Ureteroileal bypass: a new technic to treat ureteroenteric strictures in urinary diversion

Abstract

Objective:To present our technique of ureteroileal bypass to treat uretero-enteric stric- tures in urinary diversion.Materials and Methods:One hundred and forty-one medical records were reviewed from patients submitted to radical cystectomy to treat muscle-invasive bladder cancer between 2013 and 2015. Twelve (8.5%) patients developed uretero-enteric anastomotic stricture during follow-up. Five patients were treated with endoscopic dilatation and double J placement. Four were treated surgically with standard terminal-lateral im- plantation. Three patients with uretero-enteric anastomotic stricture were treated at our institution by “ureteroileal bypass”, one of them was treated with robotic surgery.Results:All patients had the diagnosis of uretero-enteric anastomotic stricture via computerized tomography and DTPA renal scan. Time between cystectomy and diag- nosis of uretero-enteric anastomotic stricture varied from five months to three years. Mean operative time was 120±17.9 minutes (98 to 142 min) and hospital stay was 3.3±0.62 days (3 to 4 days). Mean follow-up was 24±39.5 months (6 to 72 months). During follow-up, all patients were asymptomatic and presented improvement in ure-terohydronephrosis. Serum creatinine of all patients had been stable.Conclusions:Latero-lateral ureter re-implantation is feasible by open or even robotic surgery with positive results, reasonable operation time, and without complications.

A new technique in the treatment of ureteroenteric anastomosis stricture: Repair of ureteroenteric anastomosis stricture with low lombotomy incision (retroperitoneal approach)

“…Successful medium‐term results were achieved with favourable perioperative results in a new technique where the stricture was excised without excision of the dilated ureter and the intestinal segment with a proximal latero‐lateral anastomosis. The long mean operation time (120 ± 17.9 min) of this study, which was reported only in 3 patients, is a significant handicap 13 . Although each technique has its own advantages and disadvantages, actually, surgeon's experience determines the operation technique.…”

Robotic assisted reconstruction for complications following urologic oncologic procedures

“…Several novel techniques have recently been reported for robotic UEAS repair. Padovani et al [2017] recently reported a series of 3 cases of ureteroileal bypass surgery, 1 of which was performed robotically (25). Instead of dissecting out and redoing the previous anastomosis, the authors performs a 1 cm side-to-side anastomosis using a more proximal segment of the ureter.…”

“…This approach mirrors the non-transecting ureteral reimplant for traditional distal ureteral injury/obstruction. The authors reported a mean operative time of 120 minutes, no complications, and 100% success rate with a mean follow-up of 29.3 months (25). reported 8 patients with 10 renal units who underwent robotic UEAS revision with the assistance of indocyanine green (ICG) (26).…”