Abstract
PurposeTo compare open surgical anastomotic revision with endourological techniques for the treatment of ureteroenteric strictures in patients with urinary diversions.MethodsAll records of patients treated for ureteroenteric strictures in our clinic between 1989 and 2016 were retrospectively reviewed. In 76 patients, 161 completed procedures were analyzed: 26 open revisions vs. 135 endourological treatments, including balloon dilation, Wallstent and/or laser vaporization.ResultsMedian follow-up was 34 months. At 60 months, patency rates were 69% (95% CI 52–92%) after open vs. 27% (95% CI 19–39%) after endo-treatment (p = 0.003); median patency duration was 15.5 vs. 5 months, respectively (p = 0.014). Eventually, 15% of patients required open surgery after primary endo-treatment and 21% received endoscopic re-treatment after primary open surgery. Cox regression analysis revealed no confounding factors among the risk factors added to the model. Complication rates were higher after open surgery (27% Clavien 2, 12% Clavien 3–4 vs. 5% Clavien 1–2, 3% Clavien 3, p = 0.528). Median postoperative hospital stay was 14 days (open) vs. 2 days (endo), p < 0.001. Mean estimated glomerular filtration rate improved with + 17 (open) vs. + 8.1 (endo), p = 0.024. Renal function was compromised in 8% of patients in the open surgery group vs. 6% in the endo-treatment group.ConclusionsIn these patients, in terms of patency and patency duration, open surgery was superior to endourology. Nevertheless, endourological treatments offer a safe and less-invasive alternative to delay or avoid open surgery, especially in patients who are unfit for open surgery.
Highlights
For the construction of a urinary diversion, either a continent pouch (e.g., Indiana pouch), an orthotopic neobladder or an incontinent urostomy can be considered [1]
renal units (RU) Renal units ureteroenteric strictures (UES) Ureteroenteric stricture UMCU University Medical Center Utrecht 95% CI 95% Confidence interval
Two patients were excluded from the study because they opted for no treatment of their UES due to multiple sclerosis and high age, respectively
Summary
For the construction of a urinary diversion, either a continent pouch (e.g., Indiana pouch), an orthotopic neobladder or an incontinent urostomy (e.g., ileal conduit or colon conduit) can be considered [1]. This complex reconstructive surgery is associated with significant perioperative morbidity, with reported acute complication rates of 52–78% [1,2,3,4]. Strictures consist of fibrotic tissue and are typically formed at the anastomosis between ureter and bowel segment [5, 6] This is mostly considered to be the result of ischemia, caused by compromised vascularization during mobilization of the ureters in reconstructive surgery [5, 9, 10]. Presented here is our 27-year institutional experience with, to our knowledge, the largest cohort of UES patients analyzed until now
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