Department of Urology, UVA Medical Center, Fontaine Research Park, 500 Ray C. Hunt Drive, Charlottesville, VA, 22908, USA.
University of Virginia School of Medicine, Charlottesville, VA, USA.
BMC Urol. 2021 Aug 4;21(1):101. doi: 10.1186/s12894-021-00869-6.
Ureteroenteric stricture incidence has been reported as high as 20% after urinary diversion. Many patients have undergone prior radiotherapy for prostate, urothelial, colorectal, or gynecologic malignancy. We sought to evaluate the differences between ureteroenteric stricture occurrence between patients who had radiation prior to urinary diversion and those who did not.
An IRB-approved cystectomy database was utilized to identify ureteroenteric strictures among 215 patients who underwent urinary diversion at a single academic center between 2016 and 2020. Chart abstraction was conducted to determine the presence of confirmed stricture in these patients, defined as endoscopic diagnosis or definitive imaging findings. Strictures due to malignant ureteral recurrence were excluded (3 patients). Statistical analysis was performed using chi squared test, t-test, and Wilcoxon Rank-Sum Test, logistic regression, and Kaplan-Meier analysis of stricture by cancer type.
65 patients had radiation prior to urinary diversion; 150 patients did not have a history of radiation therapy. Benign ureteroenteric stricture rate was 5.3% (8/150) in the non-radiated cohort and 23% (15/65) in the radiated cohort (p = < 0.001). Initial management of stricture was percutaneous nephrostomy (PCN) in 78% (18/23) and the remaining 22% (5/23) were managed with primary retrograde ureteral stent placement. Long term management included ureteral reimplantation in 30.4% (7/23).
Our study demonstrates a significant increase in rate of ureteroenteric strictures in radiated patients as compared to non-radiated patients. The insult of radiation on the ureteral microvascular supply is likely implicated in the cause of these strictures. Further study is needed to optimize surgical approach such as utilization of fluorescence angiography for open and robotic approaches.
尿流改道后，输尿管肠吻合口狭窄的发生率高达 20%。许多患者因前列腺、尿路上皮、结直肠或妇科恶性肿瘤而接受过放射治疗。我们试图评估接受过放射治疗和未接受过放射治疗的尿流改道患者之间输尿管肠吻合口狭窄发生的差异。
利用一项经机构审查委员会批准的膀胱切除术数据库，在 2016 年至 2020 年期间，在一家学术中心对 215 例接受尿流改道的患者进行了研究，以确定输尿管肠吻合口狭窄。通过图表提取来确定这些患者是否存在确诊的狭窄，定义为内镜诊断或明确的影像学发现。排除了因恶性输尿管复发导致的狭窄（3 例）。使用卡方检验、t 检验、Wilcoxon 秩和检验、逻辑回归和基于癌症类型的狭窄 Kaplan-Meier 分析进行统计分析。
65 例患者在尿流改道前接受过放射治疗，150 例患者无放射治疗史。未接受放射治疗的患者中良性输尿管肠吻合口狭窄的发生率为 5.3%（8/150），而接受放射治疗的患者中狭窄的发生率为 23%（15/65）（p<0.001）。23 例狭窄患者中，78%（18/23）初始采用经皮肾造瘘术（PCN）治疗，其余 22%（5/23）采用原发性逆行输尿管支架置入术治疗。长期管理包括输尿管再植术，占 30.4%（7/23）。
我们的研究表明，与未接受放射治疗的患者相比，接受放射治疗的患者输尿管肠吻合口狭窄的发生率显著增加。放射对输尿管微血管供应的损害可能是导致这些狭窄的原因。需要进一步研究以优化手术方法，例如在开放和机器人手术中使用荧光血管造影。
