Impact of radiation on the incidence and management of ureteroenteric strictures: a contemporary single center analysis

BMC Urology

Perri Nelson¹  Chandler Morris¹  Mei Tuong¹  Kimberly Maciolek¹  Clinton T. Yeaman¹  Tracey L. Krupski¹  Stephen Culp²  Sumit Isharwal²  Andrew Winkelman³ 

[1] Department of Urology, UVA Medical Center, Fontaine Research Park, 500 Ray C. Hunt Drive, 22908, Charlottesville, VA, USA;Department of Urology, UVA Medical Center, Fontaine Research Park, 500 Ray C. Hunt Drive, 22908, Charlottesville, VA, USA;University of Virginia School of Medicine, Charlottesville, VA, USA;University of Virginia School of Medicine, Charlottesville, VA, USA;

关键词: Stricture;    Ureteroenteric;    Radiation;    Urinary diversion;   

DOI  :  10.1186/s12894-021-00869-6

来源: Springer

【 摘 要 】

BackgroundUreteroenteric stricture incidence has been reported as high as 20% after urinary diversion. Many patients have undergone prior radiotherapy for prostate, urothelial, colorectal, or gynecologic malignancy. We sought to evaluate the differences between ureteroenteric stricture occurrence between patients who had radiation prior to urinary diversion and those who did not.MethodsAn IRB-approved cystectomy database was utilized to identify ureteroenteric strictures among 215 patients who underwent urinary diversion at a single academic center between 2016 and 2020. Chart abstraction was conducted to determine the presence of confirmed stricture in these patients, defined as endoscopic diagnosis or definitive imaging findings. Strictures due to malignant ureteral recurrence were excluded (3 patients). Statistical analysis was performed using chi squared test, t-test, and Wilcoxon Rank-Sum Test, logistic regression, and Kaplan–Meier analysis of stricture by cancer type.Results65 patients had radiation prior to urinary diversion; 150 patients did not have a history of radiation therapy. Benign ureteroenteric stricture rate was 5.3% (8/150) in the non-radiated cohort and 23% (15/65) in the radiated cohort (p =  < 0.001). Initial management of stricture was percutaneous nephrostomy (PCN) in 78% (18/23) and the remaining 22% (5/23) were managed with primary retrograde ureteral stent placement. Long term management included ureteral reimplantation in 30.4% (7/23).ConclusionsOur study demonstrates a significant increase in rate of ureteroenteric strictures in radiated patients as compared to non-radiated patients. The insult of radiation on the ureteral microvascular supply is likely implicated in the cause of these strictures. Further study is needed to optimize surgical approach such as utilization of fluorescence angiography for open and robotic approaches.

【 授权许可】

CC BY