The Wallstent: long‐term follow‐up of metal stent placement for the treatment of benign ureteroileal anastomotic strictures after Bricker urinary diversion

Abstract

ObjectiveTo evaluate the long-term follow-up (primary and secondary patency) of metal stent placement in benign ureteroileal anastomotic strictures after Bricker urinary diversion and to compare the failed treatment group with the group of successfully treated patients to search for predisposing factors of stent failure. Patients and MethodsFor patients treated since 1989 for benign ureteroileal strictures after Bricker urinary diversion with end-to-side anastomosis, we retrospectively collected data on clinical history, stent placement, auxiliary measures and patency rates from a prospectively kept database. ResultsIn all, 49 patients (mean age 64 years) underwent 56 metal stent procedures. Placement of the stent was possible in all patients. Stent patency without auxiliary treatment remained adequate in 23 cases (primary patency of 41.1%, mean follow-up 37.7 months). A secondary treatment was successfully performed in 11 patients who had stent obstruction, mostly caused by hyperplastic reaction, encrustation, or migration of the stent. The secondary patency rate was 60.7% (mean follow-up 55.8 months), comparable with patency rates of 36-100% described in literature with mostly small patient groups and much shorter follow-up periods. ConclusionTo the best of our knowledge we report the largest series of metal stenting in benign ureteroileal anastomotic strictures with the longest follow-up. We show that placement of a metal stent can lead to a permanent de-obstruction in approximately six out of 10 patients with preservation of renal function.

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

“…Promising patency rates ran ging from 36% to 100% have since been reported in several papers, although the studies were limited by small patient numbers (<18 patients) and short follow-up duration 15,54-58 . In the largest series of 49 patients, Campschroer et al 59 reported primary and secondary patency rates of 41.1% and 60.7% after a mean follow-up duration of 37.7 months and 55.8 months, respectively, findings comparable to patency rates described in the literature. Single-J stents have also been used to treat ureteroileal anastomotic strictures: in a series of 11 patients, Zhang et al 60 reported that eight patients had long-term patency after a follow-up duration of 12-66 months.…”

“…In Campschroer's series, 11 out of 49 patients had stent obstruction or migration and required secondary treatment 59 . By contrast, Liatsikos et al 56 described no migration, infection or encrustation of stents over a mean follow-up period of 21 months after stent implantation in 18 patients with anastomotic strictures.…”

Treating benign ureteroenteric strictures: 27-year experience comparing endourological techniques with open surgical approach

“…Patency rates vary widely between different endo-treatments. For example, DiMarco et al reported very low patency rates of 15%, 15% and 5% at 1, 2 and 3 years, respectively, after balloon dilation ( p = 0.0001 vs. open) [ 13 ], whereas Campschroer et al reported that Wallstents yielded a primary patency rate of 41.1% at a mean follow-up of 37.7 months [ 20 ].…”

Treating benign ureteroenteric strictures: 27-year experience comparing endo-urological techniques with open surgical approach

“…Patency rates vary widely between different endotreatments. For example, DiMarco et al reported very low patency rates of 15%, 15% and 5% at 1, 2 and 3 years, respectively, after balloon dilation (p = 0.0001 vs. open) [13], whereas Campschroer et al reported that Wallstents yielded a primary patency rate of 41.1% at a mean follow-up of 37.7 months [20].…”