Alexander M Helfand1, Rebekah Beach2, Miriam Hadj-Moussa2, Naveen Krishnan1, Chang He3, Jeffrey S Montgomery4, Todd M Morgan4, Alon Z Weizer4, Khaled Hafez4, Cheryl T Lee4, John T Stoffel2, Ted A Skolarus5. 1. 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. 2. Department of Urology, University of Michigan Health System, Ann Arbor, MI. 3. Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI. 4. Department of Urology, University of Michigan Health System, Ann Arbor, MI; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI. 5. 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.
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. Published by Elsevier Inc.
OBJECTIVE: 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. METHODS: 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. RESULTS: 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 UASpatients who underwent reimplantation (adjusted hazard ratio [aHR] for risk of death = 0.32, 95% CI: 0.13-0.80). CONCLUSION: 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. Published by Elsevier Inc.