Incidence, Etiology, Prevention and Management of Ureteroenteric Strictures after Robot-Assisted Radical Cystectomy: A Review of Published Evidence and Personal Experience

Narita, Shintaro; Saito, Mitsuru; Numakura, Kazuyuki; Habuchi, Tomonori

doi:10.3390/curroncol28050348

Cited by 8 publications

(7 citation statements)

References 43 publications

(79 reference statements)

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“…Debate regarding the incidence of UES after open or robotic RC is ongoing, without definitively proven differences between surgical approaches [ 12 , 13 ]. Moreover, in cases of RARC, the different incidence of UES after ICUD or ECUD remains unclear, given the lack of randomized prospective studies [ 3 ]. Patients with previous urinary leakage at the uretero-enteric anastomotic site or previous episodes of UTIs, with impaired healing and scarring caused by the inflammatory mediators and released proteases, show a much higher incidence of UES [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…UES repair after RC represents a challenging surgical procedure, performed in morbid patients who have often submitted previously to multiple endourological procedures with urinary leakage, resulting in severe inflammation of the ureters and the retroperitoneum. In this scenario, the risk of complications such as blood loss, bowel perforation, or vascular involvement is high [ 3 , 4 ]. Currently, there are no established standardized therapies for treatment of UES after RC.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there are no established standardized therapies for treatment of UES after RC. Different cases must be managed in different ways, and no rigid options should be adopted [ 3 ]. Although endourologic treatment represents a minimally invasive first option to consider, it shows a low success rate compared to surgical repair, especially when the stricture length is longer than 1 cm [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Once surgery is planned, either open repair or robotic repair is possible. Open UIR is the gold standard treatment, offering excellent success rates, especially in particularly complex cases involving different organs [ 3 ]. Recently, robotic repair has been proposed as a safe option in the management of UES after RARC [ 7 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Uretero-enteric anastomotic strictures (UES) represent the main cause of renal dysfunction after urinary diversion (UD) [ 1 ] and can result from compromised vascularity (i.e., previous irradiation or excessive ureteral dissection) or improper surgical technique [ 2 , 3 ]. The gold standard for treatment of UES is open uretero-ileal reimplantation (UIR) [ 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Successful Multidisciplinary Repair of Severe Bilateral Uretero-Enteric Stricture with Inflammatory Reaction Extending to the Left Iliac Artery, after Robotic Radical Cystectomy and Intracorporeal Ileal Neobladder

et al. 2021

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Uretero-enteric anastomotic strictures (UES) after robot-assisted radical cystectomy (RARC) represent the main cause of post-operative renal dysfunction. The gold standard for treatment of UES is open uretero-ileal reimplantation (UIR), which is often a challenging and complex procedure associated with significant morbidity. We report a challenging case of long severe bilateral UES (5 cm on the left side, 3 cm on the right side) after RARC in a 55 years old male patient who was previously treated in another institution and who came to our attention with kidney dysfunction and bilateral ureteral stents from the previous two years. Difficult multiple ureteral stent placement and substitutions had been previously performed in another hospital, with resulting urinary leakage. An open surgical procedure via an anterior transperitoneal approach was performed at our hospital, which took 10 h to complete, given the massive intestinal and periureteral adhesions, which required very meticulous dissection. A vascular surgeon was called to repair an accidental rupture that had occurred during the dissection of the external left iliac artery, involved in the extensive periureteral inflammatory process. Excision of a segment of the external iliac artery was accomplished, and an interposition graft using a reversed saphenous vein was performed. Bilateral ureteroneocystostomy followed, which required, on the left side, the interposition of a Casati-Boari flap harvested from the neobladder, and on the right side a neobladder-psoas-hitching procedure with intramucosal direct ureteral reimplantation. The patient recovered well and is currently in good health, as determined at his recent 24-month follow-up visit. No signs of relapse of the strictures or other complications were detected. Bilateral ureteral reimplantation after robotic radical cystectomy is a complex procedure that should be restricted to high-volume centers, where multidisciplinary teams are available, including urologists, endourologists, and general and vascular surgeons.

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