Open Surgical Repair of Ureteral Strictures and Fistulas Following Radical Cystectomy and Urinary Diversion

Msezane, Lambda P.; Reynolds, W. Stuart; Mhapsekar, Rishi; Gerber, Glenn S.; Steinberg, Gary D.

doi:10.1016/j.juro.2007.11.083

Cited by 47 publications

(39 citation statements)

References 13 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%

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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%

“…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%

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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“…This complication may result from the need to keep the ureters long enought to reach the pouch. However, this complication was reported as not specific to the neobladder construction technique but dependant of the uretero-neobladder anastomosis technique [31]. In our experience, the Camey-Le Duc anastomosis was associated with a higher stenosis rate [32].…”

Section: Discussionmentioning

confidence: 64%

The Z‐shaped ileal neobladder after radical cystectomy: an 18 years experience with 329 patients

et al. 2011

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Eighty-three early complications in 80/294 patients (27.2%) occurred. The average Clavian rate of these early complications was 2.24. Among these, 12 complications in 12 patients (4.1%) were pouch-related, and 3 reoperations were required. Two patients died from cardiac complications. Sixty-three late complications in 60/294 patients (20.4%) were recorded. The average Clavian rate of these late complications was 2.98. Among these, 47 complications in 45/294 patients (15.3%) were pouch-related, and 18 reoperations were required, essentially for ureteral anastomosis stricture.Satisfactory daytime urinary continence was achieved in 92% of patients. Daytime continence was obtained within, on average, 6.8 ± 16.4 months. The interval between each daytime urination was 2.6 ± 0.8 h (median = 2.5 [1-5] h). Forty-four (15%) patients developed metabolic acidosis which only required oral medication.Satisfactory nocturnal urinary continence was achieved in 87% of patients. Night-time continence was obtained within, on average, 10.8 ± 22.4 months.Hyper-continence with subsequent need for CISC was observed in 4%. CONCLUSIONIn our series of 329 patients, compared with the other techniques, the Z-shaped ileal neobladder had an 'expected' complication rate for this high risk surgery with satisfactory daytime and night-time continence in nine out of ten patients.

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“…However, with longer follow-up duration, the success rate drops to 71.4-80% 6,9,[49][50][51] ; in the study with longest follow-up duration (a median of 47 months), Nassar et al 6 reported a success rate of 78% in 32 patients. This low rate of success with longer follow-up duration might be the result of an increased number of contemporary open repairs performed in patients in whom primary endoscopic interventions have failed.…”

Section: Open Repairmentioning

confidence: 96%

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

et al. 2016

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Radical cystectomy and urinary diversion is the gold-standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer. Ureteroenteric anastomotic stricture is a well-known complication of urinary diversion and is associated with serious sequelae that lead to total or partial loss of kidney function, infectious complications, and the need for additional procedures. Although the exact aetiology of benign ureteroenteric anastomotic strictures is unclear, they most likely occur secondary to ischaemia at the anastomotic region. Diagnosis can be achieved using retrograde contrast studies, CT scan or MAG3 renography. Open revision remains the gold-standard treatment for ureteroenteric anastomotic strictures; however, endourological techniques are being increasingly used and, in select patients, might be the optimal approach.

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Open Surgical Repair of Ureteral Strictures and Fistulas Following Radical Cystectomy and Urinary Diversion

Abstract: Open revision remains the gold standard management for ureteral strictures and urinary diversion-enteric fistulas occurring after radical cystectomy. The addition of the chimney modification to the orthotopic neobladder facilitates surgical repair.

Cited by 47 publications

References 13 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

The Z‐shaped ileal neobladder after radical cystectomy: an 18 years experience with 329 patients

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

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