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Beitragstitel Benign ureteroenteric strictures after robot-assisted radical cystectomy with intracorporeal urinary diversion in 68 patients
Beitragscode P020
Autor:innen
  1. Fabian Obrecht Kantonsspital Winterthur Präsentierende:r
  2. Beat Foerster Kantonsspital Winterthur
  3. Orlando Burkhardt Kantonsspital Winterthur
  4. Christoph Schlegel-Wagner Luzerner Kantonsspital
  5. Marco Randazzo Kantonsspital Winterthur
  6. Christian Padevit Kantonsspital Winterthur
  7. Hubert John Kantonsspital Winterthur
Präsentationsform moderierte Poster
Themengebiete
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Abstract-Text Introduction
Ureteroenteric strictures (UES) may occur after radical cystectomy with urinary diversion. Aim of our study was to investigate the rate and further treatment necessity of UES in patients who had robot-assisted radical cystectomy with complete intracorporeal reconstruction (iRARC).
Methods
We included all patients who underwent iRARC at our institution between January 2015 and December 2018 from our prospective registry. Urinary diversion consisted of an ileal conduit or a Studer modified orthotopic neobladder. All ureteroenteric anastomoses were applied with the Wallace type technique. UES was defined as hydronephrosis requiring intervention due to renal function impairement, local pain or urinary infection. All patients received ultrasound examination before and after postoperative stent removal, and CT imaging 3 months into follow-up.
Results
Overall, 68 patients who underwent iRARC were included with a total of 134 ureteroenteric anastomoses. There were 49/68 (72%) ileum conduits and 19/68 (28%) orthotopic neobladders. Among these upper urinary tracts, 29 (21%), 19 (14%), and 3 (2%) had postoperative hydronephrosis grade I to III, respectively. During a median follow-up of 15 months, 9/68 (13%) patients presented with hydronephrosis that required treatment. Checking for ureteroenteric anastomosis, 11 of 134 ureters (8.2%) showed UES. Of these, 6/11 ureters had postoperative hydronephrosis grade I to III. 4/68 (5.9%) patients in total underwent reimplantation surgery, whereof 2/4 were performed with a robotic approach. There was no patient after orthotopic neobladder needing reimplantation surgery.
Conclusions
The revision rate of 5.9% after robot assisted intracorporeal reconstruction due to ureteroenteric stricture in our series of 68 patients is consistent with the literature in open surgical technique. So far, uretero-intestinal anastomoses of orthotopic neobladders seem to have a much lower risk for strictures, what might be explained by the presence of the afferent sling and higher implantation site in the pelvis. Longterm renal function has to be observed.