Urologic oncology · 2025
Benign ureteroenteric anastomotic stricture predictors in radical cystectomy patients: A critical analysis focusing on the nutritional risk index and postoperative urinary tract infection.
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Citgez Sinharib, Bulbul Emre, Ozden Sami Berk, Ilki Fahri Yavuz, Yildiz Fatih, Vural Ahmet, Demirdag Cetin
Аннотация
OBJECTIVE: To investigate preoperative, surgery-related, and postoperative parameters in terms of their ability to predict benign ureteroenteric anastomotic strictures (UAS) after radical cystectomy (RC).
METHODS: The clinical data of patients who underwent RC between January 2016 and December 2022 at a tertiary referral center were retrospectively collected. A total of 79 RC patients who met the inclusion criteria were included in the study. The patients were divided into 2 groups during postoperative follow-up: those who developed UAS and those who did not develop UAS.
RESULTS: UAS developed in 20 (25.3%) patients after RC, while 59 (74.7%) patients did not develop UAS. The median follow-up times of the UAS and non-UAS groups were 38 (interquartile range: 12-69) and 35 (12-64) months, respectively (P = 0.242). The mean Nutritional Risk Index (NRI) scores of the UAS and non-UAS groups were 79±9.8 and 89.8 ± 13.8, respectively (P = 0.002). Multivariate analysis identified several independent predictors of UAS. The presence of an American Society of Anesthesiologists (ASA) IV classification (P < 0.001), preoperative hydronephrosis (P = 0.039), NRI score (P = 0.019), and postoperative urinary tract infection (UTI) (P = 0.016) were significant predictors of postoperative UAS. The optimal cut-off value of the NRI was determined to be 83.05, with an area under the curve of 0.731 at this cut-off.
CONCLUSIONS: Postoperative UTI, presence of ASA IV, and preoperative hydronephrosis were identified as independent risk factors for UAS development after RC. The NRI score was lower in patients with UAS than in those without UAS. Poor nutritional status in patients undergoing RC may contribute to an increased risk of UAS development.
METHODS: The clinical data of patients who underwent RC between January 2016 and December 2022 at a tertiary referral center were retrospectively collected. A total of 79 RC patients who met the inclusion criteria were included in the study. The patients were divided into 2 groups during postoperative follow-up: those who developed UAS and those who did not develop UAS.
RESULTS: UAS developed in 20 (25.3%) patients after RC, while 59 (74.7%) patients did not develop UAS. The median follow-up times of the UAS and non-UAS groups were 38 (interquartile range: 12-69) and 35 (12-64) months, respectively (P = 0.242). The mean Nutritional Risk Index (NRI) scores of the UAS and non-UAS groups were 79±9.8 and 89.8 ± 13.8, respectively (P = 0.002). Multivariate analysis identified several independent predictors of UAS. The presence of an American Society of Anesthesiologists (ASA) IV classification (P < 0.001), preoperative hydronephrosis (P = 0.039), NRI score (P = 0.019), and postoperative urinary tract infection (UTI) (P = 0.016) were significant predictors of postoperative UAS. The optimal cut-off value of the NRI was determined to be 83.05, with an area under the curve of 0.731 at this cut-off.
CONCLUSIONS: Postoperative UTI, presence of ASA IV, and preoperative hydronephrosis were identified as independent risk factors for UAS development after RC. The NRI score was lower in patients with UAS than in those without UAS. Poor nutritional status in patients undergoing RC may contribute to an increased risk of UAS development.