Login to Access Video or Poster Abstract: MP21-15
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Introduction

Radical cystectomy (RC) and urinary diversion carries a significant risk of postoperative morbidity, including fistula formation. We identified patients who underwent RC for bladder cancer at our institution who experienced fistulous complications and analyzed the risk factors for formation as well as their management and outcomes.

Methods

We performed a retrospective review of our institutional database and identified patients who underwent RC for bladder cancer between January 2007 and December 2015. Patients who experienced any fistulous complication were compared to those without such complication. Further chart review was carried out on all fistula patients to assess management strategies and outcomes. Those who were successfully conservatively managed were compared to those requiring surgical repair. Univariable and multivariable analyses were performed on associations with fistula formation and failure of conservative management.

Results

Of the 1041 patients, 31 (3.0%) experienced fistula formation. Mean time from RC to fistula presentation was 3.4 months (range 0.1-13.6). There was no difference in age, sex, race, body mass index, Charlson comorbidity score, type of urinary diversion, pathological stage, chemotherapy exposure, or radiation exposure between the two groups (all p>0.05). Of the 31 fistula patients, there were 14 (45.2%) orthotopic neobladders, 13 (41.9%) ileal conduits, and 4 (12.9%) continent catheterizable pouches. The most common types of fistulae were entero-diversion (17, 54.8%), entero-cutaneous (9, 29.0%), and diversion-cutaneous (4, 12.9%). Five (16.1%) patients experienced multiple fistulae. Conservative management was successful in 13 (41.9%) of patients, and surgical repair was required in 18 (58.1%). Of those requiring surgical repair, success was achieved in a single operation in 17 (94.4%). There were no malignant fistulae. On univariable analysis, age (p=0.002) and Charlson comorbidity score (p=0.029) were the only factors predictive of patients failing conservative management and requiring surgical repair, however, neither were significant on multivariable analysis (p=0.151 and p=0.286).

Conclusions

Fistulous complications are rare after RC. They generally occur within the first few months after RC, and are most commonly between the urinary diversion and small bowel. There are no clearly identifiable risk factors for fistula formation, nor for those who fail conservative management. However, surgical repair of fistulae is generally met with a high success rate in a single operation.

Funding

none