Etiology, evaluation, and management of hematuria following radical cystectomy and orthotopic urinary diversion

You have accessJournal of UrologyCME1 Apr 2023MP56-20 ETIOLOGY, EVALUATION, AND MANAGEMENT OF HEMATURIA FOLLOWING RADICAL CYSTECTOMY AND ORTHOTOPIC URINARY DIVERSION Daniel I. Sanford, Muhannad Alsyouf, Sanam Ladi-Seyedian, Kevin Wayne, Alireza Ghoreifi, Anne Schuckman, Hooman Djaladat, and Siamak Daneshmand Daniel I. SanfordDaniel I. Sanford More articles by this author , Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Sanam Ladi-SeyedianSanam Ladi-Seyedian More articles by this author , Kevin WayneKevin Wayne More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Up to 20% of patients presenting with gross hematuria have underlying urologic malignancy. In patients with orthotopic neobladder (ONB) following cystectomy, the occurrence of hematuria at follow-up has not been evaluated. Here, we assessed the etiology, evaluation, and subsequent management of patients who developed hematuria following ONB diversion. METHODS: All patients who underwent radical cystectomy and ONB between 2017-2022 and who subsequently underwent cystoscopy for hematuria were identified. Patient demographics, cystoscopy reports, cytology findings, and relevant imaging were reviewed to determine the etiology of hematuria and subsequent management. Causes of hematuria were categorized as recurrence, anticoagulation-related, inflammation/infection, or undetermined. A univariate analysis was performed to identify factors predictive of oncologic recurrence presenting with hematuria. RESULTS: Of 55 patients with ONB who underwent subsequent cystoscopy on follow-up, hematuria was the indication in 24 (44%) patients (Table 1a). Median patient age was 71 (IQR 66-74) years. Seven patients (29%) had hematuria secondary to cancer recurrence, including four with urethral recurrence, one with ureteral recurrence, and two with positive urine cytology. Other etiologies of hematuria included anticoagulation (13%), pouchitis (13%), mesh erosion into neobladder (4%), and bladder inflammation (4%). Nine patients (37%) had an undetermined cause of hematuria. In patients with recurrence, median time from cystectomy to development of hematuria was 20.1 (15.6–32.8) months. Positive surgical margins were associated with cancer recurrence in our cohort (p<0.05) (Table 1b). CONCLUSIONS: The majority of patients presenting with gross hematuria following radical cystectomy and ONB have benign etiology, yet up to one-third of patients will have underlying malignancy. A thorough evaluation is required for all patients, especially those with positive surgical margins. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e783 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel I. Sanford More articles by this author Muhannad Alsyouf More articles by this author Sanam Ladi-Seyedian More articles by this author Kevin Wayne More articles by this author Alireza Ghoreifi More articles by this author Anne Schuckman More articles by this author Hooman Djaladat More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...