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UPJ INSIGHT Lower Ureteroenteric Strictures After Stent-Free Ureteroenteric Anastomosis
By: Abdul Wasay Mahmood, MD; Roswell Park Comprehensive Cancer Center, Buffalo, New York, Ali Ahmad, BS; Roswell Park Comprehensive Cancer Center, Buffalo, New York, Muhsinah Howlader, BS; Roswell Park Comprehensive Cancer Center, Buffalo, New York, Zachary Plecas, BS; Roswell Park Comprehensive Cancer Center, Buffalo, New York, Daniel Sullivan, BS; Roswell Park Comprehensive Cancer Center, Buffalo, New York, Grace Harrington, BS; Roswell Park Comprehensive Cancer Center, Buffalo, New York, Zhe Jing, MD, MS, MPH; Roswell Park Comprehensive Cancer Center, Buffalo, New York, Qiang Li, MD, PhD; Roswell Park Comprehensive Cancer Center, Buffalo, New York, Ahmed A. Hussein, MD; Roswell Park Comprehensive Cancer Center, Buffalo, New York, Khurshid A. Guru, MD; Roswell Park Comprehensive Cancer Center, Buffalo, New York | Posted on: 17 Jul 2024
Mahmood AW, Ahmad A, Howlader M, et al. Is stent-free ureteroenteric anastomosis associated with lower ureteroenteric strictures after robot-assisted radical cystectomy and ileal conduit?. Urol Pract. 2024;11(4):753-759. doi:10.1097/UPJ.0000000000000597
Study Need and Importance
The choice of urinary diversion techniques post robot-assisted radical cystectomy (RARC) remains pivotal, with ureteroenteric strictures (UES) posing significant postoperative challenges. While ureteral stents were conventionally used to mitigate complications, recent discourse challenges their efficacy, necessitating a reevaluation of their role.
What We Found
Analyzing perioperative outcomes of RARC patients, our study revealed a notable difference in UES rates between those with stented and stent-free ureteroenteric anastomosis. Stent-free approaches exhibited significantly lower UES occurrences, emphasizing their potential superiority in minimizing postoperative complications (Figure).
Limitations
Despite meticulous propensity score matching and a comprehensive retrospective review, our study has limitations. Variability in surgical techniques over the study period and surgeon discretion in stent placement may introduce biases. Additionally, the exclusion of neobladder patients and the relatively small sample size limit the generalizability of our findings.
Interpretation for Patient Care
Our findings suggest a paradigm shift in urinary diversion post RARC, favoring the stent-free approach for its potential to reduce UES incidence. Surgeons should consider this evidence when making decisions regarding stent placement, prioritizing patient outcomes and long-term postoperative care. However, further prospective studies are warranted to validate these findings and establish standardized guidelines for optimal patient management.
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