Long-Term Results of Endoureterotomy and Open Surgical Revision for the Management of Ureteroenteric Strictures After Urinary Diversion

Laven, Brett A.; O’Connor, R. Corey; Gerber, Glenn S.; Steinberg, Gary D.

doi:10.1097/01.ju.0000086701.68756.8f

Cited by 80 publications

(47 citation statements)

References 18 publications

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“…This is consistent with previous series by Laven et al [15] and Milhoua et al [14] who reported success rates of 80 and 87.5%, respectively. These data suggest that open revision remains the gold standard for treatment of ureteroeneteric anastomotic strictures.…”

Section: Discussionsupporting

confidence: 83%

“…Lower success rates in the present series could be related to several factors. All strictures treated endoscopically were either bilateral strictures or left-sided strictures which are often more resistant to endoscopic management [15] . In contrast to the studies by Laven et al [13] , 67.5% of strictures in the present study were treated with balloon dilation instead of incision.…”

Section: Discussionmentioning

confidence: 99%

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Ureteral Stents Placed at the Time of Urinary Diversion Decreases Postoperative Morbidity

et al. 2012

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Objective: To determine the impact of stenting ureteroenteric anastomoses on postoperative stricture rate and gastrointestinal recovery in continent and noncontinent urinary diversions (UDs). Patients and Methods: We retrospectively reviewed the clinical and pathologic data on 192 consecutive patients who underwent a radical cystectomy and UD. Patients received either a continent or noncontinent UD with or without stent placement through the ureteroenteric anastomoses. Stricture rate, gastrointestinal recovery, length of hospital stay, and stricture characteristics were analyzed. Study endpoints were compared between four groups – stented and nonstented continent and stented and nonstented noncontinent UDs. Results: 36% of patients were stented and 64% were nonstented at the time of UD. Total ureteral stricture rate was 9.9%. There was no statistically significant difference in stricture rate (p = 0.11) or length of hospital stay (p = 0.081) in stented compared to nonstented patients. There was a significantly (p = 0.014) greater rate of ileus in patients who were nonstented in both continent and noncontinent UDs. Conclusion: Stenting of ureteroenteric anastomoses in both continent and noncontinent UD has no effect on postoperative stricture rate, but is associated with lower rates of postoperative ileus.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Ureteral Stents Placed at the Time of Urinary Diversion Decreases Postoperative Morbidity

et al. 2012

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“…We found a 23% success rate for EUT (on intention-to-treat-based analysis) and 87% success rate for SRA of the anastomosis at a median FU of 33 months. These results are in line with efficacy reported in previous comparative studies (success-rate EUT 0-50%, SRA 76-93%) and confirm a significantly inferior efficacy for EUT [2,6,8,9,[12][13][14]. Moreover, the short median SFP following EUT and the significant eGFR loss in case of restenosis indicate the necessity of careful FU and swift re-intervention.…”

Section: Discussionsupporting

confidence: 80%

“…Comparative studies regarding EUT and SRA are limited. All report inferior efficacy for EUT [2,6,8,9,[12][13][14]. However, it would be justified to consider EUT to delay or avoid open surgery, if the procedure is safe and does not compromise renal function.…”

mentioning

confidence: 99%

Endo-Urological Techniques for Benign Uretero-Ileal Strictures Have Poor Efficacy and Affect Renal Function

Putte

Wall²,

Werkhoven³

et al. 2017

Urol Int

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Introduction: Uretero-ileal strictures (UES) following urinary diversion are therapeutically challenging. We compared the efficacy, safety and renal outcome following therapeutic endo-urological techniques (EUTs) and open surgical revision of the anastomosis (SRA) for UES. Material and Methods: We retrospectively analysed all EUTs and SRAs performed for UES in 2 hospitals between 1987 and 2015. Restenosis was defined as recurrent radiographically diagnosed hydronephrosis and re-intervention. Renal function (estimated glomerular filtration rate [eGFR]) decrease was correlated with the number of EUTs per patient. Results: Eighty-five UES were treated with 105 EUTs and 31 open revisions. Due to total obstruction, 28 (27%) EUTs were aborted. During a median follow-up of 33 months, restenosis occurred following 53 out of 77 (69%) completed EUTs and 4 out of 31 (13%) SRAs (p < 0.001 on univariable and multivariable analyses). No serious (Clavien ≥3b) EUT-related complications occurred vs. 5 (19%) related to SRA (p < 0.001). The number of finalised EUTs was independently associated with eGFR loss (β = 12.3 mL/min/1.73 m² loss per EUT, p = 0.008), with a significant cutoff value of >1 EUTs. SRA did not affect renal function (β = 6.8 mL/min/1.73 m² loss, p = 0.276). Conclusions: Although EUTs are less invasive, they have an inferior efficacy to SRA. Our results suggest that a maximum of one EUT may be attempted without significantly compromising renal function.

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“…Open surgical revision remains the treatment of choice with a success rate of around 80% [3]. However, the difficulty due to extensive intra-abdominal adhesions, the significant operative and post-operative morbidity (vascular injury, wound infection) [4,5] leads to look for less invasive procedure with shorter hospital stay, especially that the patients are generally old with concomitant morbidity. Alternative options include endoscopic techniques such as balloon dilatation, endoscopic incision, stricture stenting, and endoscopic stricture incision combined with balloon dilatation.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Ureteral Dilations for Management of Uretero-Intestinal Anastomosis Stricture following Bricker Urinary Diversion

Harrech¹

2017

UNOAJ

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Strictures of the uretero-intestinal anastomosis after urinary diversion following radical cystectomy are usually difficult to manage for both urologists and radiologists. Traditional surgery is the gold standard treatment. However, these strictures occur in oncologic patients, often old with concomitant morbidity. This makes less invasive option suitable. In this article we describe a mini invasive percutaneous option, safe and feasible under local anaesthesia, in an outpatient basis.

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Long-Term Results of Endoureterotomy and Open Surgical Revision for the Management of Ureteroenteric Strictures After Urinary Diversion

Cited by 80 publications

References 18 publications

Ureteral Stents Placed at the Time of Urinary Diversion Decreases Postoperative Morbidity

Ureteral Stents Placed at the Time of Urinary Diversion Decreases Postoperative Morbidity

Endo-Urological Techniques for Benign Uretero-Ileal Strictures Have Poor Efficacy and Affect Renal Function

Percutaneous Ureteral Dilations for Management of Uretero-Intestinal Anastomosis Stricture following Bricker Urinary Diversion

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