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17.04.2020 | Original Article

Safety of decreasing ureteral stent duration following radical cystectomy

verfasst von: Hamza Beano, Jiaxian He, Caitlin Hensel, William Worrilow, William Townsend, Kris Gaston, Peter E. Clark, Stephen Riggs

Erschienen in: World Journal of Urology | Ausgabe 2/2021

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Abstract

Purpose

We aim to assess the safety of decreasing ureteral stenting duration following Radical Cystectomy with Urinary Diversion (RCUD).

Materials and methods

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.

Results

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.

Conclusion

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.

Parekh DJ, Reis IM, Castle EP et al (2018) Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet 391(10139):2525–2536CrossRef

Novara G, Catto JW, Wilson T et al (2015) Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol 67(3):376–401CrossRef

Mossanen M, Krasnow RE, Lipsitz SR et al (2018) Associations of specific postoperative complications with costs after radical cystectomy. BJU international 121(3):428–436CrossRef

Nielsen ME, Mallin K, Weaver MA et al (2014) Association of hospital volume with conditional 90-day mortality after cystectomy: an analysis of the National Cancer Data Base. BJU international 114(1):46–55CrossRef

Semerjian A, Milbar N, Kates M et al (2018) Hospital charges and length of stay following radical cystectomy in the enhanced recovery after surgery era. Urology 111:86–91CrossRef

Kim SP, Shah ND, Karnes RJ et al (2012) The implications of hospital acquired adverse events on mortality, length of stay and costs for patients undergoing radical cystectomy for bladder cancer. J Urol 187(6):2011–2017CrossRef

Davies BJ, Allareddy V, Konety BR (2009) Effect of postcystectomy infectious complications on cost, length of stay, and mortality. Urology 73(3):598–602CrossRef

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRef

Spiess PE, Agarwal N, Bangs R et al (2017) Bladder cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw JNCCN. 15(10):1240–1267CrossRef

10.

Mattei A, Birkhaeuser FD, Baermann C, Warncke SH, Studer UE (2008) To stent or not to stent perioperatively the ureteroileal anastomosis of ileal orthotopic bladder substitutes and ileal conduits? Results of a prospective randomized trial. J Urol 179(2):582–586CrossRef

11.

Clifford TG, Katebian B, Van Horn CM et al (2018) Urinary tract infections following radical cystectomy and urinary diversion: a review of 1133 patients. World J Urol 36(5):775–781CrossRef

12.

Sood A, Kachroo N, Abdollah F et al (2017) An evaluation of the timing of surgical complications following radical cystectomy: data from the American College of Surgeons National Surgical Quality Improvement Program. Urology 103:91–98CrossRef

13.

Al-Daghmin A, Aboumohamed A, Din R et al (2014) Readmission after robot-assisted radical cystectomy: outcomes and predictors at 90-day follow-up. Urology 83(2):350–356CrossRef

14.

Werntz RP, Martinez-Acevedo A, Amadi H et al (2018) Prophylactic antibiotics following radical cystectomy reduces urinary tract infections and readmission for sepsis from a urinary source. Urol Oncology. 36(5):23e231-e235

15.

Pariser JJ, Anderson BB, Pearce SM et al (2016) The effect of broader, directed antimicrobial prophylaxis including fungal coverage on perioperative infectious complications after radical cystectomy. Urol Oncol. 34(3):121e129-114CrossRef

16.

Regan JB, Barrett DM (1985) Stented versus nonstented ureteroileal anastomoses: is there a difference with regard to leak and stricture? J Urol 134(6):1101–1103CrossRef

17.

Mullins JK, Guzzo TJ, Ball MW et al (2012) Ureteral stents placed at the time of urinary diversion decreases postoperative morbidity. Urologiainternationalis 88(1):66–70

18.

Large MC, Cohn JA, Kiriluk KJ et al (2013) The impact of running versus interrupted anastomosis on ureterointestinal stricture rate after radical cystectomy. J Urol 190(3):923–927CrossRef

19.

Lobo N, Dupre S, Sahai A, Thurairaja R, Khan MS (2016) Getting out of a tight spot: an overview of ureteroenteric anastomotic strictures Nature reviews. Urology. 13(8):447–455PubMed

20.

Shah SH, Movassaghi K, Skinner D et al (2015) Ureteroenteric strictures after open radical cystectomy and urinary diversion: the university of southern california experience. Urology 86(1):87–91CrossRef

21.

Ahmed YE, Hussein AA, May PR et al (2017) Natural history, predictors and management of ureteroenteric strictures after robot assisted radical cystectomy. J Urol 198(3):567–574CrossRef

22.

Tuderti G, Brassetti A, Minisola F, Anceschi U, Ferriero M, Leonardo C et al (2019) Transnephrostomic indocyanine green-guided robotic ureteral reimplantation for benign ureteroileal strictures after robotic cystectomy and intracorporeal neobladder: step-by-step surgical technique. Perioper Funct Outcomes J Endourol 33(10):823–828

23.

Arora N, Jones S, Riggs SB (2017) Enhanced recovery after surgery: principles and application to urological surgery. AUA Update Ser 36(36):350–360

24.

Hensel C, Beano H, He J, et al (2018) Comparing intracorporeal and extracorporeal diversions following robotic radical cystectomy. In: POSTER PRESENTATION: 82nd Annual meeting of the SouthEastern Section of the AUA. March 22–25 2018. Orlando, FL, 2018

Titel: Safety of decreasing ureteral stent duration following radical cystectomy
verfasst von: Hamza Beano
Jiaxian He
Caitlin Hensel
William Worrilow
William Townsend
Kris Gaston
Peter E. Clark
Stephen Riggs
Publikationsdatum: 17.04.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 2/2021
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-020-03191-2

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Safety of decreasing ureteral stent duration following radical cystectomy