Abstract: PD38-03
Sources of Funding: None

Introduction

Radical cystectomy and urinary diversion is the primary treatment of patients with muscle invasive bladder cancer, which is associated with peri-operative complication rates as high as 60%. Ureteroenteric anastomotic stricture (UEAS) is a potential source significant morbidity. The etiology of UEAS is thought be either due to ischemia or inflammation.  We sought to evaluate our experience with benign UEAS in our orthotopic neobladder (ON) population. _x000D_

Methods

We retrospectively reviewed the charts of patients who underwent radical cystectomy and ON between 2000-2015 at MD Anderson Cancer Center and had at least 6 months of follow up.  We reviewed operative reports regarding the type of anastomosis (interrupted versus running), suture type (absorbable braided versus monofilament).  In those patients with UEAS, we also evaluated for history of radiation therapy and urinary tract infection (UTI). _x000D_

Results

A total of 418 patients underwent creation of ON.  The average age was 59 (SD 9.4 years) and 90% were males.  The mean follow up was 57 months (6-183 months).  There were 37 patients (8.9%) that developed UEAS, 42 renal units. Figure 1 demonstrates the number of strictures diagnosed per year.  The mean time to diagnosis was 15.8 months (0.85-90 months).  Management included placement of a nephrostomy tube or stent in 47% of patients and 32% underwent revision of anastomosis; while one patient underwent nephrectomy and the remainder were not treated at our institution.  UEAS occurred in 30 patients with an interrupted anastomosis and 4 had running anastomoses and 3 were unknown. We found that anastomosis type and suture type were not predictive of UEAS (p=0.594, p=0.586), but that perioperative UTI within 30 days of surgery and recurrent UTI were predictive of UEAS (OR 3.27 p=0.002, OR 7.06 p<0.001), while radiation was not significant (p=0.128). _x000D_

Conclusions

UEAS are associated with potentially significant morbidity following ON creation. UEAS may occur early following urinary diversion, but may also occur as late as 7 years following surgery, owing to the importance for continued observation of these patients even into survivorship.  Certainly, technical factors and surgeon experience may indeed contribute to the rate of UEAS, but it appears that perioperative UTI heralds future stricture development._x000D_

Funding

None