Table 1.
Studies discussed risk factors associated with ureteroenteric stricture development.
| Authors, year | Patients No. | Type of diversion | Technique of ureteroenteric anastomosis | UES Incidence |
Median Follow-up |
Median time to diagnosis | Affected side | Presentation | Risk factors for stricture |
|---|---|---|---|---|---|---|---|---|---|
| Liu et al. 2022 [22] | 180 -ORC:75 -RARC:105 |
IC and ONB | Bricker and Wallace | 12.2% | NR | 11 mo. | Left: 45.4% Right: 40.9% Bilateral: 13.6% |
NR | Blood transfusion (HR 0.144, 95% CI: 0.046–0.451; P = 0.001) Extracorporeal diversion (HR 3.39, 95%CI: 1.24–9.28, P = 0.017) Postoperative UTI (HR 3.62, 95% CI: 1.4–9.3,P = 0.007) |
| Krafft et al. 2021 [23] |
135 | IC, ONB and CCD | Bricker and Wallace | 15.5% | 14 mo. | 3 mo. | Left: 47.6% Right: 9.5% Bilateral: 42% |
NR | Preoperative chemotherapy (OR 9.7, 95%CI:2–46.2; P = 0.004) Clavien ≥3 complication (OR 4, 95%CI: 1.36–11.82, P = 0.012) |
| Reesink et al. 2021 [24] | 279 -ORC:192 -RARC (ICUD):87 |
IC and ONB | Bricker | 17% -ORC: 13% -RARC:25.3% |
50 mo. | 3 mo. | Left: 48.9% Right: 21.3% Bilateral: 29.8% |
Symptomatic (40.4%) | RARC (HR 2.36, 95% CI: 1.32–4.2; P = 0.004) |
| Faraj et al. 2021 [25] |
573 -ORC:337 -RARC (ICUD):39 -RARC (ECUD):197 |
IC and ONB | Bricker and Wallace | 8.2% -ORC:8% -RARC (ICUD):1.6% -RARC (ECUD):9.6% |
ORC:55 mo. RARC (ICUD):71 mo. RARC (ECUD):70 mo. |
5 mo. | Left: 51.1% Right: 44.7% Bilateral: 4.3% |
Symptomatic (98%) | BMI (HR 1.07, 95% CI: 1.02–1.13; P = 0.003). |
| Ericson et al. 2020 [26] |
968 -ORC:279 -RARC (ICUD):307 -RARC (ECUD):382 |
IC, ONB and CCD | Bricker | 11.3% -ORC:9.3% -RARC (ICUD):13% -RARC (ECUD):11.3% |
ORC:22 mo. RARC (ICUD):16.3 mo. RARC (ECUD):10.6 mo. |
4.67 mo. | Left: 50.5% Right: 31.2% Bilateral: 17.4% |
NR | RARC (ICUD) (HR 1.66, 95% CI: 1–2.74,p = 0.05) BMI (HR 1.05, 95% CI: 1.02–1.09; P < 0.01). |
| Yang et al, 2020 [12] |
2.285 | IC and ONB | Bricker and Wallace | 8% | 10.7 years | 7 mo. | Left: 53% Right: 28% Bilateral: 18% |
Symptomatic (77%) | BMI (OR 1.06, 95% CI: 1.02–1.09;P = 0.0009). Clavien ≥3 complication (OR 2.85, 95%CI: 1.90–4.28; P < 0.0001) |
| Benson et al, 2020 [13] | 418 | ONB | NR | 8.9% | Mean: 57 mo. | Mean time: 15.8 mo. | Left: 65% Right: 27% Bilateral: 14% |
NR | Perioperative UTI (HR 2.4, 95% CI 1.09–5.09, p = 0.03) Recurrent UTI (HR 5.1, 95% CI 2.4–11,p < 0.001) History of RT (HR 11.5, 95% CI 2.5–53.4,p = 0.002) |
| Goh et al, 2019 [14] |
1781 -ORC:1449 -RARC:332 |
Continent and incontinent UD | NR | ORC: 8.3% RARC: 13.9% |
At 2 years | NR | NR | NR | RARC (HR 1.64, 95%CI 1.23–2.19) Preoperative hydronephrosis (HR 1.51, 95%CI 1.17–1.94) |
| Hosseini et al, 2018 [15] | 371 (RARC +ICUD) | IC and ONB | Wallace | 6.5% | 33 mo. | 165 d. | Left: 63% Right: 29% Bilateral: 8% |
NR | Urinary leak (HR 5.17, 95% CI 1.85–14.41,p = .002) |
| Katherine et al, 2018 [16] | 2.888 | Continent and incontinent UD | NR | 4.2% | 32 mo. | NR (80% within 1st 3 years) |
Left: 53.6% Right: 40.6% Bilateral: 5.7% |
Symptomatic (76.4%) | BMI (HR 1.04, 95% CI 1.01–107, p < 0.0001) Male gender (HR 1.81, 95% CI 1.13–2.91,p = 0.014) Prior abdominal surgery (HR 3.40, 95%CI 1.84–6.28, p = 0.013) ASA III/IV (HR 1.88, 95% CI 1.2–2.9, p = 0.005) |
| Ahmed et al, 2017 [17] |
440 (RARC) | IC | Bricker | 13% | 17 mo. | 5 mo. | Left: 45% Right: 29% Bilateral: 25% |
Symptomatic (25%) | BMI (OR 1.07, 95% CI 1.01–1.13, p = 0.02) ICUD (OR 3.28, 95% CI 1.41–7.61, p = 0.006) UTI (OR 2.68, 95% CI 1.31–5.49, p = 0.007) Urinary leak (OR 3.85, 95% CI 1.05–14.1,p = 0.04) Length of the right resected ureter (OR 0.66, 95% CI 0.50–0.88, p = 0.004) ≥ 30 d eGFR (OR 0.85, 95%CI 0.74–0.98,p = 0.03) |
| Shah et al, 2015 [18] |
1964 | IC, ONB and CCD | Bricker | 2.6% | 12.4 years | 10 mo. | Left: 66% Right: 29% Bilateral: 5% |
Symptomatic (70%) |
No independent predictor for stricture |
| Richards, 2014 [19] | 463 -ORC: 439 -RARC: 24 |
IC and ONB | Bricker | 12.5% | 459 d. | Right ureter: 235 d. Left ureter: 232 d. |
Left: 56.9% Right: 24.1% Bilateral: 19% |
NR | Clavien ≥3 complication (HR2.11,1.01–4.40) Urine leak (HR 3.37, 1.08–10.46) |
| Anderson et al, 2013 [20] | 478 -ORC:375 -RARC:103 |
IC, ONB and CCD | Bricker | ORC: 8.5% RARC: 12.6% |
8.2 mo. | 5.3 mo. | Left: 42.2% Right: 24.4% Bilateral: 33.3% |
NR | No independent predictor for stricture |
| Large et al, 2013 [21] |
258 | IC and ONB | Bricker | 16.6% | -Running sututres gp: 351 d. -Interrupted sututresgp: 497 d. |
-Running sututres gp: 289 d. -Interrupted sututres gp.: 213 days |
Left: 46.5% Right: 34.8% Bilateral: 18.6% |
NR | Postoperative UTI (HR 2.4, 95% CI 1.2–5.1, p = 0.02) Running technique (HR 1.9, 95% CI 1.0–3.7,p = 0.05) |
IC= Ileal conduit; ONB=Orthotopic neobladder; BMI=Body mass index; ORC=open radical cystectomy; RARC=Robotic-assisted radical cystectomy; UD=Urinary diversion; ICUD=Intracorporeal urinary diversion; UTI=Urinary tract infection; RT=Radiotherapy; NR=Not reported.