Gaya Josep M, Territo Angelo, Basile Giuseppe, Gallioli Andrea, Martínez Christian, Turco Morena, Baboudjian Michael, Verri Paolo, Tedde Alessandro, Uleri Alessandro, Meneghetti Iacopo, Huguet Jordi, Rosales Antonio, Sanguedolce Francesco, Rodriguez-Faba Oscar, Palou Joan, Breda Alberto
Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain.
World J Urol. 2023 Mar;41(3):733-738. doi: 10.1007/s00345-023-04298-y. Epub 2023 Feb 1.
To identify preoperative predictors of endo-urological treatment (EUT) failure while promoting a new diagnostic and therapeutic pathway for benign uretero-enteric anastomosis stricture (UES) management after radical cystectomy (RC).
We relied on a prospectively maintained database including 96 individuals (122 renal units) who developed a benign UES at our institution between 1990 and 2018. UES was classified into two different types according to morphology: FP1 (i.e., sharp or duckbill) and FP2 (i.e., flat or concave). EUT feasibility, success rate, as well as intra and postoperative complications were recorded. Uni- and multivariable logistic regression analysis (MVA) assessed for predictors of EUT failure.
Overall, 78 (63.9%) and 32 (26.3%) cases were defined as FP1 and FP2, respectively. EUT was not feasible in 33 (27.1%) cases. After a median follow-up of 50 (IQR 5-240) months, successful treatment was reached only in 15/122 (12.3%) cases. EUT success rates raised when considering short (< 1 cm) (16.8%), FP1 morphology (16.7%) strictures, or the combination of these characteristics (22.4%). Overall, 5 (5.2%) cases had CD ≥ III complications. FP2 (OR: 1.91, 95%CI 1.21-5.31, p = 0.03) and stricture length ≥ 1 cm (OR: 9.08, 95%CI 2.09-65.71, p = 0.009) were associated with treatment failure at MVA.
Endoscopic treatment for benign UES after RC is feasible but harbors a low success rate. Stricture length and radiological morphology of the stricture are related to endoscopic treatment failure. Surgeons should be aware of the stricture features during the preoperative decision-making process to choose the optimal candidate for endoscopic treatment.
确定根治性膀胱切除术后良性输尿管肠吻合口狭窄（UES）管理中腔内泌尿外科治疗（EUT）失败的术前预测因素，同时推广一种新的诊断和治疗途径。
我们依据一个前瞻性维护的数据库，该数据库包含1990年至2018年间在我们机构发生良性UES的96例患者（122个肾单位）。根据形态将UES分为两种不同类型：FP1（即尖锐或鸭嘴状）和FP2（即扁平或凹陷状）。记录EUT的可行性、成功率以及术中和术后并发症。单变量和多变量逻辑回归分析（MVA）评估EUT失败的预测因素。
总体而言，分别有78例（63.9%）和32例（26.3%）病例被定义为FP1和FP2。33例（27.1%）病例中EUT不可行。中位随访50（四分位间距5 - 240）个月后，仅15/122例（12.3%）获得成功治疗。考虑短（<1 cm）（16.8%）、FP1形态（16.7%）狭窄或这些特征的组合（22.4%）时，EUT成功率提高。总体而言，5例（5.2%）病例发生了≥III级并发症。FP2（比值比：1.91，95%置信区间1.21 - 5.31，p = 0.03）和狭窄长度≥1 cm（比值比：9.08，95%置信区间2.09 - 65.71，p = 0.009）在MVA中与治疗失败相关。
根治性膀胱切除术后良性UES的内镜治疗可行，但成功率较低。狭窄长度和狭窄的放射学形态与内镜治疗失败有关。外科医生在术前决策过程中应了解狭窄特征，以选择内镜治疗的最佳候选者。
