Primary Endoscopic Management Versus Open Revision of Ureteroenteric Anastomotic Strictures After Urinary Diversion—Single Institution Contemporary Series

Milhoua, Paul M.; Miller, Nicole L.; Cookson, Michael S.; Chang, Sam S.; Smith, Joseph A.; Herrell, S. Duke

doi:10.1089/end.2008.0230

Cited by 38 publications

(24 citation statements)

References 21 publications

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“…This is consistent with previous series by Laven et al [15] and Milhoua et al [14] who reported success rates of 80 and 87.5%, respectively. These data suggest that open revision remains the gold standard for treatment of ureteroeneteric anastomotic strictures.…”

Section: Discussionsupporting

confidence: 93%

“…Laven et al [13] reported success rates of 57% with endoureterotomy applying the holmium laser. Milhoua et al [14] reported a 27% success rate using a variety of endoscopic strategies including balloon dilation, electrosurgical incision, and incision with the holmium laser. Lower success rates in the present series could be related to several factors.…”

Section: Discussionmentioning

confidence: 99%

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Ureteral Stents Placed at the Time of Urinary Diversion Decreases Postoperative Morbidity

et al. 2012

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Objective: To determine the impact of stenting ureteroenteric anastomoses on postoperative stricture rate and gastrointestinal recovery in continent and noncontinent urinary diversions (UDs). Patients and Methods: We retrospectively reviewed the clinical and pathologic data on 192 consecutive patients who underwent a radical cystectomy and UD. Patients received either a continent or noncontinent UD with or without stent placement through the ureteroenteric anastomoses. Stricture rate, gastrointestinal recovery, length of hospital stay, and stricture characteristics were analyzed. Study endpoints were compared between four groups – stented and nonstented continent and stented and nonstented noncontinent UDs. Results: 36% of patients were stented and 64% were nonstented at the time of UD. Total ureteral stricture rate was 9.9%. There was no statistically significant difference in stricture rate (p = 0.11) or length of hospital stay (p = 0.081) in stented compared to nonstented patients. There was a significantly (p = 0.014) greater rate of ileus in patients who were nonstented in both continent and noncontinent UDs. Conclusion: Stenting of ureteroenteric anastomoses in both continent and noncontinent UD has no effect on postoperative stricture rate, but is associated with lower rates of postoperative ileus.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Ureteral Stents Placed at the Time of Urinary Diversion Decreases Postoperative Morbidity

et al. 2012

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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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“…Although the exact etiology remains unclear, they most likely occur secondary to ischemia after interruption of ureteral blood supply during surgery or impaired healing due to radiotherapy [5]. 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].…”

Section: Introductionmentioning

confidence: 99%

“…The disadvantages of conventional ureteral stents are infection, bleeding, irritative symptoms, encrustation, and stone formation, all leading to a reduced quality of life [9]. Repetitive high pressure dilation with angioplasty balloon and cold cut procedures have been reported to have long-term success rates of 16 and 51%, respectively [7,10]. Therefore, long-term segmental thermo-expandable metallic stents were introduced to alleviate lower urinary tract symptoms and avoid the need for regular exchange.…”

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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Primary Endoscopic Management Versus Open Revision of Ureteroenteric Anastomotic Strictures After Urinary Diversion—Single Institution Contemporary Series

Cited by 38 publications

References 21 publications

Ureteral Stents Placed at the Time of Urinary Diversion Decreases Postoperative Morbidity

Ureteral Stents Placed at the Time of Urinary Diversion Decreases Postoperative Morbidity

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

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

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