1421 BILATERAL DILATATION OF THE UPPER URINARY TRACT (UUT) FOLLOWING ILEAL BLADDER SUBSTITUTION USING AN AFFERENT ISOPERISTALTIC TUBULAR SEGMENT: ETIOLOGY AND THERAPY

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion (II)1 Apr 20131421 BILATERAL DILATATION OF THE UPPER URINARY TRACT (UUT) FOLLOWING ILEAL BLADDER SUBSTITUTION USING AN AFFERENT ISOPERISTALTIC TUBULAR SEGMENT: ETIOLOGY AND THERAPY Bernhard Kiss, Susan D. Meierhans Ruf, George N. Thalmann, Urs E. Studer, and Beat Roth Bernhard KissBernhard Kiss Bern, Switzerland More articles by this author , Susan D. Meierhans RufSusan D. Meierhans Ruf Bern, Switzerland More articles by this author , George N. ThalmannGeorge N. Thalmann Bern, Switzerland More articles by this author , Urs E. StuderUrs E. Studer Bern, Switzerland More articles by this author , and Beat RothBeat Roth Bern, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2775AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bilateral dilatation of the UUT following cystectomy and ileal bladder substitution using an afferent isoperistaltic tubular segment is usually caused by neobladder outlet obstruction with consecutive incomplete neobladder voiding, completely resolving after transurethral catheterisation. However, some bilateral hydronephrosis still persist. The aim of this study was to evaluate the etiology and therapy in these patients. METHODS Retrospective analysis of incidence and therapy of bilateral hydronephrosis not responding to transurethral catheterisation in our cohort of 739 cystectomy patients who received an ileal orthotopic bladder substitute with an afferent tubular segment between April 1985 and August 2012. RESULTS 11 patients (1.5%; median age 69 years range 23-81) developed bilateral hydronephrosis not responding to transurethral catheterisation. The etiology was a stenosis of the afferent isoperistaltic tubular segment in all these patients. The median time of onset of the stenosis was 121 months (range 10-192) following cystectomy. We found recurrent or chronic urinary tract infections (UTI) in 10 patients (91%). This incidence of recurrent UTIs was significantly higher compared to the cohort of ileal bladder substitute patients without stenosis of the afferent segment (91% vs 10%; p<0.001). Urine cultures revealed mixed infections (24%), e. coli (16%), staphylococcus aureus (11%), enterococci (11%), klebsiella (7%), streptococci (7%) candida albicans (7%) and others (18%). 10 minimally invasive interventions were performed in 8 patients with only 1 out of 10 being successful (10%). All 7 open surgical revisions were secondary and successful. 1 patient had to undergo a second open revision for a new stenosis in a more distal part of the tubular afferent segment 116 months following resection of the primary more proximal senosis. A nephrostomy tube was placed in 2 patients who were not fit for any kind of intervention and 1 patient died of not related causes before the planned intervention. CONCLUSIONS Bilateral dilatation of the UUT not responding to catheterisation following ileal bladder substitution is likely to be caused by a stenosis of the afferent isoperistaltic tubular segment. This is almost exclusively found in patients with recurrent or chronic UTI and may develop after many years. Minimally invasive interventions are not promising whereas open surgical revision offers excellent results. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e581-e582 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bernhard Kiss Bern, Switzerland More articles by this author Susan D. Meierhans Ruf Bern, Switzerland More articles by this author George N. Thalmann Bern, Switzerland More articles by this author Urs E. Studer Bern, Switzerland More articles by this author Beat Roth Bern, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...