Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
J Urol. 2018 Mar;199(3):663-668. doi: 10.1016/j.juro.2017.08.095. Epub 2017 Aug 30.
Fistula formation is a rare and poorly described complication following radical cystectomy with urinary diversion. We sought to identify patients who experienced any type of fistulous complication and we analyzed risk factors for formation as well as management outcomes.
We retrospectively reviewed the records of patients who underwent radical cystectomy for bladder cancer at our institution. Patients who experienced any fistula were identified. Risk factors, management strategies and outcomes were analyzed. Patients underwent initial conservative treatment and those in whom this treatment failed underwent surgical repair. Univariable and multivariable analyses were performed to identify predictors of fistula formation as well as the need for surgical repair.
Of the 1,041 patients 31 (3.0%) experienced fistula formation. Median time to fistula presentation was 31 days. Enterodiversion was the most common fistula type, noted in 54.8% of patients, followed by enterocutaneous and diversion cutaneous treatment in 29.0% and 12.9%, respectively. On multivariable analyses a history of radiation therapy (OR 3.1, p = 0.03) and an orthotopic neobladder (OR 3.1, p = 0.04) were predictors of fistula formation. Conservative management was successful in 41.9% of cases. There were no predictors of failed conservative management. Of patients who required surgical repair success was achieved in 94.4% at a single operation.
Fistulas are rare after radical cystectomy and they are most common between the urinary diversion and the small bowel. A history of radiation therapy and a orthotopic neobladder are risk factors for formation. When required, surgical repair is generally successful at a single operation.
瘘管形成是根治性膀胱切除术和尿流改道后罕见且描述不佳的并发症。我们旨在确定发生任何类型瘘管并发症的患者，并分析其形成的危险因素以及管理结果。
我们回顾性地审查了在我们机构接受根治性膀胱切除术治疗膀胱癌的患者记录。确定发生任何瘘管的患者。分析了危险因素、管理策略和结果。患者接受了初始保守治疗，治疗失败的患者接受了手术修复。进行了单变量和多变量分析，以确定瘘管形成的预测因素以及手术修复的必要性。
在 1041 名患者中，有 31 名（3.0%）发生瘘管形成。瘘管出现的中位时间为 31 天。肠分流术是最常见的瘘管类型，在 54.8%的患者中观察到，其次是肠皮瘘和分流皮瘘，分别占 29.0%和 12.9%。多变量分析显示，放疗史（OR 3.1，p = 0.03）和原位新膀胱（OR 3.1，p = 0.04）是瘘管形成的预测因素。保守治疗在 41.9%的病例中成功。没有保守治疗失败的预测因素。需要手术修复的患者中，94.4%的患者在一次手术中成功。
根治性膀胱切除术后瘘管很少见，最常见于尿路分流和小肠之间。放疗史和原位新膀胱是形成的危险因素。当需要手术修复时，通常在一次手术中就能成功。
