MP5-07 BENIGN URETEROENTERIC STRICTURE IN PATIENTS UNDERGOING RADICAL CYSTECTOMY AND URINARY DIVERSION

INTRODUCTION AND OBJECTIVES: The incidence of ureteral anastomotic strictures (UAS) after cystectomy ranges from 4-8%. We examined whether renal function and overall survival outcomes varied by operative (i.e., ureteral reimplantation) versus non-operative management approaches. METHODS: We identified patients with UAS following cystectomy and urinary diversion for any cause through our IRB-approved institutional database. Demographic, perioperative, renal function and survival data were abstracted. We compared time to stricture from initial cystectomy, renal functional outcomes, and overall survival by nonoperative versus operative management for patients with UAS. We used the Student’s t-test and chi-square testing for continuous and categorical variables, respectively. A multivariable Cox proportional hazard model was used to examine whether ureteral reimplantation was associated with improved overall survival. RESULTS: We identified 69 patients who developed benign UAS. Twenty-five patients (36.2%) were treated with ureteral reimplantation on a total of 86 obstructed renal units, 63% of cases occurred on the left. Demographic data including age at cystectomy (62.0 reimplant vs. 67.4 no reimplant, p1⁄40.06), gender (p1⁄40.92) and Charlson comorbidity (p1⁄40.08) were similar between the operative and nonoperative groups. However, Karnofsky performance status was worse in non-operative patients (p1⁄40.04). The differences between baseline and follow-up creatinine (+0.41 mg/dL reimplant vs. +0.72 mg/dL no reimplant, p1⁄40.38) and GFR (-14.7 reimplant vs. -16.7 no reimplant, mL/min/1.73 m2, p1⁄40.80) were not statistically different between groups. Two patients from the non-surgical group progressed to dialysis and 30 patients died during follow up (16.0% reimplant vs. 59.1% no reimplant, p1⁄40.001). Compared to patients with non-surgical management, patients undergoing reimplantation appeared to have better survival after adjusting for demographic factors, chemotherapy, comorbidity and performance status (Adjusted hazard ratio (aHR) 0.25, 95% CI 0.08-0.76) (Figure). CONCLUSIONS: Surgical intervention does not appear to impact renal functional outcomes in patients experiencing UAS following cystectomy. However, patients with UAS managed with nonsurgical approaches have worse overall survival after controlling for comorbidity and disease status suggesting that potential complications of non-surgical management may affect longevity.