The impact of running versus interrupted anastomosis on rate of uretero-intestinal stricture following radical cystectomy

Abstract

Purpose

Benign uretero-intestinal anastomotic (UIA) stricture is not uncommon following radical cystectomy (RC) and urinary diversion. We studied the impact of running vs. interrupted technique on UIA stricture rate.

Materials and Methods

From 7/07-12/08 an interrupted end-to-side anastomosis was performed and from 1/09-7/10, a running. The primary endpoint was time to UIA stricture.

Results

258 of 266 consecutive patients were alive 30 days after RC: 149 with interrupted vs. 109 running anastomoses. The groups did not differ in age, gender, BMI, age-adjusted Charlson Comorbidity Index, receipt of chemotherapy or radiation, blood loss, operative time, diversion type, or post-operative pathology. Stricture rate per ureter was 8.5% (25/293) and 12.7% (27/213) in the interrupted vs. running groups, p=0.14. Univariate analysis suggested postoperative UTI (HR 2.1, 95% CI 1.1-4.1; p=0.04) and Clavien grade ≥3 complication (HR 2.6, 95% CI 1.4-4.9; p<0.01) were associated with UIA stricture. On multivariate analysis, postoperative UTI (HR 2.4, 95% CI 1.2-5.1; p=0.02) and running technique (HR 1.9, 95% CI 1.0-3.7; p=0.05) were associated with UIA stricture. Median times to stricture and follow-up were 289 (IQR 120-352) and 351 days (IQR 132-719) in the running vs. 213 (IQR 123-417) and 497 days (IQR 174-1289) in the interrupted cohort, with 63% (33/52) of strictures occurring within 1 year. Kaplan-Meier analysis, controlling for differential follow-up, showed a trend toward higher freedom from stricture for interrupted UIA (p=0.06).

Conclusions

Running anastomosis and postoperative UTI may be associated with uretero-intestinal anastomotic stricture. Larger series with multiple surgeons are necessary to confirm these findings.