Is The Incidence Of Uretero-Intestinal Anastomotic Stricture Increased In Patients Undergoing Radical Cystectomy With Previous Pelvic Radiation?

Main Category: Urology / Nephrology
Also Included In: Radiology / Nuclear Medicine;  Cancer / Oncology;  GastroIntestinal / Gastroenterology
Article Date: 01 Dec 2009 - 2:00 PDT

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UroToday.com - In the online edition of the British Journal of Urology, the Department of Urology at the University of Miami reported on the impact of prior pelvic radiotherapy (XRT) on the occurrence of uretero-intestinal anastomosis (UIA) stricture at subsequent urinary diversion.

Pelvic XRT can potentially affect small blood vessels and induce tissue fibrosis. In patients who have not had prior pelvic XRT, the incidence of UIA stricture with urinary diversion ranges from 1% to 9%. This patient cohort was retrospectively identified at the University of Miami from 1992 to 2008. A total of 526 patients were identified, and of these, 65 had prior pelvic XRT (group 1, 12.5%) and 461 had no prior XRT (group 2, 87.5%). In group 1, XRT was given to 37 men for prostate cancer, 23 patients for bladder cancer, 4 women for endometrial/cervical cancer and one for common cancer. The mean ages were 74 years and 68 years for groups 1 and 2, respectively. The mean interval between XRT and urinary diversion was 74 months. All group 1 patients had an ileal conduit constructed and Bricker-type refluxing UIA was standard. In group 2, 250 had an ileal conduit and 211 had a neobladder. Two patients in group 2 had a urinary leak that resolved without intervention. One of these later developed a stricture. Each UIA was considered a unit at risk, thus there were 130 UIA for evaluation in group 1 and 922 units in group 2. The total UIA stricture rate was 1.3% (12/1052). There were two UIA strictures in group 1 (1.5%) and 12 in group 2 (1.3%). If only group 2 patients who had an ileal conduit performed were considered, there were 8/500 UIA strictures (1.6%), which was not statistically significant. The mean time to UIA stricture diagnosis was 10 months.

This study does not support prior pelvic XRT as resulting in an increased UIA stricture rate at the time of subsequent urinary diversion.

Katkoori D, Samavedi S, Adiyat KT, Soloway MS, Manoharan M

BJU Int. 2009 Sep 2. Epub ahead of print.
doi:10.1111/j.1464-410X.2009.08835.x

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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