Abstract
BackgroundThe ureterointestinal anastomosis stricture (UAS) is a common complication of urinary diversion after radical cystectomy. For decades, open anastomotic revision remained the gold standard for the treatment of UAS. However, with the advancement in endoscopic technology, mini-invasive therapeutic approaches have been used in its management. Here, we report our experience with and long-term results of combined simultaneous antegrade and retrograde endoscopy (SARE) in the treatment of non-malignant UASs after urinary diversion in a consecutive series of patients.MethodsFrom March 2012 to January 2015, there were 32 consecutive patients with 32 non-malignant UASs following radical cystectomy and urinary diversion. Twenty-nine patients were treated with SARE technique and comprised the study group. Using simultaneous antegrade flexible ureteroscope combined with retrograde semi-rigid ureteroscope or nephroscope, partial or complete strictures were managed with laser incision and balloon dilation under direct visualization. A 7/12 Fr graded endopyelotomy stent was left for 3–6 months after the procedure. Success was defined as symptomatic improvement and radiographic resolution of obstruction.ResultsWith a median followup of 22 months (6–36), the overall success rate for SARE was 69.0%. Twenty patients with partial stricture had a success rate of 85%, and 9 patients with complete stricture had a success rate of 33.3%. Renal function, hydronephrosis grade, stricture type, and stricture length were significant influences on the outcome (P < 0.05). No complication was observed.ConclusionsThe SARE is a safe and effective treatment for UAS, and may be the only endoscopic treatment approach for complete UAS. While success rate for complete strictures is low compared to open revision, it should be considered as an initial approach given its low overall morbidity. For partial strictures, prudent patient selection results in higher success rates that are nearly comparable to open revision.
Highlights
The ureterointestinal anastomosis stricture (UAS) is a common complication of urinary diversion after radical cystectomy
The 85% success rate nearly comparable to open revision in patients with partial strictures in our analysis further proved that the simultaneous antegrade and retrograde endoscopy (SARE) is an effective treatment approach
Our study shows that significant hydronephrosis predicts a higher failure rate. 94.4% of UAS were successfully treated in patients with renal hydronephrosis leveled gradeI―IIverse 21.4% in patients leveled grade III―IV.Similar results were reported by Poulakis and his colleagues in a series of 40 patients with 43 UASs underwent coldknife endoureterotomy [6]
Summary
The ureterointestinal anastomosis stricture (UAS) is a common complication of urinary diversion after radical cystectomy. Open anastomotic revision remained the gold standard for the treatment of UAS. We report our experience with and long-term results of combined simultaneous antegrade and retrograde endoscopy (SARE) in the treatment of non-malignant UASs after urinary diversion in a consecutive series of patients. Despite the advances and modifications in urinary diversion after radical cystectomy, the ureterointestinal anastomosis stricture (UAS) is still a common complication of this procedure. Standard management of UAS involves open surgical revision of the anastomosis with reimplantation of the viable ureter into the urinary diversion. Treatment for UAS has changed drastically as a result of advances in endoscopic techniques and instrumentation [5]. The antegrade approach has been limited to treating only partial UAS
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
