Risk factors for benign uretero-enteric anastomotic strictures after open radical cystectomy and ileal conduit

Abstract

Introduction and objective: Radical Cystectomy (RC) is one of the most common and complex surgical procedures in urologic surgery, and benign ureteroenteric anastomosis strictures (UAS) are complications described in about 15% of patients undergoing RC with different urinary diversion (UD). The aim of this study is to evaluate and analyze risk factors related to the development of ureteral stenosis after RC.

Materials and methods: All consecutive patients who underwent RC with ileal conduit from December 2019 to December 2022 were included. According to the guidelines patients with hydronephrosis were investigates with CT-scan or Ultrasound and blood tests at 3-6-12 months and then early. UAS was confirmed with CT-scan and eventually treated with nephrostomies with (with or without descendent pyelography). Several potential risk factor releated to UAS were analyzed by univariate analysis including preoperative, intraoperative and postoperative variables.

Results: In total 116 patients were included. At 30 months mean follow up, 21 patients (19%) were diagnosed with UAS. Median time from RC to diagnosis of benign UAS was 6 months (IQR: 4-9). At the univariable analysis previous abdominal surgery (OR 13.5 CI 3.4-63.4, p < 0.001) had the strongest association with shorter time to stricture development and six-fold highest risk of UAS development (OR 6.41, IC 95%; 2.16-21.1, p < 0.001). Also, gender, age, body mass index, lower albumin serum level, higher fibrinogen serum level showed statistically significant association (p < 0.05).

Conclusion: Patients with preoperative lower albumin serum level, lower albumin/fibrinogen ratio and higher fibrinogen level are more likely to develop UAS. Moreover, having a history of PAS significantly increases the risk of strictures formation.

Keywords: Bladder cancer; ileal conduit; radical cystectomy; risk factors; ureteral stenosis.