Introduction:

Radical cystectomy with urinary diversion is a procedure known to have a high complication rate, which can include ureteral-enteric stricture. There are variations in surgical technique especially involving placement and duration of indwelling ureteral stents after urinary diversion. We sought to examine the association of stent duration with ureteral anastomosis stricture rates among patients undergoing radical cystectomy with urinary diversion.

Methods:

We retrospectively identified 117 patients between February 2020 and July 2021 who underwent radical cystectomy with urinary diversion for bladder cancer. Stent duration was stratified into two groups: greater than 10 days and less than 10 days. 30 and 90-day readmissions and complications were recorded including urine leak, pyelonephritis, urosepsis, ileus, and small bowel obstruction. Chi-square and Fisher’s exact test were used to assess differences between groups. For continuous variables, Mann-Whitney or Students T-Test were used as appropriate.

Results:

Of the 117 patients, 45 patients had ureteral stent duration of more than 10 days and 72 had stent duration for less than 10 days. There was no significant difference between ureteral-enteric stricture rates with shorter stent duration (16% for >10 day vs 14% <10 day, p =0.794). However, there was a significant decrease in the development of urosepsis (p=0.031) within 30 days of cystectomy with the shorter duration of stent. Additionally, there was a significant decrease in 90-day readmissions with earlier post-operative stent removal (38% with >10 day stent duration vs 8% with <10 days, p=0.016). Complication rates for both 30- and 90-days were also significantly lower with shorter stent duration. Urine leak in 30 days was higher with longer stent duration (11% >10 days vs 0%, p=0.01). There were no other significant differences in any of the other complications between the three groups.

Conclusion:

There was no significant difference in ureteral-enteric anastomotic stricture rates when maintaining indwelling ureteral stent for shorter duration after radical cystectomy with urinary diversion. Shorter ureteral stent duration was associated with a significant decrease in the overall 30-day urosepsis rate and 90-day complication and readmissions. This suggests that shorter ureteral stent duration is associated with decreased complications and readmissions without impacting ureteral stricture rate. Elevated rate of urine leak within 30 days with longer stent duration was thought to be due to ureteral stents not being removed once a urine leak was identified. Further investigation is required to evaluate ideal ureteral stent duration after cystectomy.

Funding: N/A