MP04-11 OBESITY MAY BE A RISK FACTOR FOR URETEROENTERIC ANASTOMOTIC STRICTURES AFTER RADICAL CYSTECTOMY WITH URINARY DIVERSION

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I1 Apr 2017MP04-11 OBESITY MAY BE A RISK FACTOR FOR URETEROENTERIC ANASTOMOTIC STRICTURES AFTER RADICAL CYSTECTOMY WITH URINARY DIVERSION Belinda Li, Robert H. Blackwell, Bethany K. Burge, Elizabeth L. Koehne, and Marcus L. Quek Belinda LiBelinda Li More articles by this author , Robert H. BlackwellRobert H. Blackwell More articles by this author , Bethany K. BurgeBethany K. Burge More articles by this author , Elizabeth L. KoehneElizabeth L. Koehne More articles by this author , and Marcus L. QuekMarcus L. Quek More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.149AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteroenteric anastomotic strictures (UAS) are a known long-term complication of radical cystectomy with urinary diversion (RCUD). Often a silent process, UAS can be associated with progressive renal function decline, and often require additional procedures. We assessed our series of RCUD to determine predictors of UAS. METHODS We completed a retrospective review of consecutive patients who underwent RCUD between 2005-2015 by a single surgeon. All ureteroenteric anastomoses were performed in a freely-refluxing end-to-side fashion over an 8Fr feeding tube. Kaplan-Meier time-to-event analysis was performed to estimate the cumulative incidence of UAS, with patients censored at last follow-up or death. Univariable and multivariable logistic regression were performed to identify predictors of UAS. The final multivariable model was selected using Akaike Information Criterion to optimize model parsimony and fit. RESULTS RCUD was performed in 286 bladder cancer patients, with a median age of 69.9 years (IQR 62.8-76.2) and median follow-up of 21.4 months (IQR 8.9-42.3). Urinary diversions included ileal conduit (164, 57.3%), orthotopic ileal neobladder (114, 39.9%), and continent cutaneous reservoir (8, 2.8%). UAS developed in 29 patients (10.1%), at a median of 6.4 months (IQR 4.4-8.8) postoperatively. The cumulative incidence of UAS was 12.5% (95% CI 8.7-17.7) at 24 months. UAS patients had higher rates of obesity (72.4% vs 28.0%, p<0.001), were younger (66.4 vs 70.3 years, p=0.003), and had a longer median follow-up (34.0 vs 20.2 months, p=0.04). There was no difference in preoperative radiation in the UAS group (3.5% vs 10.3%, p=0.2). On time-to-event analysis, obese (BMI ≥30) patients had a higher cumulative incidence of stricture than non-obese (25.2% vs 5.9%, p<0.001) at 24 months (Figure). On multivariate analysis, only obesity was an independent predictor of UAS (OR 6.4, 95%CI 2.6-156; p<0.001). CONCLUSIONS Ureteroenteric anastomotic strictures are often a silent event arising within the first year of radical cystectomy with urinary diversion. Obese patients are at a significantly increased risk of stricture development, regardless of urinary diversion type or oncologic characteristics. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e32 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Belinda Li More articles by this author Robert H. Blackwell More articles by this author Bethany K. Burge More articles by this author Elizabeth L. Koehne More articles by this author Marcus L. Quek More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...