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

Cooper R. Benson, Divya Ajay, Brittani L. Barrett-Harlow, Kathryn G. Cunningham, Yasmin Bootwala, Clay Pendleton, Hanhan Li, Hajar I. Ayoub, William J. Graber, Ouida L. Westney

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Radical cystectomy (RC) and urinary diversion in the treatment of muscle-invasive bladder cancer is associated with peri-operative complication rates as high as 60%. Ureteroenteric anastomotic stricture (UEAS) is a potential source significant morbidity often requiring secondary interventions. We sought to evaluate our experience with benign UEAS in our open ileal orthotopic neobladder (ON) population. Methods: After Internal Review Board (IRB) approval, we performed a retrospective review of patients who had RC and ON between 2000 and 2015 at MD Anderson Cancer Center and had at least 6 months of follow-up. Baseline demographics and treatment characteristics, peri-operative and post-operative outcomes, as well as information regarding anastomosis technique and suture types were evaluated. Patients with malignant ureteral obstruction were excluded from the analysis. Results: 418 patients had ON creation and the mean age was 59 years (SD 9.4 years) and 90% were males. The mean follow-up was 57 months (6–183 months). 37 patients (8.9%) developed UEAS in 42 renal units and the mean time to diagnosis was 15.8 months (0.85–90 months). Anastomosis and suture type were not predictive of UEAS (p = 0.594, p = 0.586). Perioperative UTI within 30 days of surgery, and recurrent UTI were predictive of UEAS, HR 2.4 p = 0.03, HR 5.1 p < 0.001, respectively. Conclusions: UEAS are associated with potentially significant morbidity following ON creation. UEAS may occur early following ON, but may occur as late as 7 years following surgery. Indeed, technical factors and surgeon experience contribute to the rates of UEAS, but perioperative UTI appears to herald future stricture development.

Original languageEnglish (US)
Pages (from-to)1171-1176
Number of pages6
JournalWorld Journal of Urology
Volume39
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • Bladder cancer
  • Orthotopic neobladder
  • UTI
  • Ureteral stricture

ASJC Scopus subject areas

  • Urology

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