INTRODUCTION AND OBJECTIVES: The development of a ureterointestinal anastomotic (UIA) stricture has been reported in up to 15% of patients undergoing radical cystectomy (RC) with urinary diversion. The vast majority of these strictures are the result of ischemia (benign). Herein, we characterized the incidence, risk factors, and outcomes of patients with malignant UIA strictures. METHODS: We identified 2,523 patients who underwent RC at our institution from 1980-20009, among whom 232 (9.2%) were subsequently diagnosed with a UIA stricture. Of these, 16.4% (38/232) were malignant strictures, confirmed pathologically in all cases by cytology and/or excision. Fisher's exact test and chi-square test were used to evaluate comparative clinicopathological outcomes, while survival was estimated using the Kaplan-Meier method. RESULTS: Median postoperative followup was 9.3 years (IQR 6.2, 20.2). Median time from RC to diagnosis for malignant versus benign strictures was 32.4 months versus 7.2 months, respectively (p<0.000001). Seventy-nine percent of malignant strictures were symptomatic at presentation, and in particular patients with a malignant stricture were significantly more likely to present with gross hematuria compared to patients with a benign stricture (29% vs 6%; p<0.000001). A total of 10 patients with a malignant stricture (26%) were diagnosed with synchronous distant metastatic disease. Patients who developed a malignant stricture were significantly more likely to have CIS on the initial ureteral margin during RC (25% vs 7.3%; p=0.0001), as well as a final pathologic stage of CIS (50% vs 18.4%, p<.000001) or non-muscleinvasive disease (71.1% vs 45.9%, p=0.002) compared to those who did not develop a malignant stricture. More than half (22/38; 58%) of patients with a malignant stricture were managed with open excision. A total of 32 patients with a malignant UIA stricture died during follow-up, including 26 who died of urothelial carcinoma. Following malignant stricture diagnosis, 5- and 10- year cancer specific survival was 30% and 20%, respectively, while overall survival was 23% and 16%. CONCLUSIONS: Malignant strictures are uncommon after RC. Most patients are symptomatic, frequently with gross hematuria. Carcinoma in situ at RC is associated with a significantly increased risk of developing a malignant stricture. Notably, malignant strictures present significantly later than benign strictures, underscoring the importance of continued patient follow-up.
Westerman, M. E., Viers, B. R., Karnes, R. J., Tarrell, R., Thapa, P., Thompson, R. H., … Boorjian, S. A. (2016). PD12-04 MALIGNANT URETEROINTESTINAL ANASTOMOTIC STRICTURE FOLLOWING RADICAL CYSTECTOMY: PATTERNS, RISK FACTORS, AND OUTCOMES. Journal of Urology, 195(4S). https://doi.org/10.1016/j.juro.2016.02.899