Natural History, Predictors and Management of Ureteroenteric Strictures after Robot Assisted Radical Cystectomy

No AccessJournal of UrologyAdult Urology1 Sep 2017Natural History, Predictors and Management of Ureteroenteric Strictures after Robot Assisted Radical Cystectomy Youssef E. Ahmed, Ahmed A. Hussein, Paul R. May, Basim Ahmad, Taimoor Ali, Ayesha Durrani, Saira Khan, Prasanna Kumar, and Khurshid A. Guru Youssef E. AhmedYoussef E. Ahmed Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author , Ahmed A. HusseinAhmed A. Hussein Department of Urology, Cairo University, Cairo, Egypt More articles by this author , Paul R. MayPaul R. May Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author , Basim AhmadBasim Ahmad Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author , Taimoor AliTaimoor Ali Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author , Ayesha DurraniAyesha Durrani Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author , Saira KhanSaira Khan Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author , Prasanna KumarPrasanna Kumar Department of Radiology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author , and Khurshid A. GuruKhurshid A. Guru Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3339AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Ureteroenteric strictures represent the most common complication requiring reoperation after radical cystectomy. We investigated the prevalence, outcomes, predictors and management of ureteroenteric strictures. Materials and Methods: We retrospectively reviewed our quality assurance, robot assisted radical cystectomy database to identify patients in whom ureteroenteric strictures developed. Data were reviewed for demographics, perioperative outcomes and ureteroenteric stricture characteristics. The Kaplan-Meier method was used to calculate time to ureteroenteric stricture and multivariable stepwise regression was done to evaluate predictors of ureteroenteric strictures. Results: Ureteroenteric strictures developed in 12%, 16% and 19% of 51 patients (13%) at 1, 3 and 5 years after robot assisted radical cystectomy, respectively. All patients were initially treated endoscopically or percutaneously, including 57% treated only endoscopically or percutaneously and 43% who required surgery, which was open repair in 6 and robot assisted repair in 16. At a median followup of 23 months 33 patients (65%) were free of disease, including 13 after endoscopic or percutaneous treatment, 15 after robot assisted repair and 5 after open revision. Open and robot assisted revisions showed comparable perioperative outcomes. On multivariable analysis the predictors of ureteroenteric anastomotic strictures were body mass index (OR 1.07, 95% CI 1.01–1.13, p = 0.02), intracorporeal urinary diversion (OR 3.28, 95% CI 1.41–7.61, p = 0.006), length of the right resected ureter (OR 0.66, 95% CI 0.50–0.88, p = 0.004), estimated glomerular filtration rate 30 days after assisted radical cystectomy (OR 0.85, 95% CI 0.74–0.98, p = 0.03), urinary tract infection (OR 2.68, 95% CI 1.31–5.49, p = 0.007) and leakage (OR 3.85, 95% CI 1.05–14.1, p = 0.04). Male gender (OR 0.19, 95% CI 0.04–0.96, p = 0.04) and higher body mass index (OR 0.85, 95% CI 0.72–0.996, p = 0.05) were associated with lower odds of successful endoscopic management. Conclusions: Multiple modifiable factors were associated with ureteroenteric anastomotic strictures following robot assisted radical cystectomy. Surgical revision can provide a definitive management with comparable outcomes for open and robotic repairs. 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Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGhoreifi A and Djaladat H (2021) Evaluation of Ureteroenteric Anastomotic Strictures after the Introduction of Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Results from a Large Tertiary Referral Center. Letter.Journal of Urology, VOL. 207, NO. 1, (239-239), Online publication date: 1-Jan-2022.Reesink D, Gerritsen S, Kelder H, van Melick H and Stijns P (2020) Evaluation of Ureteroenteric Anastomotic Strictures after the Introduction of Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Results from a Large Tertiary Referral CenterJournal of Urology, VOL. 205, NO. 4, (1119-1125), Online publication date: 1-Apr-2021.Chang S (2019) Re: Lessons from 151 Ureteral Reimplantations for Postcystectomy Ureteroenteric Strictures: A Single-Center Experience over a DecadeJournal of Urology, VOL. 201, NO. 2, (226-226), Online publication date: 1-Feb-2019.Nouhaud F, Cornu J and Pfister C (2018) Re: Preoperatively Dilated Ureters are a Specific Risk Factor for the Development of Ureteroenteric Strictures after Open Radical Cystectomy and Ileal NeobladderJournal of Urology, VOL. 199, NO. 6, (1635-1637), Online publication date: 1-Jun-2018. Volume 198Issue 3September 2017Page: 567-574Supplementary Materials Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsroboticscystectomyurinary bladderureterpathologicconstrictionMetricsAuthor Information Youssef E. Ahmed Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author Ahmed A. Hussein Department of Urology, Cairo University, Cairo, Egypt More articles by this author Paul R. May Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author Basim Ahmad Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author Taimoor Ali Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author Ayesha Durrani Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author Saira Khan Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author Prasanna Kumar Department of Radiology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author Khurshid A. Guru Department of Urology, Roswell Park Cancer Institute, Buffalo, New York More articles by this author Expand All Advertisement PDF downloadLoading ...