title: The effect of length of ureteral resection on benign ureterointestinal stricture rate in ileal conduit or ileal neobladder urinary diversion following radical cystectomy.
abstract: OBJECTIVE
  To assess the effect of the length of the ureter resected and other clinical variables on ureterointestinal anastomotic (UIA) stricture rate following radical cystectomy and ileal segment urinary diversion.
  
  
  METHODS
  We identified 519 consecutive patients who underwent cystectomy and ileal conduit or ileal orthotopic neobladder diversion from January 2007 to August 2012. The length of the ureter resected was defined as the length of the ureter in the cystectomy specimen plus the length of the distal ureter submitted for pathologic analysis. The primary end point was the risk of UIA stricture formation, assessed by Cox proportional hazards analysis.
  
  
  RESULTS
  A total of 463 patients met the inclusion criteria with complete data. Median follow-up was 459 days (interquartile range [IQR]: 211-927). Median time to stricture formation was 235 (IQR: 134-352) and 232 days (IQR: 132-351) on the right and the left ureter, respectively. Overall stricture rate per ureter was 5.9% on the right vs. 10.0% on the left (P = 0.03). There was no difference in demographic, operative, or perioperative variables between patients with and without UIA strictures. On multivariate analysis adjusted for age, sex, anastomosis technique (running vs. interrupted), and length of ureter resected, only a Clavien complication≥III (hazard ratio = 2.11, 1.01-4.40) and urine leak (hazard ratio = 3.37, 1.08-10.46) significantly predicted for left- and right-sided stricture formation, respectively. The length of the ureter resected did not predict UIA stricture formation on either side.
  
  
  CONCLUSIONS
  The etiology of benign UIA strictures following ileal urinary diversion is likely multifactorial. Our data suggest that a complicated postoperative course and urine leak are risk factors for UIA stricture formation. The length of the distal ureter resected did not significantly affect stricture rate.
authors.affiliation: Section of Urology, Department of Surgery, The University of Chicago Medical Center, Chicago, IL. Electronic address: Kyle.Richards@uchospitals.edu.
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Richards
authors.affiliation: Section of Urology, Department of Surgery, The University of Chicago Medical Center, Chicago, IL.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cohn
authors.affiliation: Section of Urology, Department of Surgery, The University of Chicago Medical Center, Chicago, IL; Urology of Indiana, Indianapolis, IN.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Large
authors.affiliation: Section of Urology, Department of Surgery, The University of Chicago Medical Center, Chicago, IL.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Bales
authors.affiliation: Section of Urology, Department of Surgery, The University of Chicago Medical Center, Chicago, IL.
authors.forename: Norm D
authors.initials: ND
authors.lastname: Smith
authors.affiliation: Section of Urology, Department of Surgery, The University of Chicago Medical Center, Chicago, IL.
authors.forename: Gary D
authors.initials: GD
authors.lastname: Steinberg
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*
keywords: Cystectomy; Postoperative complications; Reimplantation; Ureteral stricture; Ureterointestinal anastomosis; Urinary bladder neoplasms