Robot-assisted uretero-enteric reimplantation for uretero-enteric anastomotic strictures following robot-assisted radical cystectomy: Surgical approach and outcomes over two decades
Abdul Wasay Mahmood,Grace Harrington,Zhe Jing,Qiang Li,Ahmed A. Hussein,Khurshid A. Guru*()
Department of Urology, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, New York, NY, USA
Objective: We described the technique and outcomes of robot-assisted repair of uretero-enteric strictures (UES) following robot-assisted radical cystectomy (RARC) and urinary diversion.
Methods: Retrospective review of our RARC database from November 2005 to August 2023 at Roswell Park Comprehensive Cancer center was performed. Patients who developed UES and ultimately underwent robot-assisted uretero-enteric reimplantation (RUER) were identified. Kaplan-Meier method was used to compute the cumulative incidence recurrence rate of UES after RUER. A multivariable regression model was used to identify variables associated with UES recurrence.
Results: A total of 123 (15%) out of 808 RARC patients developed UES, of whom 52 underwent reimplantation (45 patients underwent RUER [n=55 cases] and seven patients underwent open uretero-enteric reimplantation). The median time from RARC to UES was 4.4 (interquartile range 3.0-7.0) months, and the median time between UES and RUER was 5.2 (interquartile range 3.2-8.9) months. The 3-year recurrence rate after RUER is about 29%. On multivariable analysis, longer hospital stay (hazard ratio 1.37, 95% confidence interval 1.16-1.61, p<0.01) was associated with recurrent UES after RUER.
Conclusion: RUER for UES after RARC is feasible with durable outcomes although a notable subset of patients experienced postoperative complications and UES recurrence.
. [J]. Asian Journal of Urology, 2024, 11(3): 384-390.
Abdul Wasay Mahmood, Grace Harrington, Zhe Jing, Qiang Li, Ahmed A. Hussein, Khurshid A. Guru. Robot-assisted uretero-enteric reimplantation for uretero-enteric anastomotic strictures following robot-assisted radical cystectomy: Surgical approach and outcomes over two decades. Asian Journal of Urology, 2024, 11(3): 384-390.
Intracorporeal approach urinary diversion at cystectomy
41 (98)
12 (92)
53 (96)
0.42
Neobladder urinary diversion
7 (17)
0 (0)
7 (13)
0.18
Ileal conduit urinary diversion
35 (83)
13 (100)
48 (87)
-
Type of ureteral anastomosisa
Bricker
36 (88)
13 (100)
49 (91)
0.32
Wallace
5 (12)
0 (0)
5 (9)
-
Stent placement at cystectomy
37 (88)
12 (92)
49 (89)
1
Parameters at the time of RUER
Age at RUER, year
69 (61-73)
65 (61-69)
66 (61-73)
0.51
BMI at RUER, kg/m2
29 (27-34)
27 (23-32)
29 (25-33)
0.21
Months from RARC to UES
4.5 (3.3-7.5)
3.9 (1.9-5.5)
4.4 (3.0-7.0)
0.18
Months from UES to RUER
4.8 (2.5-8.9)
5.3 (4.1-9.4)
5.2 (3.2-8.9)
0.33
Estimated blood loss, mL
50 (20-88)
150 (100-150)
50 (25-120)
0.001
Type of ureteral anastomosis
Bricker
40 (95)
10 (77)
50 (91)
0.08
Wallace
2 (5)
2 (15)
4 (7)
-
Left to right
0 (0)
1 (8)
1 (2)
-
Stent placement at RUER
19 (45)
7 (54)
26 (47)
0.75
Operative time, min
163 (129-186)
179 (170-279)
174 (135-189)
0.03
Transfusion
0 (0)
0 (0)
0 (0)
-
Conversion to open
0 (0)
0 (0)
0 (0)
-
Laterality of RUER
Left side
31 (74)
6 (46)
37 (67)
0.09
Right side
11 (26)
7 (54)
18 (33)
-
LOS, day
3 (2-4)
6 (2-7)
3 (2-4)
0.03
ICU admission
6 (14)
1 (8)
7 (13)
1
ICG intraoperative use
10 (24)
1 (8)
11 (20)
0.27
GFR, mL/min
Before RUER
44 (37-67)
41 (34-56)
43 (36-66)
0.59
Day 90 after RUER
46 (34-58)
41 (35-48)
43 (34-56)
0.59
Number of conservative managements before RUER
2 (2-3)
2 (1-3)
2 (2-3)
0.67
Variable
No UES after RUER (n=42)
UES after RUER (n=13)
Total (n=55)
p-Value
Any complication
20 (48)
11 (85)
31 (56)
0.03
Wound (incision hernia)
0 (0)
0 (0)
0 (0)
-
Gastrointestinal (ileus)
1 (2)
1 (8)
2 (4)
0.42
Genitourinary (ureteral leakage)
0 (0)
2 (15)
2 (4)
0.05
Infectious
Sepsis
1 (2)
1 (8)
2 (4)
0.42
UTI
8 (19)
2 (15)
10 (18)
1
High-grade (Clavien-Dindo Grade 3 or higher) complication
9 (21)
3 (23)
12 (22)
1
Re-admission
6 (14)
1 (8)
7 (13)
1
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