PURPOSE Ureteroenteric strictures (UESs) are a common and morbid complication of radical cystectomy and urinary diversions. UES occurs in 4% to 25% of all patients undergoing urinary diversion, and anastomotic ischemia is implicated in stricture formation. SPY fluorescence angiography is a technology that can be employed during open surgery that allows for evaluation of ureteral perfusion. MATERIALS AND METHODS We performed a prospective single-institution study of intraoperative use of SPY for ureteral assessment with a primary outcome of UES incidence compared with a cohort of historic controls prior to the use of SPY during urinary diversion at our institution. Chart abstraction was conducted to determine the presence of confirmed stricture in these patients, defined as endoscopic diagnosis or definitive imaging findings. Statistical analysis was performed using χ2 test for UES incidence. Demographic characteristics were analyzed with Wilcoxon rank sum test and χ2 test. RESULTS A total of 332 patients underwent urinary diversion during the study period. UES occurred in 31 of 277 patients (11.1%) in the control group compared with 1 of 55 patients (1.8%) enrolled in the SPY arm (P = .03). The per-ureter UES rate was 6.7% (33/582) in the control group compared with 0.9% (1/107) in the SPY group. Median follow-up in the SPY group was 17.5 months and 58.6 months in the control group. Median Charlson Comorbidity Index was 5 in the SPY group and 4 in the control group. There were no other significant demographic differences between the study groups. CONCLUSIONS SPY fluorescent angiography can be used during open urinary diversion to ensure perfusion to ureteroenteric anastomosis. Our single-institution study demonstrates a decreased incidence of UES when ureteral perfusion assessment is performed. CLINICAL TRIAL REGISTRATION NO. NCT05022199.

中文翻译：

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SPY 荧光血管造影对尿流改道术后输尿管狭窄发生率的影响。


目的 尿路肠狭窄 （UES） 是根治性膀胱切除术和尿流改道术的常见病态并发症。在所有接受尿流改道术的患者中，有 4%-25% 发生 UES，吻合口缺血与狭窄形成有关。SPY 荧光血管造影是一种可在开放手术中采用的技术，可用于评估输尿管灌注。材料和方法我们进行了一项前瞻性单机构研究，研究术中使用 SPY 进行输尿管评估，主要结果是 UES 发生率，与在我们机构尿流改道期间使用 SPY 之前的历史对照队列相比。进行图表提取以确定这些患者是否存在确诊的狭窄，定义为内窥镜诊断或明确的影像学检查结果。使用 χ2 检验对 UES 发生率进行统计分析。采用 Wilcoxon 秩和检验和 χ2 检验分析人口统计学特征。结果 研究期间共有 332 例患者接受了尿流改道术。对照组 277 名患者中有 31 名 （11.1%） 发生 UES，而 SPY 组入组的 55 名患者中有 1 名 （1.8%） 发生 UES （P = .03）。对照组每输尿管 UES 率为 6.7% （33/582），而 SPY 组为 0.9% （1/107）。SPY 组的中位随访时间为 17.5 个月，对照组为 58.6 个月。SPY 组的中位 Charlson 合并症指数为 5，对照组为 4。研究组之间没有其他显著的人口统计学差异。结论 SPY 荧光血管造影可用于开腹尿流改道术，以确保灌注至输尿管肠吻合口。 我们的单机构研究表明，进行输尿管灌注评估时 UES 的发生率降低。临床试验注册号 NCT05022199。