Lessons from 151 ureteral reimplantations for postcystectomy ureteroenteric strictures: A single-center experience over a decade.
Ureteroenteric anastomotic strictures are common after cystectomy with urinary diversion. Endoscopic treatments have poor long-term success, although ureteral reimplantation is associated with morbidity. Predictors of successful open repair are poorly defined. Our objective was to characterize outcomes of ureteral reimplantation after cystectomy and identify risk factors for stricture recurrence.



We performed a retrospective review of 124 consecutive patients with a total of 151 open ureteral reimplantations for postcystectomy ureteroenteric strictures between January 2006 and December 2015. Baseline clinicopathologic characteristics and perioperative outcomes were examined. Predictors for stricture recurrence were assessed by univariable testing and univariate Cox proportional hazards regression.



Most patients underwent preoperative drainage by percutaneous nephrostomy (PCN; 43%) or percutaneous nephroureterostomy (PCNU; 44%). Major iatrogenic injuries included enterotomies requiring bowel anastomosis (3.2%) and major vascular injuries (2.4%). Overall, 60 (48%) patients suffered 90-day complications, of which 15 (12%) patients had high-grade complications. Median length of stay was 6 days [interquartile range: 5, 8] and median follow-up was 21 months [interquartile range: 5, 43]. The overall success rate per ureter was 93.4%. On univariate analysis, the only significant predictor of stricture recurrence was preoperative PCNU placement compared with PCN placement or no drainage (success rates: 85.5% vs. 98.9%, respectively, P = 0.002). Cox proportional hazards regression demonstrated that preoperative PCNU placement yielded a hazard ratio of 10.2 (95% CI: 1.27-82.6) for stricture recurrence (P<0.005). Stricture recurrence was independent of previous endoscopic interventions (P = 0.42). Stricture length was unable to be assessed.



Postcystectomy ureteral reimplantation was associated with relatively low rates of major iatrogenic injuries and high-grade complications. Preoperative PCN placement rather than PCNU may yield better results.
Section of Urology, University of Chicago, Chicago, IL. Electronic address: vignesh.packiam@uchospitals.edu.
Vignesh T
VT
Packiam
Section of Urology, University of Chicago, Chicago, IL.
Vijay A
VA
Agrawal
Section of Urology, University of Chicago, Chicago, IL.
Andrew J
AJ
Cohen
Section of Urology, University of Chicago, Chicago, IL.
Joseph J
JJ
Pariser
Section of Urology, University of Chicago, Chicago, IL.
Scott C
SC
Johnson
Section of Urology, University of Chicago, Chicago, IL.
Gregory T
GT
Bales
Section of Urology, University of Chicago, Chicago, IL.
Norm D
ND
Smith
Section of Urology, University of Chicago, Chicago, IL.
Gary D
GD
Steinberg
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003251:Constriction, Pathologic / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D004724:Endoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007422:Intestines / Q000473:pathology / Q000601:surgery; D053844:Lasers, Solid-State / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012092:Replantation / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D014513:Ureter / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods
Cystectomy; Percutaneous nephrostomy; Stricture; Ureteral reimplantation; Ureteroenteric stricture