Treatment of ureteral anastomotic strictures with reimplantation and survival after cystectomy and urinary diversion

Helfand, Alexander M.; Beach, Rebekah; Hadj-Moussa, Miriam; Krishnan, Naveen; He, Chang; Montgomery, Jeffrey S.; Morgan, Todd M.; Weizer, Alon Z.; Hafez, Khaled S.; Lee, Cheryl T.; Stoffel, John T.; Skolarus, Ted A.

doi:10.1016/j.urolonc.2016.07.018

Cited by 10 publications

(11 citation statements)

References 33 publications

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“…In studies focusing on renal function, open surgery does not seem superior to less-invasive or observational strategies. Helfand et al compared long-term renal function between re-implantation and non-operative UES management, including ureteral stent or nephrostomy tube; no significant differences were found in ΔeGFR (– 25.0 vs. – 18.9 ml/min/1.73 m 2 , p = 0.66) or rates of renal function loss (34.6% vs. 39.5%, p = 0.68) [ 7 ]. Rivera et al analyzed chronic kidney disease - free survival, comparing active intervention (open or endourologic treatment) with observation alone; no significant differences were found in 5-year chronic kidney disease-free survival (observation 50% vs. active treatment 33% p = 0.40) [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…This complex reconstructive surgery is associated with significant perioperative morbidity, with reported acute complication rates of 52–78% [ 1 – 4 ]. Among potential long-term complications, benign obstructive ureteroenteric strictures (UES) form an important risk factor for renal function deterioration [ 5 – 7 ]. Although symptoms can include severe flank pain and recurrent urinary tract infections, UES can also be asymptomatic [ 6 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…Patienten mit einer operativen Korrektur hatten jedoch ein signifikant besseres Gesamtüberleben (aHR 0.32, 95 % Konfidenzintervall 0,13 -0,80, p = 0,01). Dies war auch nach Ausschluss von wichtigen klinischen Parametern wie Alter und Nebenerkrankungen weiter ein signifikanter Faktor [43].…”

Section: Anatomische Komplikationenunclassified

Blasenkarzinom − Komplikationen der Harnableitung

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Niegisch

2020

Aktuelle Urol

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ZusammenfassungAuch heute noch stellt die radikale Zystektomie mit Anlage einer Harnableitung einen der komplikationsträchtigsten Eingriffe in der Uro-Onkologie dar. Insbesondere im Langzeitverlauf, aber auch perioperativ spielen dabei durch die Harnableitung bedingte Probleme eine wesentliche Rolle.Perioperativ stehen dabei im Wesentlichen gastrointestinale Probleme wie etwa ein Ileus, aber auch Infekte und frühe Komplikationen der unterschiedlichen Anastomosen im Vordergrund. Während ein Ileus ebenso wie perioperative Infekte i. d. R. medikamentös behandelt werden können, erfordern Insuffizienzen der intestinalen Anastomose regelhaft und Insuffizienzen der ureterointestinalen Anastomosen häufig operative Revisionen.Im Langzeitverlauf können Narbenbildungen zu chronischen Harnabflussbehinderungen und bei kontinenten Harnableitungen zur Steinbildung führen und ebenso wie parastomale Hernien weitere Therapien erforderlich machen. Funktionelle Darmprobleme können die Lebensqualität der Patienten nachhaltig beeinflussen.Durch eine verbesserte Vorbereitung präoperativ und die begleitenden Maßnahmen während des stationären Aufenthalts können nicht operationsbedingte Komplikationen signifikant reduziert werden.Die Zystektomie mit der therapieassoziierten Morbidität ist ein Paradebeispiel für eine zentrumsbasierte Operation um Komplikationen sowohl perioperativ als auch im weiteren Follow-up zu reduzieren.

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“…This complex reconstructive surgery is associated with significant perioperative morbidity, with reported acute complication rates of 52-78% [1][2][3][4]. Among potential long-term complications, benign obstructive ureteroenteric strictures (UES) form an important risk factor for renal function deterioration [5][6][7]. Although symptoms can include severe flank pain and recurrent urinary tract infections, UES can also be asymptomatic [6,8].…”

Section: Introductionmentioning

confidence: 99%

“…This is mostly considered to be the result of ischemia, caused by compromised vascularization during mobilization of the ureters in reconstructive surgery [5,9,10]. With a reported prevalence of 1.4-15% [6][7][8][9][11][12][13], UES usually occur within the first 12 months after construction of the urinary diversion, although in some cases strictures may form many years postoperatively [6,8,12,13]. Open surgical revision of the anastomosis has considerable risks because it is often impeded by intra-abdominal adhesions [9,12].…”

Section: Introductionmentioning

confidence: 99%

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

Son¹,

Lock²,

Putte³

et al. 2018

European Urology Supplements

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Purpose To compare open surgical anastomotic revision with endourological techniques for the treatment of ureteroenteric strictures in patients with urinary diversions. Methods All records of patients treated for ureteroenteric strictures in our clinic between 1989 and 2016 were retrospectively reviewed. In 76 patients, 161 completed procedures were analyzed: 26 open revisions vs. 135 endourological treatments, including balloon dilation, Wallstent and/or laser vaporization. Results Median follow-up was 34 months. At 60 months, patency rates were 69% (95% CI 52-92%) after open vs. 27% (95% CI 19-39%) after endo-treatment (p = 0.003); median patency duration was 15.5 vs. 5 months, respectively (p = 0.014). Eventually, 15% of patients required open surgery after primary endo-treatment and 21% received endoscopic re-treatment after primary open surgery. Cox regression analysis revealed no confounding factors among the risk factors added to the model. Complication rates were higher after open surgery (27% Clavien 2, 12% Clavien 3-4 vs. 5% Clavien 1-2, 3% Clavien 3, p = 0.528). Median postoperative hospital stay was 14 days (open) vs. 2 days (endo), p < 0.001. Mean estimated glomerular filtration rate improved with + 17 (open) vs. + 8.1 (endo), p = 0.024. Renal function was compromised in 8% of patients in the open surgery group vs. 6% in the endo-treatment group. Conclusions In these patients, in terms of patency and patency duration, open surgery was superior to endourology. Nevertheless, endourological treatments offer a safe and less-invasive alternative to delay or avoid open surgery, especially in patients who are unfit for open surgery.

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Treatment of ureteral anastomotic strictures with reimplantation and survival after cystectomy and urinary diversion

Cited by 10 publications

References 33 publications

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

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

Blasenkarzinom − Komplikationen der Harnableitung

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

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