Presentation Authors: Hamza Beano*, Jiaxian He, Caitlin Hensel, William Worrilow, Jared Brown, Jaclyn Mieczkowski, Kris Gaston, Peter Clark, Stephen Riggs, Charlotte, NC
Introduction: Ureteroenteric Strictures (UES) are a potential long-term complication of Radical Cystectomy with Urinary Diversion (RCUD). Renal scintigraphy findings associated with UES have not been well defined. Since 4/1/2015, we obtained a MAG-3 lasix renal scan at 6 weeks postoperatively as part of our Departmental follow-up protocol. We posited that a functional evaluation such as renal scintigraphy may predict present or futures issues with UES and readmission rates.
Methods: We retrospectively analyzed an IRB-approved, prospectively collected RCUD dataset. We included adult RCUD patients diagnosed with malignancy from January 2014 through January 2018. Cohorts were divided according to scintigraphy excretion half-life ( < 10 minutes vs â‰¥10 minutes) and sidedness of significant scintigraphy results. Our endpoints were ipsilateral UES, 90-day readmission and urinary-source related readmission. UES was defined as evidence of obstruction on imaging associated with recurrent pyelonephritis, persistent flank pain or worsening renal function. Fischer's exact test, t-test and multivariable logistic regression were used for analysis.
Results: 144 patients had complete data and underwent analysis. There was no difference in the cohorts with respect to race, age, gender, surgical approach, diversion type, pathological staging, neoadjuvant chemotherapy or history of radiotherapy to the abdomen or pelvis. Table 1 summarizes univariate analysis of outcomes. On multivariate analysis, a half-lifeâ‰¥10 minutes predicted a higher UES for the left (OR 3.75 95% CI 1.36-11.28, p=0.011) and right sides (OR 3.75 95% CI 1.29-10.90, p=0.015). A left half-lifeâ‰¥10 had a higher 90-day readmission (OR 2.92 95% CI 1.34-6.36, p=0.007). The negative predictive value (NPV) for future UES if half-life < 10 minutes was 90% and 92% for the right and left kidneys respectively.
Conclusions: Lasix renal scintigraphy appears to be associated with an increased rate of UES and 90-day readmission rate following RCUD. Importantly, a UES in the setting of a normal renal scan (1/2 life < 10 min) following RCUD is unlikely with a NPV exceeding 90%. Future efforts will be directed towards determining its clinical and cost effectiveness as compared to other radiographic modalities