Presentation Authors: Jose Agudelo*, Riccardo Bertolo, Juan Garisto, Amr Fergany, Jihad Kaouk, Cleveland, OH
Introduction: The occurrence of ureteroenteric anastomosis stricture (UES) after robot-assisted radical cystectomy (RARC) is relatively common. We aimed to assess the prevalence and the risk factors of UES in a single-center cohort.
Methods: We reviewed the consecutive patients who underwent RARC from December 2013 to December 2017 collected in our prospectively maintained, institutional review board-approved database (IRB: 251647). Either ileal conduit or neobladder, and either intracorporeal or extracorporeal approach to urinary diversion were pooled. Only patients undergoing surgery for bladder cancer were considered. UES was confirmed by imaging in all cases. Demographics, intraoperative and postoperative variables were analyzed. Univariable and multivariable Cox regression models were fit to evaluate predictors of UES.
Results: 296 patients underwent RARC within the study period. 260 with diagnosis of bladder cancer were included. Urinary diversions were performed with an extracorporeal and intracorporeal approach in 148 (57%) and 112 (43%) patients, respectively. 204 (78.4%) were derived by an ileal conduit, and 56 (21.5%) by a neobladder. At a mean follow-up of 17.2 months, prevalence of UES after RARC was 11.5%. The mean time from surgery to UES diagnosis was 12.5 months. Univariable analysis found BMI > 30 kg (OR 1.07, 95% CI 1.02 â€“ 1.13, p=0.006), operative time > 6 hours (OR 1.36, CI 95% 1.10 â€“ 1.66, p=0.002), blood loss > 500 ml (OR 1.001 CI 95% 1.000 â€“ 1.001, p=0.002), positive margin (OR 3.72 CI 95% 1.10 â€“ 12.3, p=0.03), perioperative urinary tract infection (OR 2.52 95% CI 1.20-5.52 p=0.02) and pelvic recurrence (OR 5.24 CI 95% 2.0-13.8, p=0.0008) as predictors of UES. On the multivariate model, BMI, pelvic recurrence, and > pT3 (OR 2.84 95% CI 1.17-6.0) remained independent factors.
Conclusions: From our analysis, more challenging surgery and more aggressive cancer behavior were associated with higher odds of the development of UES.