Abstract: PD38-01
Sources of Funding: Roswell Park Alliance Foundation

Introduction

Uretero-enteric strictures of the (UES) represent the most common complication requiring reoperation after radical cystectomy. We sought to investigate the prevalence and predictors of developing UES after robot-assisted radical cystectomy (RARC).

Methods

We retrospectively reviewed our RARC database and identified patients who developed UES. Data was reviewed for demographics and perioperative outcomes. UES were further described in terms of their presentation, time to diagnosis, laterality, and management. Kaplan Meier method was used to compute time to UES and a logistic regression model was fit to evaluate and assess predictors of stricture development.

Results

Our database included 418 patients. Uretero-ileal complications were identified in 70 (17%): strictures 51 (12%); malignant obstruction 9 (2%); and leakage 10 (2%). Median time to UES following RARC was 5 months (IQR 2-12). UES occurred at a rate of 12%, 16% and 19% at 1, 3 and 5 years after RARC (Figure 1). Thirteen (25%) had bilateral strictures, 23 (45%) had right and 15 (29%) had left. Patients had an average of 2 interventions prior to successful management. Patients with UES had higher BMI (31 vs 28, p=0.02), received neoadjuvant chemotherapy (NAC) more frequently (36% vs 23%, p=0.05), received intra-corporeal diversion (ICUD) more often (84% vs 63%, p=0.004) and had shorter lengths of resected ureters (15 vs 20 mm, p=0.02; 15 vs 22 mm p<0.001, on the left and right sides respectively). They developed more urinary tract infections (UTI) (37% vs 12%, p<0.001) and postoperative urine leakage (10% vs 2%, p=0.02). Multivariable logistic regression revealed that BMI (OR=1.07, CI 95% 1.02-1.13, p=0.008), ICUD (OR=3.07, CI 95% 1.40-6.72, p=0.005), longer length of the right resected ureter (OR=0.69, CI 95% 0.53-0.89, p=0.004), year of RARC (2009-2012 OR 4.03, 95% CI 1.49-10.96, p=0.006; 2012-2016 OR 3.31, 95% CI 1.18-8.77, p=0.02), postoperative UTI (OR=4.27, CI 95% 2.23-8.18, p<0.001) and leakage (OR=4.64, CI 95% 1.46-14.81, p=0.009) were significantly associated with UES.

Conclusions

Multiple factors which can be modified were associated with higher incidence of UES following RARC.

Funding

Roswell Park Alliance Foundation