Experience With Ureteroenteric Strictures After Radical Cystectomy and Diversion: Open Surgical Revision

Nassar, Omaya; Alsafa, Mohamed E. S.

doi:10.1016/j.urology.2011.01.040

Cited by 69 publications

(42 citation statements)

References 24 publications

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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: 90%

“…This high complication rate is not surprising because of the invasive nature of the procedure and likelihood of the occurrence of intra-abdominal adhesions due to prior surgery, but it is higher than the reported rate in previous studies (7-13%) [6,8,9,13,14]. This might be explained by a relatively high number of patients with a history of pelvic radiotherapy [6].…”

Section: Discussionmentioning

confidence: 76%

“…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%

See 2 more Smart Citations

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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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 76%

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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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“…These may require further endoscopic or surgical intervention and represent a potentially preventable complication of RARC. [14][15][16] Feasibility of expert and crowd-sourced review of intraoperative video for quality improvement of intracorporeal urinary diversion during robotic radical cystectomy goldenberg et al tension-free anastomosis, which underpin good technique believed to minimize strictures. 17,19,20 Careful intraoperative video review may allow for refinement of robotic surgical technique involved in uretero-ileal anastomosis.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of expert and crowd-sourced review of intraoperative video for quality improvement of intracorporeal urinary diversion during robotic radical cystectomy

Goldenberg

Nabhani

Wallis

et al. 2017

CUAJ

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Introduction: Development of uretero-ileal stricture (UIS) after robotic-assisted radical cystectomy (RARC) may be dependent on surgical technique. Video review of intraoperative technique is an emerging paradigm for surgical quality improvement. We examined whether surgeon-perceived risk of UIS or crowd-sourced assessment of robotic skill are associated with the development of UIS. Methods: We conducted a case-control study comparing the operative technique of uretero-ileal anastomoses resulting in clinically significant UIS with the contralateral anastomosis for the same patient. De-identified videos were analyzed by 1) five high-volume surgeons; and 2) crowd workers (Crowd-Sourced Assessment of Technical Skill, C-SATS) to determine Global Evaluative Assessment of Robotic Skill (GEARS) score. Mantel-Haenszel common odds ratio (OR) estimates were calculated to assess the association between surgeon performance and the development of UIS. Logistic regression models were used to examine the association between GEARS scores and the development of UIS. Results: A total of 10 UIS videos were compared to eight control videos by five surgeons and 2142 crowd workers. Expert surgeons systematically evaluated intraoperative footage, however, no association between the expert mode response and UIS (OR 0.42; 95% confidence interval [CI] 0.05-3.45; p=0.91) was identified. Crowd-sourced assessment was not predictive of UIS (p=0.62). Conclusions: We used video review to systematically analyze procedure-specific content and technique. The inability of surgeons to predict UIS may reflect the questionnaire, uncontrolled patient factors, or a lack of power. Crowd-sourced GEARS score was unsuccessful in predicting UIS after RARC.

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“…A. Nassar, M. E. Alsafa [12], исполь-зование баллонных дилатаций для лечения стриктур зоны уретероэнтероанастомоза оправдано при одно-сторонней локализации стриктуры и ее протяженно-сти < 1 см, а также при развитии их в сроки до 6 мес. При развитии стриктур в отдаленные сроки после цистэктомии при билатеральных и протяженных (> 1 см) стриктурах показано выполнение открытых операций.…”

Section: Introductionunclassified

Experience with balloon dilations of benign ureteroneocystoanastomotic strictures in patients with bladder cancer after radical cystectomy

Belov¹,

Belova²,

Тимофеев³

et al. 2015

Onkourologiya

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Experience With Ureteroenteric Strictures After Radical Cystectomy and Diversion: Open Surgical Revision

Cited by 69 publications

References 24 publications

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

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

Feasibility of expert and crowd-sourced review of intraoperative video for quality improvement of intracorporeal urinary diversion during robotic radical cystectomy

Experience with balloon dilations of benign ureteroneocystoanastomotic strictures in patients with bladder cancer after radical cystectomy

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