MP5-07 BENIGN URETEROENTERIC STRICTURE IN PATIENTS UNDERGOING RADICAL CYSTECTOMY AND URINARY DIVERSION

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 2014MP5-07 BENIGN URETEROENTERIC STRICTURE IN PATIENTS UNDERGOING RADICAL CYSTECTOMY AND URINARY DIVERSION Kamran Movassaghi, Anh Huy Nguyen, Hamed Ahmadi, Anne Schuckman, Siamak Daneshmand, and Hooman Djaladat Kamran MovassaghiKamran Movassaghi More articles by this author , Anh Huy NguyenAnh Huy Nguyen More articles by this author , Hamed AhmadiHamed Ahmadi More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.390AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the risk factors, management and outcome of benign ureteroenteric strictures (UES) in patients undergoing open radical cystectomy (RC) and urinary diversion for urothelial bladder carcinoma (UBC). METHODS Using our IRB approved institutional bladder cancer database we identified 1,964 patients who underwent RC for UBC at our institution between 1971 and 2008. We reviewed clinicopathological variables, stricture management and their outcome per renal unit. A multivariate logistic regression model was used to identify independent predictors of UES. RESULTS 49 patients and 51 renal units were retrospectively identified with benign UES (2.6%). Their clinicopathologic characteristics are summarized in table 1. All the ureteral reimplants were refluxing to ileum. Median follow up was 12.4 years (0.2 – 27.3 yrs) and median time from cystectomy to stricture diagnosis was 10 months (range 2 months-10 years). Most patients were asymptomatic, but common presentations were flank pain (22%) and urinary tract infection (9%). 31 patients underwent primary endoscopic treatments including dilatation and stenting. Of those, 13 (42%) required secondary endoscopic treatment and 9 (29%) eventually needed open revisions. Three patients underwent primary open surgical management. Median eGFR (Glomerular filtration rate) did not change significantly post surgical management of the stricture (47 mL/min to 44 mL/min, P > 0.05), but imaging studies showed improvement in 50% of cases. A multivariate logistic regression model did not reveal any role for age, body mass index, Charleson comorbidity index, perioperative radiation/chemotherapy, or pre-operative serum albumin to predict UES. CONCLUSIONS Benign ureteroenteric strictures are uncommon after cystectomy and urinary diversion. It is mostly seen on the left side and usually present few months after cystectomy. No specific predisposing factor has been determined and surgical technique still plays an important role in ureteroenteric reconstruction. Median age (range) 63 (42-84) Gender (%) Male 42 (86%) Median BMI (Kg/m2) (range) 26.2 (21.5-32.4) Charlson Comorbidity Index (CCI) 0 68% 1 24% ≥ 2 8% Hx of pre-cystectomy pelvic radiation (%) 6 (12%) Previous abdominopelvic surgery (%) 16 (33%) Stricture Side Left 66% Right 29% Bilateral 5% Median Stricture Length (range) 2 (1-5.5) cm Pathologic stage OC (=< T2) 23 (46%) EV (T3,T4) 27 (54%) AnyT N+ 16 (32%) Ureteral Positive Margin 3 (6%) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e84 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Kamran Movassaghi More articles by this author Anh Huy Nguyen More articles by this author Hamed Ahmadi More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...