PD12-03 PRIMARY URETEROENTERIC ANASTOMOTIC REVISION AFTER URINARY DIVERSION

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I1 Apr 2016PD12-03 PRIMARY URETEROENTERIC ANASTOMOTIC REVISION AFTER URINARY DIVERSION Greg Gin, Jaspreet Parihar, Bertram Yuh, Jonathan Yamzon, Clayton Lau, and Kevin Chan Greg GinGreg Gin More articles by this author , Jaspreet PariharJaspreet Parihar More articles by this author , Bertram YuhBertram Yuh More articles by this author , Jonathan YamzonJonathan Yamzon More articles by this author , Clayton LauClayton Lau More articles by this author , and Kevin ChanKevin Chan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.898AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteroenteric strictures occur in 3-13% of patients after urinary diversion. Primary endoscopic management of these strictures is most commonly performed and carries a low success rate with the need for multiple interventions. Open revision is considered the gold standard with over a 90% success rate. We reviewed our experience of open and robotic primary revision for ureteroenteric strictures. METHODS Between 2007 and 2015, we revised 53 renal units in 44 patients. Fifty of these revisions were the primary treatment, and 3 patients had a previous endoscopic intervention. Forty-eight revisions were performed open and 5 were performed robotically. The left side was performed in 60.4% of the revisions and the right side in 39.6%. The type of urinary diversion was 14 (31.8%) ileal conduits, 21 (47.7%) ileal neobladders, and 9 (20.5%) Indiana pouches. Ileoureteral interposition was utilized in 6 patients. Success was defined as improvement in hydronephrosis on radiographic imaging and/or reflux during pouchogram. RESULTS At a median follow-up of 16.3 months (0.1-91.8), the success rate of primary ureteroenteric anastomotic revision was 98%. The median length of stay (LOS) was 6 days (2-16). The median operating room time was 215 minutes (126-455) and the median estimated blood loss was 75 mL (1-500). There were a total of 15 complications in 14 patients (33% 30 day complication rate). Of the 15, only 1 (2.3%) was a major complication (≥ Clavien 3). The most common complications were wound infection (n=4) and ileus (n=3). The median time with a percutaneous nephrostomy was 1.6 months (0.3-18). Robotic ureteroenteric revision (n=5) had a LOS of 3 days (2-4) with no complications. The one patient who failed primary revision had a malignant stricture and is currently being evaluated for recurrence. CONCLUSIONS Open and robotic ureteroenteric anastomotic revisions have an excellent success rate. Performing revision as a primary treatment may reduce the time with a nephrostomy tube and obviate the need for multiple interventions. Open revision is associated with mostly minor complications. Robotic ureteroenteric revision may reduce the morbidity of an open revision in select cases. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e293-e294 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Greg Gin More articles by this author Jaspreet Parihar More articles by this author Bertram Yuh More articles by this author Jonathan Yamzon More articles by this author Clayton Lau More articles by this author Kevin Chan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...