Getting out of a tight spot: an overview of ureteroenteric anastomotic strictures

Lobo, Niyati; Dupré-Crochet, Sophie; Sahai, Amit; Thurairaja, Ramesh; Khan, Muhammad Shamim

doi:10.1038/nrurol.2016.104

Cited by 43 publications

(32 citation statements)

References 83 publications

(96 reference statements)

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“…It is believed that extraureteric stent migration is a result of a very fragile ureteric wall that could be due to chronic inflammation, ureteric wall trauma and even malignancy 2. The exact aetiology of benign ureteroenteric anastomotic strictures is unclear but they are most likely the result of periureteral fibrosis and scarring secondary to ischaemia or urine leakage at the anastomotic site 12. The exact mechanism for the stent migration is not known, however it potentially can be attributed to trauma during her increasingly difficult stent exchanges to an already ischaemic strictured area.…”

Section: Discussionmentioning

confidence: 99%

The mystery of the ureteric stent in the lumen of the terminal ileum

et al. 2020

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A 65-year-old comorbid female patient presented to our urology department with a history of multiple interventions to treat severe overactive bladder symptoms. She had a history of clam ileocystoplasty, which was then converted to an ileal conduit due to failure to resolve her symptoms. She subsequently developed multiple complications, most significantly ureteroileal stenosis, managed with bilateral ureteric stents. She later decided on bilateral nephrostomies and subsequent antegrade stent insertion. At follow-up, the proximal end of the left stent remained within the kidney and the distal end was free within the abdominal cavity. There was further migration of the stent in its entirety into the lumen of the terminal ileum on subsequent imaging. She denied any significant gastrointestinal symptoms, signs or peritonitis. Consideration was made for the endoscopic removal of the stent by the gastrointestinal team; however, the patient refused any further procedures preferring to be monitored.

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Section: Discussionmentioning

confidence: 99%

The mystery of the ureteric stent in the lumen of the terminal ileum

et al. 2020

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“…25 Furthermore, the higher rate of left ureteral strictures as opposed to right suggests that increased mobilization may be leading to anastomotic ischemia, resulting in UESs. 6…”

Section: Discussionmentioning

confidence: 99%

Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy

Shen

Jamnagerwalla

Yuh

et al. 2019

Therapeutic Advances in Urology

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Background: Ischemia is thought to contribute to benign ureteroenteric stricture (UES) after radical cystectomy with urinary diversion (RCUD). Our institution adopted the use of ureteral perfusion assessment during all RCUDs using real-time indocyanine green angiography using the SPY fluorescence imaging platform (Stryker Corp., Kalamazoo, MI, USA). This guides the location of ureteral transection prior to ureteroenteric anastomosis. We sought to compare UES rates before and after adoption of SPY. Methods: A retrospective chart review was undertaken for the first 47 consecutive cases of RCUD using SPY as well as the previous 47 consecutive cases, which were performed without SPY. Fisher’s exact and Wilcoxon rank-sum tests were used to compare benign UES rates and the length of ureter excised during anastomosis. A p < 0.05 indicated statistical significance. Results: Median follow up was 12.0 months for SPY cases and 24.3 months for non-SPY cases. The UES rate for SPY RCUDs was 0% (0/93 ureters) compared with 7.5% (7/93 ureters) for non-SPY RCUDs ( p = 0.01). Amongst SPY RCUDs, 86 ureters had no hydronephrosis and 7 had mild hydronephrosis with reflux on loopogram. A total of 34.4% of ureters (32/93) had poor distal perfusion, requiring a more proximal anastomosis. The median length excised for ureters with poor distal perfusion was 3.8 cm, compared with 2.2 cm for ureters with good distal perfusion ( p < 0.0001). No complications attributable to the use of SPY were noted. Conclusion: Use of SPY to assess ureteral perfusion was associated with a decrease in the UES rate after RCUD. A total of 34.4% of ureters demonstrated poor distal perfusion, requiring a significantly more proximal ureteroenteric anastomosis.

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“…Advances in endourology have given rise to alternative treatment modalities such as stent insertion, balloon dilation, and cold ureterotomy, each with varying success rates. Endoscopic approaches have the advantage of acceptable long-term success rates for restoring and maintaining ureteral patency, while reducing intraoperative blood loss, pain, surgical morbidity, and length of hospital stay [8]. Nevertheless, the purported benefits of endourological management must be weighed against the potential side-effects of long-term stenting.…”

Section: Discussionmentioning

confidence: 99%

“…Open surgical revision of the ureteroileal anastomosis and ureter re-implantation remains the gold standard with long-term success rates ranging from 76 to 92% [6,7]. However, this may prove to be technically challenging due to the formation of fibrotic adhesions [8]. Minimally invasive strategies are increasingly being used in highrisk and elderly populations, or patients who do not wish to undergo reconstructive surgery.…”

Section: Introductionmentioning

confidence: 99%

Impact of Thermo-Expandable Memokath Ureteral Stent on Renal Function in the Management of Ureteroileal Anastomotic Stricture

et al. 2018

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Purpose: The study aimed to assess the impact of the Memokath 051 stent (MK) on glomerular filtration rate (GFR) and split renal function in the management of ureteroileal anastomotic strictures. Materials and Methods: We treated 6 patients in the ages of 66–77 years, 2 of whom had bilateral strictures, with a total of 8 ureteroileal strictures using the MK stent. Five patients had chronic kidney disease (CKD) prior to MK insertion. Mean time between conduit surgery and MK insertion was 28.4 months. Serum creatinine, GFR, and MAG-3 renography were determined before stent insertion and postoperatively at 3 months. Results: Postoperative complications at 3-month follow-up included migration in 2 patients, occlusion in 2 patients, and urinary tract infection in 4 patients. The mean stent indwelling time was 353.4 ± 169.3 days. Mean preoperative creatinine, GFR, right, and left split renal function were 158.3 ± 76.3 μmol/L, 43.6 ± 32.9 mL/min/1.73 m², 52.8 ± 22.2%, and 47.1 ± 22.2%, respectively. Mean postoperative values were 168.1 ± 84 μmol/L (p = 0.84), 40.8 ± 28.4 mL/min/1.73 m² (p = 0.56), 51.1 ± 18.3% (p = 1), and 48.8 ± 18.3% (p = 1), respectively. Conclusion: MK stent is a safe and efficient minimally invasive long-term treatment option to preserve GFR in patients who develop CKD through ureteroileal anastomotic stricture. In spite of MK stent insertion and alleviation of obstruction, it was presumably inserted too late to improve renal function.

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Getting out of a tight spot: an overview of ureteroenteric anastomotic strictures

Cited by 43 publications

References 83 publications

The mystery of the ureteric stent in the lumen of the terminal ileum

The mystery of the ureteric stent in the lumen of the terminal ileum

Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy

Impact of Thermo-Expandable Memokath Ureteral Stent on Renal Function in the Management of Ureteroileal Anastomotic Stricture

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