Ureteroenteric anastomosis in orthotopic neobladder creation: do urinary tract infections impact stricture rate?

Benson, Cooper; Ajay, Divya; Barrett-Harlow, Brittani; Cunningham, Kathryn; Bootwala, Yasmin; Pendleton, Clay; Li, Hanhan; Ayoub, Hajar I.; Graber, William; Westney, O. Lenaine

doi:10.1007/s00345-020-03266-0

Cited by 5 publications

(9 citation statements)

References 12 publications

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“…There was a wide discrepancy in the stricture rates among the studies (2.6–17%). The median time to stricture diagnosis was similar across the studies lying between 3 and 10 months, only one study reported a later stricture diagnosis at the median time of 15.8 months [ 13 ]. Left-sided ureteral stricture was the most predominant (42.2–66%), followed by right-sided stricture (9.5–44.7%) and bilateral involvement (5–42%).…”

Section: Resultsmentioning

confidence: 93%

“… Left: 53% Right: 28% Bilateral: 18% Symptomatic (77%) BMI (OR 1.06, 95% CI: 1.02–1.09; P = 0.0009). Clavien ≥3 complication (OR 2.85, 95%CI: 1.90–4.28; P < 0.0001) Benson et al, 2020 [ 13 ] 418 ONB NR 8.9% Mean: 57 mo. Mean time: 15.8 mo.…”

Section: Resultsmentioning

confidence: 99%

“…This theory seemed logical, but the data in the literature are still contradictory. Bensen et al found that preoperative RT is associated nearly with 11 times higher risk for stricture formation [ 13 ]; however, only 2% of the patients received the preoperative therapy, which is small proportion that could affects the results. Yang et al, examined 2,285 patients, with 12.5% of patients receiving RT, which is considered an appropriate number; in the univariate analysis, RT was not a risk factor (OR 1.25, CI: 0.80–1.87, p = 0.35) [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for ureteroenteric stricture after radical cystectomy and urinary diversion: A systematic review

Mahmoud,

Krafft,

Al-Nader

et al. 2023

Arab Journal of Urology

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Introduction Ureteroenteric stricture (UES) is the leading cause of renal function deterioration after radical cystectomy (RC) and urinary diversion (UD). The aim of the present review is to summarize studies that discussed the risk factors associated with UES development. Identifying the responsible factors is of importance to help surgeons to modify their treatment or follow-up strategies to reduce this serious complication. Materials and Methods A comprehensive search of the literature using the PubMed database was conducted. The target of the search was only studies that primarily aimed to identify risk factors of UES after RC and UD. References of searched papers were also checked for potential inclusion. Results The search originally yielded a total of 1357 articles, of which only 15 met our inclusion criteria, comprising 13, 481 patients. All the studies were observational, and retrospective published between 2013 and 2022. The natural history of UES and the reported risk factors varied widely across the studies. In 13 studies, a significant association between some risk factors and UES development was demonstrated. High body mass index (BMI) was the most frequently reported stricture risk factor, followed by perioperative urinary tract infection (UTI), robotic-assisted radical cystectomy (RARC), occurrence of post-operative Clavian grade ≥ 3 complications and urinary leakage. Otherwise, many other risk factors were reported only once. Conclusion The literature is still lacking well-designed prospective studies investigating predisposing factors of UES. The available data suggest that the high BMI, RARC and complicated postoperative course are the main risk factors for stricture formation.

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Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk factors for ureteroenteric stricture after radical cystectomy and urinary diversion: A systematic review

Mahmoud,

Krafft,

Al-Nader

et al. 2023

Arab Journal of Urology

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“…Literature works reported that the incidence of UEAS with anti-reflux anastomosis ranges from 2% to 29% in various anastomotic techniques, which is twice as high as that with direct anastomosis [27, 34-37]. The exact etiology of UEAS remained unclear [38-40]. It was found that 80% of UEAS occurred on the left side.…”

Section: Discussionmentioning

confidence: 99%

“…Pooling data of studies showed no significant difference of postoperative pyelonephritis between anti-reflux anastomosis and direct anastomosis (OR = 0.84; 95% CI: 0.48–1.47; p = 0.54, I 2 = 0%). The current view was that the postoperative pyelonephritis was mainly related to factors such as UEAS and vesicoureteral reflux with bacteriuria [40, 49]. Urinary obstruction, chemotherapy, and pyelonephritis were important factors influencing the pathogenesis of pyelonephritis, but the evidence was insufficient [52].…”

Section: Discussionmentioning

confidence: 99%

Is Anti-Reflux Anastomosis an Advantage in an Orthotopic Ileal Neobladder? A Systematic Review and Meta-Analysis

et al. 2022

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Introduction: We conducted a systematic review and meta-analysis to assess the available literature regarding the postoperative effects of anti-reflux anastomosis and direct anastomosis in orthotopic ileal neobladder (ONB). Methods: We searched PubMed, Embase, and the Cochrane Library in October 2021. We included 11 studies of patients with bladder cancer who underwent radical cystectomy and ONB as urinary diversion. Outcomes evaluated in this review were ureteroenteric anastomotic stricture (UEAS), vesicoureteral reflux, renal function (RFn) impairment, and pyelonephritis. All data were analyzed using Review Manager 5.4.4 and subgroup analyses were applied. Results: A total of 11 studies were eligible for meta-analysis. The synthetic data suggested that anti-reflux anastomosis and direct anastomosis were comparable in terms of RFn impairment (odds ratio (OR) = 1.69; 95% confidence interval (CI): 0.18–15.6; p = 0.65, I2 = 69%) and pyelonephritis (OR = 1.13; 95% CI: 0.65–1.99; p = 0.66, I2 = 1%) without significant difference in each group statistically. The pooled study data showed a significantly higher incidence of UEAS (OR = 2.84; 95% CI: 1.75–4.61, p < 0.0001, I2 = 50%) and a lower incidence of vesicoureteral reflux (OR = 0.24; 95% CI: 0.10–0.59; p = 0.002, I2 = 75%) in anti-reflux anastomosis compared to direct anastomosis. In subgroup analysis, anti-reflux anastomosis was more likely to result in UEAS than direct anastomosis, especially when ureteral stent was removed within 14 days. Conclusion: Although meta-analysis showed that overall incidence of vesicoureteral reflux was higher with direct anastomosis than anti-reflux anastomosis, the rate of vesicoureteral reflux was not directly related to impairment of RFn. The anti-reflux mechanism of ONB was positively associated with a higher incidence of significant UEAS compared to the direct approach, which can lead to kidney damage and an increased risk of secondary surgical procedures.

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Patient Selection and Outcomes of Urinary Diversion

Hebert

Matta

Myers

2022

Urologic Clinics of North America

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Ureteroenteric anastomosis in orthotopic neobladder creation: do urinary tract infections impact stricture rate?

Cited by 5 publications

References 12 publications

Risk factors for ureteroenteric stricture after radical cystectomy and urinary diversion: A systematic review

Risk factors for ureteroenteric stricture after radical cystectomy and urinary diversion: A systematic review

Is Anti-Reflux Anastomosis an Advantage in an Orthotopic Ileal Neobladder? A Systematic Review and Meta-Analysis

Patient Selection and Outcomes of Urinary Diversion

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