Ureteroenteric Strictures After Open Radical Cystectomy and Urinary Diversion: The University of Southern California Experience

Shah, Swar; Movassaghi, Kamran; Skinner, Donald G.; Dalag, Leonard; Miranda, Gus; Cai, Jie; Schuckman, Anne; Daneshmand, Siamak; Djaladat, Hooman

doi:10.1016/j.urology.2015.03.014

Cited by 90 publications

(50 citation statements)

References 7 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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“…Anderson et al 1 noted that stricture rates are often under-reported owing to variable follow-up durations and nonstandardized use and frequency of urinary tract imaging. The majority of strictures occur within 2 years of surgery, with median time to diagnosis in the literature reported as 7-25 months after surgery 7,8,[11][12][13] , although they can occur as late as 160 months postoperatively 14 .…”

Section: Incidencementioning

confidence: 99%

“…Most strictures develop within 2 years after radical cystectomy and urinary diversion 11,15 , emphasizing the importance of close postoperative monitoring to ensure early recognition and prompt management. Currently, no published guidelines are available stating the optimal follow-up period.…”

Section: Key Pointsmentioning

confidence: 99%

“…No association between age, gender or American Society of Anesthesiologists (ASA) Physical Status Score and stricture rates has been identified 1,8,10,11,16 . Obesity, however, has been implicated in the development of ureteroenteric strictures, with one study demonstrating an association between stricture formation and patients with a high BMI 17 .…”

Section: Risk Factors Patient-specific Risk Factorsmentioning

confidence: 99%

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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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Endoscopic Management of Ureteroenteric Strictures

Masterson

Marcovich

2018

Smith's Textbook of Endourology

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Ureteroenteric Strictures After Open Radical Cystectomy and Urinary Diversion: The University of Southern California Experience

Cited by 90 publications

References 7 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

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

Endoscopic Management of Ureteroenteric Strictures

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