Is the incidence of uretero-intestinal anastomotic stricture increased in patients undergoing radical cystectomy with previous pelvic radiation?
METHODS
Therapy (case series).


METHODS
4.


OBJECTIVE
To present our long-term experience comparing uretero-intestinal anastomotic (UIA) stricture rates after radical cystectomy (RC) in patients with and without previous pelvic radiotherapy (pRT), as the risk of stricture is thought to be higher in patients undergoing RC and urinary diversion (UD) with a history of pRT.


METHODS
We retrospectively analysed patients who had RC and UD between 1992 and 2008 by one surgical team. Patients were divided into two groups, those with (group 1) and with no (group 2) previous pRT. Relevant clinical and pathological data were entered into a database. Patients who were symptomatic and required intervention for a UIA stricture were analysed; patients with malignant strictures were excluded.


RESULTS
In all, 526 patients had RC by one surgical team during the study period; 65 had pRT before RC, 37 for prostate cancer, 23 for bladder cancer and the rest for other pelvic malignancies. All the patients in group 1 had an ileal conduit (IC) diversion. There were 250 IC and 211 neobladder diversions in group 2. There were 130 (12%) UIAs in group 1, vs 922 (88%) in group 2. There was no statistically significant difference between the groups in demographic profile and follow-up. The overall stricture rate for UIA was 1.3%; there were two (1.5%) UIA strictures in group 1 vs 12 (1.3%) in group 2. The mean (median, range) time to onset of the stricture was 10 (6, 2-39) months. There was no statistically significant difference in stricture rate between the groups (P > 0.05).


CONCLUSIONS
In patients undergoing RC with UD there was no significant difference in UIA stricture rates between those with and without previous pRT.
Katkoori
Devendar
D
Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA.
Samavedi
Srinivas
S
Adiyat
Kishore Thekke
KT
Soloway
Mark S
MS
Manoharan
Murugesan
M
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000453:epidemiology; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007422:Intestines / Q000601:surgery*; D008297:Male; D010386:Pelvic Neoplasms / Q000532:radiotherapy; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects*