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

Putte, Elisabeth E. Fransen van de; Wall, Liesbeth L de; Werkhoven, Erik van; Heldeweg, Eddi A.; Bex, Axel; Poel, Henk G. van der; Horenblas, Simon; Hendricksen, Kees

doi:10.1159/000475508

Cited by 7 publications

(2 citation statements)

References 20 publications

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“…However, they have been scarcely investigated and the results seem to be suboptimal. A recent study found 23% success rate for endourological techniques and 87% success rate for open surgical revision anastomosis at a median follow-up of 33 months (12). These results are in line with previous studies reporting success rates of 0–50% with endourological techniques (5,7,10) and 76–93% with open surgical revision (4,7,11,13).…”

Section: Ureteroileal Strictures After Ileal Conduit Diversion: Incidmentioning

confidence: 99%

A retrosigmoid ileal conduit might prevent ureteroileal anastomotic stricture after ileal conduit diversion

Gomes¹,

Laferreira²

2018

Transl. Androl. Urol

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Section: Ureteroileal Strictures After Ileal Conduit Diversion: Incidmentioning

confidence: 99%

A retrosigmoid ileal conduit might prevent ureteroileal anastomotic stricture after ileal conduit diversion

Gomes¹,

Laferreira²

2018

Transl. Androl. Urol

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“…[2][3][4][5] Kidney function loss and uretero-ileal anastomotic (UIA) stricture are possible late postoperative complications. 6 Several patient and procedural factors may influence the risk of complications following RC. For instance, patients with pre-existing medical conditions, such as cardiovascular disease or diabetes mellitus, may be at higher risk of developing complications.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Major Complications and the Association with Oncological Outcomes After Radical Cystectomy for Bladder Cancer: A Nationwide Registry Study

Ginkel

Meijer

Boormans³

et al. 2023

MRAJ

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Introduction Radical cystectomy improves survival of patients with muscle invasive and high-risk non-muscle invasive bladder cancer, but is a challenging surgical procedure as patients may experience major complications after surgery. Objectives To assess the incidence of Clavien-Dindo ≥3 complications in patients who underwent radical cystectomy and to assess the association of these complications with pre-operative and peroperative parameters. The secondary aim was to study the association of complications with long-term oncological outcome. Methods A nationwide registry was set up in 19 Dutch hospitals that studied patients with muscle invasive bladder cancer and high-risk non-muscle invasive bladder cancer treated by radical cystectomy. Major complications were classified as complications that were related to uretero-ileal anastomosis, intra-abdominal (e.g. urinoma, bowel leakage) infectious and cardiovascular complications. Multivariable logistic regression analyses were performed to assess the correlation between these groups and perioperative, clinical and pathological factors. Kaplan-Meier survival curves were constructed to analyze the correlation between complications and overall survival. Results The study population consisted of 1,464 patients, of whom 420 (29%) developed severe complications. The most common complications were intra-abdominal (n=328, 60%) and uretero-ileal anastomosis related (n=92, 17%). Male gender (odds ratio 1.6, p=0.007), American Society of Anaesthesiologists score ≥3 (odds ratio 1.6, p=0.003), Charlson Comorbidity Index score ≥5 (odds ratio 2.1, p=0.002) and blood loss >700ml (odds ratio 1.4, p=0.044) were associated with severe complications. In addition, open radical cystectomy was associated with multiple complications (odds ratio 2.6, p=0.001). Furthermore, the overall survival of patients with major complications was worse than those who had no major complications. The median overall survival was 3.8 years versus 6.2 years for patients with and without severe complications (p<0.001). Conclusions In a real-world setting, 29% of patients undergoing radical cystectomy developed severe complications. The risk of severe complications was higher in men, patients with impaired pre-operative condition, and in those who underwent open surgery. Severe complications had a negative impact on overall survival.

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New clinical insights into the treatment of benign uretero‐ileal anastomotic stricture following radical cystectomy and urinary diversion

Mou,

Yao,

Liu

et al. 2024

Cancer Medicine

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BackgroundBenign uretero‐ileal anastomotic stricture (UIAS) is a potentially serious complication that can arise after radical cystectomy (RC) and subsequent urinary diversion. To preserve residual renal function and improve prognosis, it is crucial to derive insights from experience and tailor individualized treatment strategies for different patients.Patients and MethodsFrom October 2014 to June 2021, a total of 47 patients with benign UIAS underwent endoscopic management (n = 19) or reimplantation surgery (n = 28). The basic data, perioperative conditions, and postoperative outcomes of the two groups were compared and analyzed to evaluate efficacy.ResultsComparing preoperative and postoperative clinical efficacy within the same group, the endoscopic group showed no significant differences in creatinine and blood urea nitrogen (BUN) levels before surgery or after extubation (p > 0.05). However, significant differences were observed in glomerular filtration rate (GFR) levels on the affected side before surgery and after extubation (p < 0.05). In contrast, the laparoscopic reimplantation group did not exhibit significant differences in creatinine, BUN, or GFR levels of affected side before surgery and after extubation (p > 0.05). Postoperative clinical efficacy showed no significant difference in creatinine and BUN levels between the two groups (p > 0.05). However, GFR values of affected side in the endoscopic treatment group decreased more than those in the laparoscopic reimplantation group (p < 0.05). Additionally, the laparoscopic reimplantation group was able to remove the single‐J tube earlier than the endoscopic treatment group (p < 0.05), had a lower recurrence rate of hydronephrosis after extubation (p < 0.05), and experienced a later onset of hydronephrosis compared to the endoscopic treatment group (p < 0.05).ConclusionsBased on our experience in treating UIAS following RC combined with urinary diversion, laparoscopic reimplantation effectively addresses the issue of UIAS, allowing for the removal of the ureteral stent relatively soon after surgery. This approach maintains long‐term ureteral patency, preserves residual renal function, reduces the risk of ureteral restenosis and hydronephrosis, and has demonstrated superior therapeutic outcomes in this study.

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

Cited by 7 publications

References 20 publications

A retrosigmoid ileal conduit might prevent ureteroileal anastomotic stricture after ileal conduit diversion

A retrosigmoid ileal conduit might prevent ureteroileal anastomotic stricture after ileal conduit diversion

Predictors of Major Complications and the Association with Oncological Outcomes After Radical Cystectomy for Bladder Cancer: A Nationwide Registry Study

New clinical insights into the treatment of benign uretero‐ileal anastomotic stricture following radical cystectomy and urinary diversion

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