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MP21-15 FISTULOUS COMPLICATIONS FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER: ANALYSIS OF A LARGE MODERN COHORT
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
successful management of UES after an average of 2 procedures (endoscopic 13; robot-assisted revision 15; and open revision 5) (Figure 1). Only female gender (OR 0.13, 95% CI 0.03-0.56, p¼0.007) and BMI (OR 0.88, 95% CI 0.77-0.99, p¼0.05) were significant predictors of successful endoscopic management. CONCLUSIONS: None of the stricture characteristics or the cancer stage predicted successful endoscopic management of UES after RARC. Only patient-related factors (male gender and lower BMI) were associated with successful endoscopic management.
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MP21-15 FISTULOUS COMPLICATIONS FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER: ANALYSIS OF A LARGE MODERN COHORT Zachary Smith*, Riley McGinnis, Chicago, IL; VIraj Maniar, Indianapolis, IN; Gary Steinberg, Norm Smith, Chicago, IL INTRODUCTION AND OBJECTIVES: Radical cystectomy (RC) and urinary diversion carries a significant risk of postoperative morbidity, including fistula formation. We identified patients who underwent RC for bladder cancer at our institution who experienced fistulous complications and analyzed the risk factors for formation as well as their management and outcomes. METHODS: We performed a retrospective review of our institutional database and identified patients who underwent RC for bladder cancer between January 2007 and December 2015. Patients who experienced any fistulous complication were compared to those without such complication. Further chart review was carried out on all fistula patients to assess management strategies and outcomes. Those who were successfully conservatively managed were compared to those requiring surgical repair. Univariable and multivariable analyses were performed on associations with fistula formation and failure of conservative management. RESULTS: Of the 1041 patients, 31 (3.0%) experienced fistula formation. Mean time from RC to fistula presentation was 3.4 months (range 0.1-13.6). There was no difference in age, sex, race, body mass index, Charlson comorbidity score, type of urinary diversion, pathological stage, chemotherapy exposure, or radiation exposure between the two groups (all p>0.05). Of the 31 fistula patients, there were 14 (45.2%) orthotopic neobladders, 13 (41.9%) ileal conduits, and 4 (12.9%) continent catheterizable pouches. The most common types of fistulae were entero-diversion (17, 54.8%), entero-cutaneous (9, 29.0%), and diversion-cutaneous (4, 12.9%). Five (16.1%) patients experienced multiple fistulae. Conservative management was successful in 13 (41.9%) of patients, and surgical repair was required in 18 (58.1%). Of those requiring surgical repair, success was achieved in a single operation in 17 (94.4%). There were no malignant fistulae. On univariable analysis, age (p¼0.002) and Charlson comorbidity score (p¼0.029) were the only factors predictive of patients failing conservative management and requiring surgical repair, however, neither were significant on multivariable analysis (p¼0.151 and p¼0.286). CONCLUSIONS: Fistulous complications are rare after RC. They generally occur within the first few months after RC, and are most commonly between the urinary diversion and small bowel. There are no clearly identifiable risk factors for fistula formation, nor for those who fail conservative management. However, surgical repair of fistulae is generally met with a high success rate in a single operation. Source of Funding: none
MP21-16 THE ASSOCIATION BETWEEN BLOOD TYPE AND RISK OF VENOUS THROMBOEMBOLISM FOLLOWING RADICAL CYSTECTOMY Kayvan Kazerouni*, Soroush T. Bazargani, Gus Miranda, Jie Cai, Siamak Daneshmand, Hooman Djaladat, Los Angeles, CA
Source of Funding: Roswell Park Alliance foundation
INTRODUCTION AND OBJECTIVES: Venous thromboembolism (VTE) is a serious complication following radical cystectomy (RC). Several risk factors have been identified including high BMI, immobility and advanced cancer. Hematologic studies have recently found ABO blood type as a genetic risk factor for VTE. We attempted to elucidate the relationship between ABO blood type and risk of VTE post RC. METHODS: 1409 patients with urothelial bladder cancer who underwent RC (intent-to-cure) between 2003 and 2015 were identified. All these patients received VTE prophylaxis that included oral Coumadin (2003-2009), subcutaneous heparin (2009-2015), and postdischarge 4-week lovenox (2013-2015). 1341 patients had their blood
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
successful management of UES after an average of 2 procedures (endoscopic 13; robot-assisted revision 15; and open revision 5) (Figure 1). Only female gender (OR 0.13, 95% CI 0.03-0.56, p¼0.007) and BMI (OR 0.88, 95% CI 0.77-0.99, p¼0.05) were significant predictors of successful endoscopic management. CONCLUSIONS: None of the stricture characteristics or the cancer stage predicted successful endoscopic management of UES after RARC. Only patient-related factors (male gender and lower BMI) were associated with successful endoscopic management.
