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. 2023 Mar;41(3):733-738.
doi: 10.1007/s00345-023-04298-y. Epub 2023 Feb 1.

Optimizing decision-making process of benign uretero-enteric anastomotic stricture treatment after radical cystectomy

Josep M Gaya #  1 , Angelo Territo #  1 , Giuseppe Basile  2 , Andrea Gallioli  1 , Christian Martínez  1 , Morena Turco  1 , Michael Baboudjian  1 , Paolo Verri  1 , Alessandro Tedde  1 , Alessandro Uleri  1 , Iacopo Meneghetti  1 , Jordi Huguet  1 , Antonio Rosales  1 , Francesco Sanguedolce  1 , Oscar Rodriguez-Faba  1 , Joan Palou  1 , Alberto Breda  1
Affiliations

Optimizing decision-making process of benign uretero-enteric anastomotic stricture treatment after radical cystectomy

Josep M Gaya et al. World J Urol. 2023 Mar.

Abstract

Purpose: To identify preoperative predictors of endo-urological treatment (EUT) failure while promoting a new diagnostic and therapeutic pathway for benign uretero-enteric anastomosis stricture (UES) management after radical cystectomy (RC).

Materials and methods: We relied on a prospectively maintained database including 96 individuals (122 renal units) who developed a benign UES at our institution between 1990 and 2018. UES was classified into two different types according to morphology: FP1 (i.e., sharp or duckbill) and FP2 (i.e., flat or concave). EUT feasibility, success rate, as well as intra and postoperative complications were recorded. Uni- and multivariable logistic regression analysis (MVA) assessed for predictors of EUT failure.

Results: Overall, 78 (63.9%) and 32 (26.3%) cases were defined as FP1 and FP2, respectively. EUT was not feasible in 33 (27.1%) cases. After a median follow-up of 50 (IQR 5-240) months, successful treatment was reached only in 15/122 (12.3%) cases. EUT success rates raised when considering short (< 1 cm) (16.8%), FP1 morphology (16.7%) strictures, or the combination of these characteristics (22.4%). Overall, 5 (5.2%) cases had CD ≥ III complications. FP2 (OR: 1.91, 95%CI 1.21-5.31, p = 0.03) and stricture length ≥ 1 cm (OR: 9.08, 95%CI 2.09-65.71, p = 0.009) were associated with treatment failure at MVA.

Conclusions: Endoscopic treatment for benign UES after RC is feasible but harbors a low success rate. Stricture length and radiological morphology of the stricture are related to endoscopic treatment failure. Surgeons should be aware of the stricture features during the preoperative decision-making process to choose the optimal candidate for endoscopic treatment.

Keywords: Radical cystectomy; Ureteral stricture; Uretero-enteric anastomosis; Urinary diversion.

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References

    1. Anderson CB, Morgan TM, Kappa S, Moore D, Clark PE, Davis R et al (2013) Ureteroenteric anastomotic strictures after radical cystectomy-does operative approach matter? J Urol 189:541–547. https://doi.org/10.1016/J.JURO.2012.09.034 - DOI - PubMed
    1. Tal R, Sivan B, Kedar D, Baniel J (2007) Management of benign ureteral strictures following radical cystectomy and urinary diversion for bladder cancer. J Urol 178:538–542. https://doi.org/10.1016/J.JURO.2007.03.142 - DOI - PubMed
    1. Shah SH, Movassaghi K, Skinner D, Dalag L, Miranda G, Cai J et al (2015) Ureteroenteric strictures after open radical cystectomy and urinary diversion: the University of Southern California experience. Urology 86:87–91. https://doi.org/10.1016/J.UROLOGY.2015.03.014 - DOI - PubMed
    1. Large MC, Cohn JA, Kiriluk KJ, Dangle P, Richards KA, Smith ND et al (2013) The impact of running versus interrupted anastomosis on ureterointestinal stricture rate after radical cystectomy. J Urol 190:923–927. https://doi.org/10.1016/J.JURO.2013.02.091 - DOI - PubMed
    1. Minervini R, Pagni R, Mariani C, Morelli A, Morelli G, Minervini A (2010) Effects on renal function of obstructive and nonobstructive dilatation of the upper urinary tract in ileal neobladders with refluxing ureteroenteric anastomoses. Eur J Surg Oncol 36:287–291. https://doi.org/10.1016/J.EJSO.2009.09.003 - DOI - PubMed

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