Definition of benign ureteroenteric anastomotic strictures in ileal conduits after radical cystectomy - Experience from a single center and previously published literature

Simone Buchardt Brandt, Pernille Skjold Kingo, Jens Reumert Laurberg, Gitte Wrist Lam, Jørgen Bjerggaard Jensen

Abstract

OBJECTIVE: To evaluate a cohort of patients diagnosed with benign ureteroenteric stricture (UES) after radical cystectomy with ileal conduits using a strict predefined definition of strictures. Additionally, we want to illustrate the UES debut, regarding symptoms and clinical findings. UES is a well-known long-term complication after radical cystectomy, affecting up to 20% of all patients. In the literature, different incidence rates are reported. However, these are based on various definitions of strictures.

METHODS: We used strict predefined criteria to evaluate UES incidence including symptoms, timing, diagnostic methods, treatment, and outcome in all patients who underwent radical cystectomy with an ileal conduit between 2012 and 2018 at a single high-volume center.

RESULTS: Of a total of 693 patients who underwent radical cystectomy with ileal conduit, we found 109 patients with 135 UES in total, corresponding to 15.7% of patients (CI: 13.2-18.6) and 10% of all included ureteroenteric anastomosis (CI: 8.5-11.6) after radical cystectomy. Median follow-up was 24months (interquartile range (IQR): 12-31), and postoperatively UES was diagnosed after a median of 6months (IQR: 3-16). A total of 56% was diagnosed with elevated creatinine. Every UES underwent a median of two (IQR: 1-2) treatment attempts and 122 UES were treated successfully.

CONCLUSION: Benign UES is a significant cause of morbidity following radical cystectomy. Our findings contribute to the knowledge of timing, incidence, and recommended treatment of strictures. We argue the importance of establishing a clear gold standard when defining UES to ensure accurate reporting in future research.

Original languageEnglish
JournalUrology
ISSN0090-4295
DOIs
Publication statusE-pub ahead of print - 6 Mar 2024

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