e253
MP21-15 FISTULOUS COMPLICATIONS FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER: ANALYSIS OF A LARGE MODERN COHORT Zachary Smith*, Riley McGinnis, Chicago, IL; VIraj Maniar, Indianapolis, IN; Gary Steinberg, Norm Smith, Chicago, IL INTRODUCTION AND OBJECTIVES: Radical cystectomy (RC) and urinary diversion carries a significant risk of postoperative morbidity, including fistula formation. We identified patients who underwent RC for bladder cancer at our institution who experienced fistulous complications and analyzed the risk factors for formation as well as their management and outcomes. METHODS: We performed a retrospective review of our institutional database and identified patients who underwent RC for bladder cancer between January 2007 and December 2015. Patients who experienced any fistulous complication were compared to those without such complication. Further chart review was carried out on all fistula patients to assess management strategies and outcomes. Those who were successfully conservatively managed were compared to those requiring surgical repair. Univariable and multivariable analyses were performed on associations with fistula formation and failure of conservative management. RESULTS: Of the 1041 patients, 31 (3.0%) experienced fistula formation. Mean time from RC to fistula presentation was 3.4 months (range 0.1-13.6). There was no difference in age, sex, race, body mass index, Charlson comorbidity score, type of urinary diversion, pathological stage, chemotherapy exposure, or radiation exposure between the two groups (all p>0.05). Of the 31 fistula patients, there were 14 (45.2%) orthotopic neobladders, 13 (41.9%) ileal conduits, and 4 (12.9%) continent catheterizable pouches. The most common types of fistulae were entero-diversion (17, 54.8%), entero-cutaneous (9, 29.0%), and diversion-cutaneous (4, 12.9%). Five (16.1%) patients experienced multiple fistulae. Conservative management was successful in 13 (41.9%) of patients, and surgical repair was required in 18 (58.1%). Of those requiring surgical repair, success was achieved in a single operation in 17 (94.4%). There were no malignant fistulae. On univariable analysis, age (p¼0.002) and Charlson comorbidity score (p¼0.029) were the only factors predictive of patients failing conservative management and requiring surgical repair, however, neither were significant on multivariable analysis (p¼0.151 and p¼0.286). CONCLUSIONS: Fistulous complications are rare after RC. They generally occur within the first few months after RC, and are most commonly between the urinary diversion and small bowel. There are no clearly identifiable risk factors for fistula formation, nor for those who fail conservative management. However, surgical repair of fistulae is generally met with a high success rate in a single operation. Source of Funding: none
MP21-16 THE ASSOCIATION BETWEEN BLOOD TYPE AND RISK OF VENOUS THROMBOEMBOLISM FOLLOWING RADICAL CYSTECTOMY Kayvan Kazerouni*, Soroush T. Bazargani, Gus Miranda, Jie Cai, Siamak Daneshmand, Hooman Djaladat, Los Angeles, CA
Source of Funding: Roswell Park Alliance foundation
INTRODUCTION AND OBJECTIVES: Venous thromboembolism (VTE) is a serious complication following radical cystectomy (RC). Several risk factors have been identified including high BMI, immobility and advanced cancer. Hematologic studies have recently found ABO blood type as a genetic risk factor for VTE. We attempted to elucidate the relationship between ABO blood type and risk of VTE post RC. METHODS: 1409 patients with urothelial bladder cancer who underwent RC (intent-to-cure) between 2003 and 2015 were identified. All these patients received VTE prophylaxis that included oral Coumadin (2003-2009), subcutaneous heparin (2009-2015), and postdischarge 4-week lovenox (2013-2015). 1341 patients had their blood