@Article{cju.2025.069546,
AUTHOR = {Abdelkader Akkad, Franck Bruyere, Ali Bourgi},
TITLE = {Uretero-enteric strictures after cystectomy: revealing the modifiable risk factors},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {33},
YEAR = {2026},
NUMBER = {1},
PAGES = {155--163},
URL = {http://www.techscience.com/CJU/v33n1/66451},
ISSN = {1488-5581},
ABSTRACT = { <b>Objectives:</b> Uretero-enteric strictures are feared complications following cystectomy. Despite surgical advancements, particularly the rise of robot-assisted approaches, the risk factors associated with these strictures remain poorly defined. This study aimed to identify the risk factors associated with uretero-enteric anastomotic strictures after cystectomy, according to the surgical approach and type of urinary diversion (extracorporeal vs. intracorporeal). <b>Methods:</b> We conducted a single-center retrospective study including 340 patients who underwent cystectomy between 2016 and 2024 at Tours University Hospital. Clinical, biological, perioperative, and postoperative data were analyzed. The occurrence of a uretero-ileal anastomotic stricture was defined radiologically by a uretero-hydronephrosis ≥20 mm. We constructed and analyzed a learning curve for robotic surgery with intracorporeal urinary diversion. <b>Results:</b> Strictures occurred in 60 patients (17.6%). On multivariable analysis, reduced preoperative glomerular filtration rate (odds ratio [OR] = 1.45 per 10 mL/min decrease, 95% CI [1.12–1.87], <i>p</i> = 0.004), elevated creatinine (OR = 1.30 per 10 µmol/L increase, 95% CI [1.05–1.61], <i>p</i> = 0.018), prior myocardial infarction (OR = 2.25, 95% CI [1.10–4.62], <i>p</i> = 0.027), and postoperative urinary tract infection (OR = 3.10, 95% CI [1.65–5.82], <i>p</i> &lt; 0.001) were independent predictors. Most strictures were left-sided. Intracorporeal robotic diversion had a higher, though non-significant, stricture rate (21.5% vs. 15.2%, OR = 1.52, <i>p</i> = 0.12). Stricture rates fell markedly after 20 robotic cases per surgeon (23.8% vs. 12.1%). <b>Conclusion:</b> Uretero-enteric strictures are multifactorial, strongly influenced by baseline renal function, cardiovascular comorbidity, and postoperative infection. Robotic intracorporeal diversion shows a learning curve effect, underlining the importance of surgical expertise and infection prevention in reducing risk.},
DOI = {10.32604/cju.2025.069546}
}