The cause analysis of benign uretero-ileal anastomotic stricture after radical cystectomy and urinary diversion

Abstract

BackgroundBenign uretero-ileal anastomotic stricture (UIAS) is a major complication following radical cystectomy (RC) and ileal orthotopic bladder substitution, and it can occur in combination with other complications. But risk factors for patients with UIAS have not been well described.Material and methodsWe retrospectively reviewed 198 patients treated with RC for bladder cancer from 2014 to 2019 at the Zhejiang Provincial People’s Hospital. Patient demographic and clinical variables were examined to determine the risk factors associated with UIAS by univariate and multivariate logistic regression analysis.ResultsA total of 180 patients into the group standards and in all 360 uretero-ileal anastomoses. Among the above cases, 22 patients developed UIAS, including 10 cases of left UIAS, nine cases of right UIAS, and three cases of bilateral UIAS. There was no difference in demographic, operative, or perioperative variables between patients with and without UIAS. In a multivariate analysis, after adjusting for gender, age, surgical methods, and underlying diseases, intraoperative or postoperative blood transfusion (HR = 0.144, P <0.01), postoperative urinary tract infection (HR = 3.624, P <0.01), and extracorporeal bladder anastomosis (HR = 3.395, P = 0.02) significantly increased the risk of UIAS.ConclusionsIn our experience, intraoperative or postoperative blood transfusion, postoperative urinary tract infection, and extracorporeal neobladder anastomoses increased the risk of UIAS after radical cystectomy and ileal orthotopic bladder substitution surgery. Further studies with larger samples are necessary to validate this result.

Intraoperative ICG-Fluorescence as a Method to Prevent Postoperative Strictures of Uretero-Ileal Anastomoses in Robot-Assisted Radical Cystectomy

“…Лечение таких осложнений вызывает трудности и часто требует дальнейшего радикального вмешательства [3]. Частота возникновения доброкачественных уретеро-энтеральных стриктур при выполнении радикальной цистэктомии колеблется от 1,3 до 12,7 % при использовании техники прямого анастомоза [4][5][6]. Хотя точные механизмы формирования доброкаче ственной стриктуры мочеточниково-кишечного ана стомоза неизвестны, считается, что это происходит преимущественно из-за ишемии и последующего руб цевания анастомоза [5].…”

Migration of double-J ureteral stent in patients with ureteroileal anastomosis stricture undergoing radical cystectomy and orthotopic neobladder: Analysis risk factors of stent migration

“…Certain factors, including intraoperative or postoperative blood transfusion, postoperative urinary tract infection, and extracorporeal neobladder anastomoses, can heighten the risk of developing benign UIAS. [5,6] Placement of an internal double-J ureteral stent (DJUS) after radical cystectomy and orthotopic neobladder surgery can reduce the incidence of benign UIAS. However, if UIAS occurs after removal of the DJUS, reinserting an internal ureteral stent is crucial for relieving the urinary system and preventing functional obstruction or even renal failure.…”