Lessons from 151 ureteral reimplantations for postcystectomy ureteroenteric strictures: A single-center experience over a decade

Vignesh T. Packiam, Vijay A. Agrawal, Andrew J. Cohen, Joseph J Pariser, Scott C. Johnson, Gregory T. Bales, Norm D. Smith, Gary D. Steinberg

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives 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. Patients and methods 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. Results 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. Conclusions 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.

Original languageEnglish (US)
Pages (from-to)112.e19-112.e25
JournalUrologic Oncology: Seminars and Original Investigations
Volume35
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

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Replantation
Pathologic Constriction
Pregnenolone Carbonitrile
Recurrence
Cystectomy
Drainage
Percutaneous Nephrostomy
Urinary Diversion
Vascular System Injuries
Wounds and Injuries
Ureter
Length of Stay
Morbidity
1-(2-chloroethyl)-3-(2,6-dioxo-3-piperidinyl)-1-nitrosourea

Keywords

  • Cystectomy
  • Percutaneous nephrostomy
  • Stricture
  • Ureteral reimplantation
  • Ureteroenteric stricture

Cite this

Lessons from 151 ureteral reimplantations for postcystectomy ureteroenteric strictures : A single-center experience over a decade. / Packiam, Vignesh T.; Agrawal, Vijay A.; Cohen, Andrew J.; Pariser, Joseph J; Johnson, Scott C.; Bales, Gregory T.; Smith, Norm D.; Steinberg, Gary D.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 35, No. 3, 01.03.2017, p. 112.e19-112.e25.

Research output: Contribution to journalArticle

Packiam, Vignesh T. ; Agrawal, Vijay A. ; Cohen, Andrew J. ; Pariser, Joseph J ; Johnson, Scott C. ; Bales, Gregory T. ; Smith, Norm D. ; Steinberg, Gary D. / Lessons from 151 ureteral reimplantations for postcystectomy ureteroenteric strictures : A single-center experience over a decade. In: Urologic Oncology: Seminars and Original Investigations. 2017 ; Vol. 35, No. 3. pp. 112.e19-112.e25.
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title = "Lessons from 151 ureteral reimplantations for postcystectomy ureteroenteric strictures: A single-center experience over a decade",
abstract = "Objectives 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. Patients and methods 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. Results 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. Conclusions 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.",
keywords = "Cystectomy, Percutaneous nephrostomy, Stricture, Ureteral reimplantation, Ureteroenteric stricture",
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T1 - Lessons from 151 ureteral reimplantations for postcystectomy ureteroenteric strictures

T2 - A single-center experience over a decade

AU - Packiam, Vignesh T.

AU - Agrawal, Vijay A.

AU - Cohen, Andrew J.

AU - Pariser, Joseph J

AU - Johnson, Scott C.

AU - Bales, Gregory T.

AU - Smith, Norm D.

AU - Steinberg, Gary D.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Objectives 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. Patients and methods 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. Results 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. Conclusions 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.

AB - Objectives 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. Patients and methods 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. Results 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. Conclusions 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.

KW - Cystectomy

KW - Percutaneous nephrostomy

KW - Stricture

KW - Ureteral reimplantation

KW - Ureteroenteric stricture

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