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Management of Uretero-Enteric Strictures after Robot-Assisted Radical Cystectomy

Login to Access Video or Poster Abstract: MP21-14
Sources of Funding: Roswell Park Alliance foundation

Introduction

When conservative management for uretero-enteric strictures (UES) following robot-assisted radical cystectomy (RARC) fails, the gold standard is open revision, which may be associated with higher morbidity and technical complexity. We sought to investigate the predictors of successful endoscopic management for UES after RARC.

Methods

We retrospectively reviewed our RARC database and identified patients who developed UES. All patients were initially managed with an endoscopic/percutaneous approach. Successful management was defined as absence of significant urinary tract obstruction on postoperative imaging. Data was reviewed for demographics operative approach, and perioperative outcomes. A logistic regression model was fit to evaluate predictors for successful endoscopic management.

Results

Our database included 418 patients. UES were identified in 51 (12%) patients. Median time to UES following RARC was 5 months (IQR 2-12). Median time to primary management was 22 (IQR 4-54) days after diagnosis. Sixteen patients had a robot-assisted (RA) repair and 6 had open (Table 1). Thirty three patients had successful management of UES after an average of 2 procedures (endoscopic 13; robot-assisted revision 15; and open revision 5) (Figure 1). Only female gender (OR 0.13, 95% CI 0.03-0.56, p=0.007) and BMI (OR 0.88, 95% CI 0.77-0.99, p=0.05) were significant predictors of successful endoscopic management.

Conclusions

None of the stricture characteristics or the cancer stage predicted successful endoscopic management of UES after RARC. Only patient-related factors (male gender and lower BMI) were associated with successful endoscopic management.

Funding

Roswell Park Alliance foundation

Authors
Youssef Ahmed
Ahmed Hussein
Paul May
Basim Ahmad
Taimoor Ali
Prasanna Kumar
Khurshid Guru
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