ArticleThe Canadian journal of urology2026
Uretero-enteric strictures after cystectomy: revealing the modifiable risk factors.
Article in The Canadian journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesUretero-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).
methodsWe 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.
resultsStrictures 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], p = 0.004), elevated creatinine (OR = 1.30 per 10 µmol/L increase, 95% CI [1.05-1.61], p = 0.018), prior myocardial infarction (OR = 2.25, 95% CI [1.10-4.62], p = 0.027), and postoperative urinary tract infection (OR = 3.10, 95% CI [1.65-5.82], p < 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, p = 0.12). Stricture rates fell markedly after 20 robotic cases per surgeon (23.8% vs. 12.1%).
conclusionUretero-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.
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