Ureterointestinal strictures following Bricker ileal conduit: management via a percutaneous approach

Abstract

Placement of a double J stent via a percutaneous approach seems to have offered a viable option in the management of ureterointestinal strictures in this patient population. In addition, periodical retrograde replacement of the stent probably does not constitute a factor compromising quality of life. However, further studies are required to justify these primary clinical data.

Urinary diversion in patients with muscle-invasive bladder cancer and severe ureteral stricture: A case report of a new surgical technique

“…The overall ureteral stricture developed in 5.7% of the patients, according to a recent meta-analysis. [5] The placement of a double-J stent through a percutaneous approach [6] or the placement of a Bracci ureteral catheter is a viable option in the management of ureterointestinal strictures. In 1957, the use of a cutaneous pedicle tube into which the exteriorized ureter is drawn was described in order to avoid the use of a ureteral catheter.…”

Nephroureteral Stents: Principles and Techniques

“…An ileal conduit is created by anastomosing the ureters to a loop of bowel that is then secured to the anterior abdominal wall to allow for ostomy bag drainage. 1 Up to 15% of patients develop complications in the form of stricture at the ureteroenteric junction causing obstruction. The importance of this is the eventual outcome of hydronephrosis and kidney loss in neglected patients.…”

“…The importance of this is the eventual outcome of hydronephrosis and kidney loss in neglected patients. [1][2][3] These situations can be treated by percutaneous techniques that have proved to be safer and less invasive than open surgical repair. Treatment success of ureteric strictures and subsequent hydronephrosis by percutaneous methods can reach up to 100%.…”

“…In addition, placement of retrograde transileal conduit nephroureteral stents can be successful in 90 to 95% of cases. [1][2][3] The RNUS insertion is a common procedure done in patients with urinary diversion to treat a variety of clinical situations such as ureteric strictures, ureteroenteric anastomotic strictures, and ureteric leaks and fistulas. 4 The main contraindications faced are similar to those for the placement of a percutaneous nephrostomy (PCN) and obtaining access to the kidney; otherwise, if the patient already has percutaneous access to the kidney then usually no significant issues are faced except in situations where there is significant urinary infection or hematuria.…”

“…The stents were exchanged at 3-to 6-month intervals. 1 Others have found the pigtail configuration (RNUS) to be superior to the double-J stents for several reasons. The pigtail nephroureteral stent provides drainage directly into the stoma bag, thus minimizing urine stasis within the ileal conduit, which in turn decreases ureteric reflux and possible ascending infection.…”