Department of Urology, University of Virginia Medical Center, Charlottesville, Virginia.
J Urol. 2024 Dec;212(6):844-850. doi: 10.1097/JU.0000000000004198. Epub 2024 Aug 20.
Ureteroenteric strictures (UESs) are a common and morbid complication of radical cystectomy and urinary diversions. UES occurs in 4% to 25% of all patients undergoing urinary diversion, and anastomotic ischemia is implicated in stricture formation. SPY fluorescence angiography is a technology that can be employed during open surgery that allows for evaluation of ureteral perfusion.
We performed a prospective single-institution study of intraoperative use of SPY for ureteral assessment with a primary outcome of UES incidence compared with a cohort of historic controls prior to the use of SPY during urinary diversion at our institution. Chart abstraction was conducted to determine the presence of confirmed stricture in these patients, defined as endoscopic diagnosis or definitive imaging findings. Statistical analysis was performed using χ test for UES incidence. Demographic characteristics were analyzed with Wilcoxon rank sum test and χ test.
A total of 332 patients underwent urinary diversion during the study period. UES occurred in 31 of 277 patients (11.1%) in the control group compared with 1 of 55 patients (1.8%) enrolled in the SPY arm ( = .03). The per-ureter UES rate was 6.7% (33/582) in the control group compared with 0.9% (1/107) in the SPY group. Median follow-up in the SPY group was 17.5 months and 58.6 months in the control group. Median Charlson Comorbidity Index was 5 in the SPY group and 4 in the control group. There were no other significant demographic differences between the study groups.
SPY fluorescent angiography can be used during open urinary diversion to ensure perfusion to ureteroenteric anastomosis. Our single-institution study demonstrates a decreased incidence of UES when ureteral perfusion assessment is performed.
CLINICAL TRIAL REGISTRATION NO.: NCT05022199.
输尿管-肠吻合口狭窄（UES）是根治性膀胱切除术和尿流改道的常见且严重的并发症。UES 发生在所有接受尿流改道的患者的 4%至 25%，吻合口缺血与狭窄形成有关。SPY 荧光血管造影是一种可在开放手术中使用的技术，可用于评估输尿管灌注。
我们进行了一项前瞻性单机构研究，即在我院进行尿流改道时，使用 SPY 对输尿管进行术中评估，主要结局是与之前未使用 SPY 时的历史对照队列相比，UES 的发生率。通过图表摘录确定这些患者中是否存在确认的狭窄，定义为内镜诊断或明确的影像学发现。使用 χ 检验比较 UES 发生率进行统计学分析。使用 Wilcoxon 秩和检验和 χ 检验分析人口统计学特征。
在研究期间，共有 332 例患者接受了尿流改道。对照组 277 例患者中有 31 例（11.1%）发生 UES，SPY 组 55 例患者中有 1 例（1.8%）（ =.03）。对照组 582 个输尿管中 UES 发生率为 6.7%（33/582），SPY 组 107 个输尿管中发生率为 0.9%（1/107）。SPY 组的中位随访时间为 17.5 个月，对照组为 58.6 个月。SPY 组的 Charlson 合并症指数中位数为 5，对照组为 4。两组间无其他显著的人口统计学差异。
SPY 荧光血管造影可用于开放尿流改道，以确保输尿管-肠吻合口的灌注。我们的单机构研究表明，当进行输尿管灌注评估时，UES 的发生率降低。
NCT05022199。
