Management of Benign Ureteral Strictures Following Radical Cystectomy and Urinary Diversion for Bladder Cancer

Tal, Raanan; Sivan, Bezalel; Kedar, Daniel; Baniel, Jack

doi:10.1016/j.juro.2007.03.142

Cited by 86 publications

(60 citation statements)

References 11 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%

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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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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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“…3 The published rate of uretero-ileal anastomotic stricture after urinary diversion in the literature varies from 1.3-13%. [4][5][6][7][8][9][10] Though exact reasons for the development of uretero-ileal anastomotic stricture remain to be elucidated, it is thought to be due to an inflammatory or ischemic etiology. 6 It has been proposed that in most, the cause is likely multifactorial.…”

Section: Introductionmentioning

confidence: 99%

Diabetes and elevated urea level predict for uretero-ileal stricture after radical cystectomy and ileal conduit formation

Hoag

Papa

Beharry

et al. 2017

CUAJ

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Cite as: Can Urol Assoc J 2017;11(3-4):E88-92. http://dx.doi.org/10.5489/cuaj.3848 Published online March 16, 2017 Abstract Introduction: Benign uretero-ileal anastomotic stricture is a significant complication following radical cystectomy and ileal conduit urinary diversion after radical cystectomy. We examined risk factors for stricture formation to predict those at greatest stricture risk. Methods: A retrospective chart review was conducted for patients undergoing radical cystectomy and ileal conduit diversion between 2002 and 2012. Demographic data and patient variables were analyzed to determine risk factors for uretero-ileal stricture using multivariate logistic regression. Results: Over the study period, 133 patients underwent cystectomy and ileal conduit formation, with 14 (10.5%) developing ureteroileal anastomotic stricture. Diabetes and elevated serum urea level (defined as >7.1 mmol/L) were associated with increased risk for development of uretero-ileal stricture (odds ratio 4.31 and 4.28, respectively; p<0.05 for each). Conclusions: In this patient cohort, diabetes and elevated serum urea level were predictive for the development of uretero-ileal anastomotic stricture. Further prospective study with larger patient samples is required.

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“…However, one of the most frequent complications to occur in these patients is the stricture of the uretero-intestinal anastomosis (UIA). Globally, the incidence of UIA stricture is up to 13% [2]. It is usually asymptomatic and may lead to hydronephrosis, deterioration in renal function, urinary infection and kidney loss.…”

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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Management of Benign Ureteral Strictures Following Radical Cystectomy and Urinary Diversion for Bladder Cancer

Cited by 86 publications

References 11 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

Diabetes and elevated urea level predict for uretero-ileal stricture after radical cystectomy and ileal conduit formation

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

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