Effect of intracorporeal urinary diversion on the incidence of benign ureteroenteric stricture after cystectomy

Abstract

Abbreviations & Acronyms BMI = body mass index ECUD = extracorporeal urinary diversion HR = hazard ratio ICG = indocyanine green ICUD = intracorporeal urinary diversion IQR = interquartile range ORC = open radical cystectomy RARC = robot-assisted radical cystectomy RC = radical cystectomy STROBE = Strengthening the Reporting of Observational Studies in Epidemiology Ta = non-invasive papillary carcinoma Tis = carcinoma in situ UES = ureteroenteric stricture

Incidence, Etiology, Prevention and Management of Ureteroenteric Strictures after Robot-Assisted Radical Cystectomy: A Review of Published Evidence and Personal Experience

“…Among five available studies comparing UES rates between RARC and ORC [15,16,[18][19][20][21]23], four showed that RARC promoted higher UES incidence rates compared to ORC, whereas one showed that RARC had lower rates of UES [20]. Moreover, two studies concluded that RARC had a significantly higher UES rates compared to ORC [18,21].…”

“…A benign UES is a known complication of radical cystectomy (RC) and urinary diversion with an incidence rate ranging from 3% to 10% [10][11][12][13][14]. Accumulating evidence from studies focusing on UES has suggested that 6.5%-25.3% of patients who undergo RARC develop UES [15][16][17][18][19][20][21] (Table 1). However, the duration of follow-up and definition of UES in the previous literature vary.…”

“…Excessive ureteral handling may be associated with higher incidences of UES in both ECUD and ICUD, but ICUD may be associated with less traumatic maneuvers (e.g., excessive stretching) of the ureters and a more accurate surgical technique thanks to magnification. A study by Faraj et al, which was conducted to investigate UES rates with RARC-ECUD or RARC-ICUD, noted that ICUD had a lower UES incidence (2.6%) compared to ECUD (6.4%) [20]. However, the impact of ICUD or ECUD on the incidence rates of UES remains unclear considering the lack of large-scale randomized prospective studies.…”

Management of upper urinary tract problems after radical cystectomy for urothelial carcinoma: tips and tricks

“…In the extracorporeal group the UES incidence was 9.6% versus 2.6% in the intracorporeal group. Due to the small sample size and the skewed distribution significance was not reached [21–23,24,25 ▪▪ ]. Reesink et al compared open RC with RARC and ICUD.…”

“…In the extracorporeal group the UES incidence was 9.6% versus 2.6% in the intracorporeal group. Due to the small sample size and the skewed distribution significance was not reached [21][22][23]24 There was a peak incidence in the year the robot procedure was introduced indicating a learning curve [26 ]. It is thought that manipulation of the ureter, ureteral ischemia, urinary tract infection and ureteroenteric anastomotic urine leakage are risk factors for developing UES [22][23][24].…”