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BMI, UTI predict ureteroenteric strictures after robot-assisted radical cystectomy

30 Aug 2017

Ureteroenteric anastomotic strictures following robot-assisted radical cystectomy are associated with several modifiable factors, a recent study suggests.

Researchers retrospectively reviewed the quality assurance, robot-assisted radical cystectomy database to identify patients who developed ureteroenteric strictures. Data on demographics, perioperative outcomes and ureteroenteric stricture characteristics were reviewed.

Researchers used the Kaplan-Meier method to calculate time to ureteroenteric strictures and performed multivariable stepwise regression to assess predictors of ureteroenteric strictures.

At 1, 3 and 5 years after robot-assisted radical cystectomy, ureteroenteric strictures developed in 12, 16 and 19 percent of 51 patients (13 percent), respectively. All patients initially underwent endoscopic or percutaneous treatment, including 57 percent treated only endoscopically or percutaneously and 43 percent who required surgery, which was open repair in six and robot-assisted repair in 16.

A total of 33 patients (65 percent) were disease-free at a median follow-up of 23 months, including 13 after endoscopic or percutaneous treatment, 15 after robot-assisted repair and five after open revision. There were similar perioperative outcomes between open and robot-assisted revisions.

Multivariable analyses revealed that body mass index (BMI: odds ratio [OR], 1.07; 95 percent CI, 1.01 to 1.13; p=0.02), intracorporeal urinary diversion (OR, 3.28; 1.41 to 7.61; p=0.006), length of the right resected ureter (OR, 0.66; 0.50 to 0.88; p=0.004), estimated glomerular filtration rate 30 days after assisted radical cystectomy (OR, 0.85; 0.74 to 0.98; p=0.03), urinary tract infection (OR, 2.68; 1.31 to 5.49; p=0.007) and leakage (OR, 3.85; 1.05 to 14.1; p=0.04) predicted ureteroenteric strictures.

Male gender (OR, 0.19; 0.04 to 0.96; p=0.04) and higher BMI (OR, 0.85; 0.72 to 0.996; p=0.05) correlated with lower odds of successful endoscopic management.

“Surgical revision can provide a definitive management with comparable outcomes for open and robotic repairs,” according to researchers.

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