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 analyze the risk factors for formation as well as management outcomes.
We performed a retrospective review 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 management and those who failed underwent surgical repair. Univariable and multivariable analyses were performed to identify predictors of fistula formation as well as the need for surgical repair.
Of the 1041 patients, 31 (3.0%) experienced fistula formation. Median time to fistula presentation was 31 days. Entero-diversion was the most common fistula type (54.8%), followed by entero-cutaneous (29.0%), and diversion-cutaneous (12.9%). On multivariable analyses, a history of radiation therapy (OR 3.1, p = 0.03) and orthotopic neobladder (OR 3.1, p = 0.04) were both predictors of fistula formation. Conservative management was successful in 41.9%. There were no predictors of failing conservative management. Of those requiring surgical repair, success was achieved in a single operation in 94.4%.
Fistulae are rare after radical cystectomy and are most common between the urinary diversion and small bowel. History of radiation therapy and orthotopic neobladder are risk factors for formation. When required, surgical repair is generally successful in a single operation.
The Journal of urology. 2017 Aug 28 [Epub ahead of print]
Zachary L Smith, Scott C Johnson, Shay Golan, J Riley McGinnis, Gary D Steinberg, Norm D Smith
Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA. Electronic address: ., Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA.