Faculty Collaboration Database

Fistulous Complications following Radical Cystectomy for Bladder Cancer: Analysis of a Large Modern Cohort. J Urol 2018 Mar;199(3):663-668

Date

09/02/2017

Pubmed ID

28859892

DOI

10.1016/j.juro.2017.08.095

Scopus ID

2-s2.0-85040671574 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

PURPOSE: Fistula formation is a rare and poorly described complication following radical cystectomy with urinary diversion. We sought to identify patients who experienced any type of fistulous complication and we analyzed risk factors for formation as well as management outcomes.

MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent radical cystectomy for bladder cancer at our institution. Patients who experienced any fistula were identified. Risk factors, management strategies and outcomes were analyzed. Patients underwent initial conservative treatment and those in whom this treatment failed underwent surgical repair. Univariable and multivariable analyses were performed to identify predictors of fistula formation as well as the need for surgical repair.

RESULTS: Of the 1,041 patients 31 (3.0%) experienced fistula formation. Median time to fistula presentation was 31 days. Enterodiversion was the most common fistula type, noted in 54.8% of patients, followed by enterocutaneous and diversion cutaneous treatment in 29.0% and 12.9%, respectively. On multivariable analyses a history of radiation therapy (OR 3.1, p = 0.03) and an orthotopic neobladder (OR 3.1, p = 0.04) were predictors of fistula formation. Conservative management was successful in 41.9% of cases. There were no predictors of failed conservative management. Of patients who required surgical repair success was achieved in 94.4% at a single operation.

CONCLUSIONS: Fistulas are rare after radical cystectomy and they are most common between the urinary diversion and the small bowel. A history of radiation therapy and a orthotopic neobladder are risk factors for formation. When required, surgical repair is generally successful at a single operation.

Author List

Smith ZL, Johnson SC, Golan S, McGinnis JR, Steinberg GD, Smith ND

Author

Scott C. Johnson MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Conservative Treatment
Cystectomy
Female
Follow-Up Studies
Humans
Male
Middle Aged
Postoperative Complications
Reoperation
Retrospective Studies
Treatment Outcome
Urinary Bladder Neoplasms
Urinary Fistula
Urologic Surgical Procedures