Risk Factors Analysis And Prediction Model Establishment Of Ureteroenteric Strictures After Urinary Diversion For Bladder Cancer

Objective:The clinical data of patients who underwent radical cystectomy and urinary diversion were retrospectively analyzed to explore the independent risk factors for ureteroenteric strictures,and to establish a Logistic regression prediction model to provide reference for clinical prevention of ureterointestinal anastomotic stenosis.Methods:According to the inclusion and exclusion criteria,the clinical data of 258 patients who underwent radical cystectomy and urinary diversion in our hospital from January 2014 to January 2022 were collected,including general data,preoperative laboratory and imaging data,surgery-related data and postoperative follow-up data.According to the occurrence of ureteroenteric strictures,the patients were divided into ureteroenteric strictures group and non-ureteroenteric strictures group.Univariate analysis was used to screen the factors with statistical difference(P<0.05),and multivariate analysis was used to determine the independent risk factors of ureteroenteric strictures after urinary diversion,and to establish Logistic regression prediction model and evaluate the model performance.Kaplan-Meier curve was used to analyze the relationship between the postoperative time and the incidence of ureteroenteric strictures.Results:The follow-up of 258 patients who underwent radical cystectomy and urinary diversion,32 patients occurred ureteroenteric strictures with incidence of 12.40%.Univariate analysis showed that BMI(Z=-4.322,P<0.001),hypertension(c~2=6.402,P=0.011),preoperative creatinine level(Z=-1.975,P=0.048),preoperative total cholesterol(t=-2.264,P=0.024),preoperative low-density lipoprotein cholesterol(t=-2.708,P=0.007),preoperative dilatation of urinary tube(c~2=4.090,P=0.043),and urinary tract infection within 90 days after operation(c~2=11.112,P=0.001)were related to the occurrence of ureteroenteric strictures.Multivariate Logistic regression analysis was performed to select the factors with statistical significance in univariate analysis,and the results showed BMI,preoperative creatinine,preoperative low-density lipoprotein cholesterol and urinary tract infection within 90 days after operation were independent risk factors for ureteroenteric strictures(P<0.05 and OR>1).The prediction model obtained by regression equation was Logit(P)=-12.845+0.320×BMI+0.011×preoperative creatinine+0.612×preoperative low-density lipoprotein cholesterol+1.525X(X=1 is urinary tract infection within 90days after surgery,otherwise it is 0).Hosmer and Lemeshow test of this model showed that P=0.563 and area under ROC curve was 0.787,95%CI(0.699～0.874),P<0.001.Kaplan-Meier analysis showed that ureteroenteric strictures occurred mainly within 2 years after urinary diversion and the median diagnostic time was 5.4(1.6～41.2)months.Conclusion(s):1.Ureteroenteric strictures is an important late complication after radical cystectomy and urinary diversion.In this study.the incidence of ureteroenteric strictures was 12.40%.Most of them occurred within 2 years after urinary diversion;2.BMI,preoperative creatinine,low density lipoprotein cholesterol and urinary tract infection within 90 days after operation are independent risk factors for ureteroenteric strictures after urinary diversion for bladder cancer.3.The risk prediction model established in this study can better predict the risk of ureteroenteric strictures.