The therapeutic analysis of benign uretero-ileal anastomotic stricture after radical cystectomy and urinary diversion.

Abstract

Background: Benign uretero-ileal anastomotic stricture (UIAS) is a potentially serious complication following radical cystectomy (RC) and urinary diversion after RC. In order to preserve residual renal function and enhance prognosis, it is imperative to draw insights from experience and tailor individualized treatment strategies for different patients. Patients and methods: Between October 2014 to June 2021, 47 patients with benign UIAS underwent endoscopic management (n=19) or reimplantation surgery (n=28). The basic data, perioperative conditions and postoperative conditions of the two groups were compared and analyzed to evaluating the efficacy. Results: In the comparison of preoperative and postoperative clinical efficacy of the same group, the endoscopic group exhibited no significant differences in creatinine and blood urea nitrogen (BUN) levels before surgery or after extubation (P>0.05), but BUN and glomerular filtration rate (GFR) levels on the affected side showed significant differences before surgery and after extubation (P<0.05). While the laparoscopic reimplantation group didn't show significant differences in creatinine, BUN and GFR levels before surgery and after extubation (P>0.05). According to the data of postoperative clinical efficacy between the two groups, there was no significant difference in creatinine and BUN levels (P>0.05), but GFR values in the endoscopic treatment group decreased more than those in the laparoscopic reimplantation group (P<0.05). Additionally, the laparoscopic reimplantation group could remove the single J tube earlier than the endoscopic treatment group (P<0.05) with a lower recurrence rate of hydronephrosis after extubation (P<0.05), and hydronephrosis occurred earlier in the endoscopic treatment group (P<0.05). Conclusions: In our experience for the treatment of UIAS after RC combined with urinary diversion, laparoscopic reimplantation can fundamentally solve the problem of UIAS, remove the ureteral stent in a relatively short time after surgery, maintain the patency of the ureter for a long time, truly preserve the residual renal function, reduce the occurrence of ureteral restenosis and hydronephrosis, and demonstrate relatively better therapeutic outcomes in this research.