EAU 2018: Treating Benign Ureteroenteric Strictures: 27-year Experience Comparing Endo-Urological Techniques With Open Surgical Approach
Dr. M. J. Van Son (MD) from University Medical Center Utrecht Department of Radiotherapy from Utrecht, Netherlands presents a retrospective analysis of all patients treated for UES at their institution from 1989 to 2016. More specifically, 173 completed procedures were analyzed in 79 patients and technique (i.e. open revisions vs. endourologic revisions) was compared with regard to patient outcomes of patency, duration, and secondary intervention.
Of the 173 procedures accomplished, there were 26 (15.0%) open revisions and 147 (85.0%) endourologic revisions in 51 male versus 28 female patients. 64 (81%) patients underwent diversion via ileal conduit, while 9 (11.4%), 5 (6.3%), and 1 (1.3%) were performed via Indiana pouch, orthotopic neobladder, and colon conduit, respectively.
In the endourologic treatment group, 5.4% and 2.7% of patients experienced Clavien-Dindo 1-2 and Clavien-Dindo 3 complications, respectively. In comparison, the open treatment group had 26.9% and 11.5% of patients with Clavien-Dindo 1-2 and Clavien-Dindo 3 complications, respectively (p<0.01). The mean eGFR improved +8.1 in the endourologic group and +17 in the open group (p=0.03). At a median follow-up of 60 months, 6% of patients in the endourologic group experienced renal function deterioration as compared to 7.7% of patients in the open group.
In terms of technical successes in addressing UES, open surgery appears to be superior to endourologic procedures. In discussion, Dr. Van Son addressed endourologic procedures as a possible alternative to avoid the morbidities associated with open surgeries – especially since only 13% of patients who underwent primary endo-treatment required a secondary open surgery. Similarly, the median postoperative hospital stay was significantly less for the endo-treatment group (2 days vs. 14 days).
Some factors to consider when assessing a patient for endo-treatment vs. open surgery, then, include more advanced age, worse ASA score, higher BMI, history of chemotherapy, history of pelvic radiation therapy, and worse kidney function – all of which were independent predictors of treatment successes in multivariable regression modeling.
Presenter: M. J. Van Son
Authors: Van Son M.J. 1 , Lock T. 2 , Fransen Van De Putte E. 3 , Peters M. 1 , Meijer R. 2
Written by: Linda M. Huynh, B.S, University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark