The cause analysis of benign uretero-ileal anastomotic stricture after radical cystectomy and urinary diversion

Abstract

Background: Benign uretero-ileal anastomotic stricture (UIAS) is a major complication following radical cystectomy (RC) and ileal orthotopic bladder substitution, and it can occur in combination with other complications. But risk factors for patients with UIAS have not been well described.

Material and methods: We retrospectively reviewed 198 patients treated with RC for bladder cancer from 2014 to 2019 at the Zhejiang Provincial People's Hospital. Patient demographic and clinical variables were examined to determine the risk factors associated with UIAS by univariate and multivariate logistic regression analysis.

Results: A total of 180 patients into the group standards and in all 360 uretero-ileal anastomoses. Among the above cases, 22 patients developed UIAS, including 10 cases of left UIAS, nine cases of right UIAS, and three cases of bilateral UIAS. There was no difference in demographic, operative, or perioperative variables between patients with and without UIAS. In a multivariate analysis, after adjusting for gender, age, surgical methods, and underlying diseases, intraoperative or postoperative blood transfusion (HR = 0.144, P <0.01), postoperative urinary tract infection (HR = 3.624, P <0.01), and extracorporeal bladder anastomosis (HR = 3.395, P = 0.02) significantly increased the risk of UIAS.

Conclusions: In our experience, intraoperative or postoperative blood transfusion, postoperative urinary tract infection, and extracorporeal neobladder anastomoses increased the risk of UIAS after radical cystectomy and ileal orthotopic bladder substitution surgery. Further studies with larger samples are necessary to validate this result.

Keywords: anastomosis; bladder cancer; radical cystectomy; uretero-ileal anastomotic stricture; urinary diversion.

Figure 1

Univariate logistic regression analysis. WBC, white blood cell; ALT, Alanine transferase; AST, Aspartate transferase; HB, Hemoglobin.

Figure 2

Nomogram based on Logistic regression model. Abbreviations: HR, hazard ratio. The scores of the three risk factors are added together to form the total score, ranging from 0 to 260 points. The percentage corresponding to the total score downward is the probability of UIAS in patients with Radical cystectomy with urinary diversion.