Department of Urology, Carolinas Medical Center/Atrium Health, 1000 Blythe Ave, Suite 163, Medical Education Building, Charlotte, NC, 28203, USA.
Department of Cancer Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, USA.
World J Urol. 2021 Feb;39(2):473-479. doi: 10.1007/s00345-020-03191-2. Epub 2020 Apr 17.
We aim to assess the safety of decreasing ureteral stenting duration following Radical Cystectomy with Urinary Diversion (RCUD).
We analyzed a prospectively and retrospectively collected dataset for cystectomy patients at our tertiary center. Adult patient who underwent RCUD for malignancy from January 2013 to February 2018 were included. Patients with a history of abdominal/pelvic radiation and continent diversions were excluded. The patient population was divided to late stent removal group (LSR-POD 14) and early stent removal group (ESR-POD5). Our endpoints were total stent duration, 90-day readmission, 90-day total-UTI, 90-day urinary-readmissions, complications and Ureteroenteric Stricture (UES) rates. Statistical methods included t test, Chi-squared test and multivariate logistic regression.
One hundred and seventy-eight patients were included in the final analysis after inclusion/exclusion criteria were applied. The LSR (n = 74) and ESR (n = 104) groups were similar in preoperative characteristics except higher intracorporeal ileal conduit formation in ESR. The duration of stenting decreased significantly from approximately 15.5-5 days (P < 0.001). The LSR had higher 90-day overall readmission rates (OR = 2.57, 95% CI 1.19-5.53, P = 0.016) and total-UTIs (OR = 2.36, 95%CI 1.11-5.04, P = 0.026). With a median follow-up of 9.8 months, UES was similar between the two groups.
Shorter ureteral stent duration is a safe and non-inferior option following RCUD. It allows for stent removal prior to discharge and less outpatient visits. In addition, decreasing stent duration was linked decreased readmissions and total-UTIs without increased risk of UES. However, future studies are needed to establish causality and promote stent duration change.
我们旨在评估根治性膀胱切除术（RCUD）后减少输尿管支架留置时间的安全性。
我们分析了我们的三级中心接受 RCUD 治疗的患者前瞻性和回顾性收集的数据。纳入 2013 年 1 月至 2018 年 2 月期间因恶性肿瘤接受 RCUD 的成年患者。排除有腹部/盆腔放疗和连续性引流史的患者。患者分为晚期支架取出组（LSR-POD14）和早期支架取出组（ESR-POD5）。我们的终点是总支架时间、90 天再入院率、90 天总尿路感染、90 天尿再入院率、并发症和输尿管肠吻合口狭窄（UES）发生率。统计方法包括 t 检验、卡方检验和多变量逻辑回归。
应用纳入/排除标准后，178 例患者纳入最终分析。LSR（n=74）和 ESR（n=104）组在术前特征上相似，但 ESR 组的腔内回肠导管形成率较高。支架留置时间明显缩短，从大约 15.5-5 天（P<0.001）。LSR 的 90 天总体再入院率（OR=2.57，95%CI1.19-5.53，P=0.016）和总尿路感染（OR=2.36，95%CI1.11-5.04，P=0.026）较高。中位随访 9.8 个月，两组 UES 相似。
RCUD 后较短的输尿管支架留置时间是一种安全且非劣效的选择。它可以在出院前取出支架，减少门诊就诊次数。此外，减少支架留置时间与减少再入院率和总尿路感染有关，而不会增加 UES 的风险。然而，需要进一步的研究来确定因果关系并促进支架留置时间的改变。
