilateral hydronephrosis by comparing preoperative and postoperative imaging. Univariate and multivariable Cox proportional hazards models were utilized to identify features associated with UAS formation.

Results: UAS developed in 123 of 2888 patients following RC. There were 94 symptomatic and 29 asymptomatic strictures. Median follow-up was 32 months (IQR 12, 72) for patients without stricture. Higher BMI (P = 0.002), ASA score >2 (P < 0.0001), lymph node positive disease (P = 0.027), and 30-day postoperative grade 3I+ complications (P = 0.017) on univariate analysis and male gender on multivariable analysis were significantly associated with time to stricture development. However, history of prior abdominal surgery (PAS) had the strongest association with time to stricture formation (HR 3.25, 95% CI 1.78, 5.94, P = 0.0001). Risk of developing a stricture within 10 years was 1.9% for patients without PAS vs 9.3% with PAS.

Conclusion: Associated factors with an increased risk of benign UAS include higher BMI, ASA score >2, lymph node involvement, grade 3/4 complications within 30 days, male sex, and a history of PAS. We conclude that while surveillance is important for patients who undergo cystectomy for malignancy, it may be beneficial for patients with history of PAS to undergo more intensive follow-up compared to those patients without history of PAS.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Cumulative incidence estimates for time to developing a stricture. Black line represents patients with no history of prior abdominal surgery; red line represents patients with a history of prior abdominal surgery. The number at risk is approximate due to the use of imputation.
See this image and copyright information in PMC

References

    1. Campbell MF, Wein AJ, and Kavoussi LR. Campbell-Walsh urology. 2007; 9th:[4 v. (xlii, 3945, cxv p.) ill. + 1 CD-ROM(s) (4 3/4 in.).].
    1. Madersbacher S, et al., The long-term outcome of medical therapy for BPH. Eur Urol, 2007. 51(6): p. 1522–33. - PubMed
    1. Hautmann RE, de Petriconi RC, and Volkmer BG, 25 years of experience with 1,000 neobladders: long-term complications. J Urol, 2011. 185(6): p. 2207–12. - PubMed
    1. Shimko MS, et al., Long-term complications of conduit urinary diversion. J Urol, 2011. 185(2): p. 562–7. - PubMed
    1. Katkoori D, et al., Is the incidence of uretero-intestinal anastomotic stricture increased in patients undergoing radical cystectomy with previous pelvic radiation? BJU Int, 2010. 105(6): p. 795–8. - PubMed