Smith ZL, et al. – The objective of this research was to distinguish patients who experienced any type of fistulous complication and analyze the risk factors for formation as well as management outcomes. It was demonstrated that fistulae are rare after radical cystectomy and are most common between the urinary diversion and small bowel. Moreover, history of radiation therapy and orthotopic neobladder are risk factors for formation. In addition, surgical repair is generally successful in a single operation when needed.

Methods

• Researchers conducted a retrospective review of patients who underwent radical cystectomy for bladder cancer at their institution.
• They distinguished patients who experienced any fistula.
• They examined risk factors, management strategies, and outcomes.
• In this study, patients underwent initial conservative management and those who failed underwent surgical repair.
• They conducted univariable and multivariable analyses to distinguish predictors of fistula formation as well as the need for surgical repair.

Results

• As per the data, 31 (3.0%) experienced fistula formation out of the 1041 patients.
• 31 days were the median time to fistula preservation..
• They found that 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.
• In 41.9%., conservative management was successful.
• No predictors of failing conservative management were observed.
• Remarkably, of those requiring surgical repair, success was achieved in a single operation in 94.4%.