Treatment of ureteral anastomotic strictures with reimplantation and survival after cystectomy and urinary diversion.
To examine whether long-term renal function and overall survival outcomes vary according to management approach for ureteral anastomotic stricture (UAS) after cystectomy and urinary diversion.



We conducted a retrospective cohort study of patients with benign UAS following cystectomy and urinary diversion using our institutional database. We compared time to stricture, renal function, rates of renal loss, and overall survival between patients undergoing ureteral reimplantation vs. those undergoing nonoperative management (nephrostomy tube or ureteral stent). A multivariable Cox proportional hazard model was used to determine whether reimplantation was independently associated with overall survival.



We identified 87 UAS in 69 patients. Reimplantation was performed in 26 patients (37.7%), and 43 patients (62.3%) were managed nonoperatively. The interval between cystectomy and stricture diagnosis was similar in the reimplanted and nonoperative groups (3.06 vs. 4.34mo, P = 0.42). The differences between baseline and follow-up creatinine levels (+0.40 vs.+0.40mg/dl, P = 0.72) and estimated glomerular filtration rate (-25.0 vs.-18.9ml/min/1.73m2, P = 0.66) were similar between groups, as were rates of renal loss (34.6% vs. 39.5%, P = 0.68); however, mortality was significantly higher in the nonoperative group. After multivariable adjustment, overall survival remained significantly higher among UAS patients who underwent reimplantation (adjusted hazard ratio [aHR] for risk of death = 0.32, 95% CI: 0.13-0.80).



Reimplantation was associated with improved overall survival but not with improved long-term renal functional outcomes compared with nonoperative management. Nonrenal complications of nonoperative UAS management may play an important role in reducing longevity.
Department of Urology, University of Michigan Health System, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Alexander M
AM
Helfand
Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Rebekah
R
Beach
Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Miriam
M
Hadj-Moussa
Department of Urology, University of Michigan Health System, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Naveen
N
Krishnan
Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Chang
C
He
Department of Urology, University of Michigan Health System, Ann Arbor, MI; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI.
Jeffrey S
JS
Montgomery
Department of Urology, University of Michigan Health System, Ann Arbor, MI; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI.
Todd M
TM
Morgan
Department of Urology, University of Michigan Health System, Ann Arbor, MI; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI.
Alon Z
AZ
Weizer
Department of Urology, University of Michigan Health System, Ann Arbor, MI; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI.
Khaled
K
Hafez
Department of Urology, University of Michigan Health System, Ann Arbor, MI; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI.
Cheryl T
CT
Lee
Department of Urology, University of Michigan Health System, Ann Arbor, MI.
John T
JT
Stoffel
Department of Urology, University of Michigan Health System, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI; Center for Clinical Management Research, Veterans Affairs (VA) Health Services Research & Development Service, VA Ann Arbor Healthcare System, Ann Arbor, MI. Electronic address: tskolar@med.umich.edu.
Ted A
TA
Skolarus
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D000074643:Nephrotomy; D011183:Postoperative Complications / Q000628:therapy*; D012092:Replantation; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000209:etiology / Q000628:therapy*; D014547:Urinary Diversion / Q000009:adverse effects*
D003404:Creatinine
Bladder cancer; Complications; Cystectomy; Operative; Reimplant; Stricture