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

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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.

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Authors and Affiliations

  1. Division of Urology, University of Texas at Houston Health Science Center McGovern School of Medicine, Houston, USA

    Cooper R. Benson, Brittani L. Barrett-Harlow, Clay Pendleton & Hajar I. Ayoub

  2. Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Cooper R. Benson, Divya Ajay, Brittani L. Barrett-Harlow, Kathryn G. Cunningham, Yasmin Bootwala, Clay Pendleton, Hanhan Li, William J. Graber & O. Lenaine Westney

Authors
  1. Cooper R. Benson
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  2. Divya Ajay
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  3. Brittani L. Barrett-Harlow
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  4. Kathryn G. Cunningham
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  5. Yasmin Bootwala
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  6. Clay Pendleton
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  7. Hanhan Li
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  8. Hajar I. Ayoub
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  9. William J. Graber
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  10. O. Lenaine Westney
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Contributions

CR Benson: Data collection and analysis, manuscript writing. D Ajay: Data Analysis and manuscript editing. B Barrett-Harlow: data collection. KG Cunningham: Data collection and analysis, manuscript editing. Y Bootwala: Data Collection. C Pendleton: Data Collection. HI Ayoub: Data collection, manuscript editing. WJ Graber: project development. OL Westney: project development, data analysis, manuscript editing.

Corresponding author

Correspondence to O. Lenaine Westney.

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Conflict of interest

The authors declare no conflict of interest as it relates to this project and manuscript.

Research involving human participants and/or animals

Ethical approval: All procedures performed in this retrospective study involving human participants were in accordance with the ethical standards of the institutional review board of the University of Texas MD Anderson Cancer and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Not applicable for this retrospective analysis.

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Benson, C.R., Ajay, D., Barrett-Harlow, B.L. et al. Ureteroenteric anastomosis in orthotopic neobladder creation: do urinary tract infections impact stricture rate?. World J Urol 39, 1171–1176 (2021). https://doi.org/10.1007/s00345-020-03266-0

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  • DOI: https://doi.org/10.1007/s00345-020-03266-0

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