Predictors of Benign Uretero-enteric Anastomotic Strictures After Radical Cystectomy and Urinary Diversion. Katherine A A, Emily A V, Gillian S, Ali Fathollahi, Daniel D S, S Machele D, Harry H, Bernard B, Guido D, Jaspreet S S. Urology. 2018
OBJECTIVE: To determine predictors of symptomatic uretero-enteric anastomotic strictures (UAS) formation following radical cystectomy (RC) and urinary diversion (UD).
MATERIALS AND METHODS: 2,888 consecutive patients who underwent open RC at our institution from 1995-2014 were included for analysis. Data was collected from institutional databases and individual medical records. Symptomatic benign UAS was defined as percutaneous nephrostomy tube insertion for rising creatinine or unilateral hydronephrosis comparing pre- and post-operative imaging. Univariate and multivariable Cox proportional hazards models were utilized to identify features associated with UAS formation.
RESULTS: UAS developed in 123/2,888 patients following RC. There were 94 symptomatic and 29 asymptomatic strictures. Median follow-up was 32 months (IQR 12, 72) for patients without stricture. Higher BMI (p=0.002), ASA score >2 (p<0.0001), lymph node positive disease (p=0.027) and 30-day post-operative complications grade 3+ (p=0.017) on univariate analysis and male gender on multivariable analysis were significantly associated with time to stricture development. However, history of prior abdominal surgery (PAS) had the strongest association with time to stricture formation (HR 3.25, 95% CI 1.78, 5.94, p=0.0001). Risk of developing a stricture within 10 years was 1.9% for patients without PAS vs. 9.3% with PAS.
CONCLUSIONS: Associated factors with increased risk of benign UAS include higher BMI, ASA score >2, lymph node involvement, grade III/IV complications within 30 days, male sex, and a history of PAS. We conclude that while surveillance is important for patients who undergo cystectomy for malignancy, it may be beneficial for patients with history of PAS undergo more intensive follow-up compared to those patients without history of PAS.
دکتر علی فتح الهی، متخصص جراحی کلیه و مجاری ادراری ( اورولوژی ) - سلامت جنسی هستم اگر در این زمینه سوالی دارید میتوانم .به شما مشاوره دهم