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Kachrilas S, Bourdoumis A, Karaolides T, Nikitopoulou S, Papadopoulos G, Buchholz N, Masood J. Current status of minimally invasive endoscopic management of ureteric strictures. Ther Adv Urol 2013; 5:354-65. [PMID: 24294293 DOI: 10.1177/1756287213505671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Endourological techniques are used more often nowadays in the treatment of ureteric strictures of various etiologies. Advances in technology have provided new tools to the armamentarium of the endoscopic urological surgeon. Numerous studies exist that investigate the efficiency and safety of each of the therapeutic modalities available. In this review, we attempt to demonstrate the available and contemporary evidence supporting each minimally invasive modality in the management of ureteric strictures.
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Affiliation(s)
- Stefanos Kachrilas
- Endourology and Stone Services, Royal London Hospital, Barts Health NHS Trust, London, UK
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2
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Tratamiento quirúrgico a cielo abierto y por vía endoscópica de las estenosis ureteroileales. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1761-3310(09)70019-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE To highlight the current status of ureteroscopic endoureterotomy (UE) by reporting extensive experience with the endoscopic management of ureteric strictures, with special emphasis on factors determining success, and by reviewing publications on the minimally invasive management of ureteric strictures. PATIENTS AND METHODS The study comprised 50 patients (mean age 53 years, range 18-85, equal sex distribution) with ureteric strictures of varying causes; all had their stricture treated endoscopically. The follow-up was 0.5-9 years; 10 patients with recurrent strictures had two ipsilateral stents placed to try to improve the outcome, and eight patients with completely obliterating strictures were treated by ureteroscopic re-canalization. RESULTS The site of stricture had no bearing on the eventual outcome. Patients with uretero-enteric and malignant strictures did not fare so well. The most important predictor of failure was the length of the stricture, with failure in all seven patients with strictures of > 2 cm. In the 10 patients treated with two ipsilateral stents, eight were successful, which was very promising considering that these patients had recalcitrant strictures and placing one stent had previously failed. The overall success rate was 74%. CONCLUSION UE has become the procedure of choice for the initial management of ureteric strictures. Simple balloon dilatation is also effective in certain situations. The characteristics of the stricture often govern the eventual outcome. In properly selected cases success rates of approximately 75% can be expected.
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Affiliation(s)
- Sanjay Razdan
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Fluoroscopy Guided Retrograde Ureteral Stent Insertion in Patients With a Ureteroileal Urinary Conduit: Method and Results. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65081-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fluoroscopy Guided Retrograde Ureteral Stent Insertion in Patients With a Ureteroileal Urinary Conduit: Method and Results. J Urol 2002. [DOI: 10.1097/00005392-200205000-00024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Costamagna G, Shah SK, Mutignani M, Tringali A, Alevras PP, Vamvakousis V, Racioppi M, D'Addessi A, Perri V. Use of a duodenoscope to manage complications at the ureteroileal anastomotic site after total urinary bladder resection and the Bricker procedure. Gastrointest Endosc 2002; 55:242-8. [PMID: 11818933 DOI: 10.1067/mge.2002.120888] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND A novel flexible endoscopic technique is described for the treatment of ureteroileal strictures and leaks after the Bricker procedure. METHODS Seventeen patients with 24 ureteroileal complications (strictures, 22; leaks, 2) were treated under conscious sedation with a side-viewing duodenoscope. The ureter was cannulated and stent insertion, dilation, or both were performed. RESULTS Immediate technical success was achieved in 19 of the 24 (79.2%) ureteroileal complications. Treatment included stent placement alone in 12, dilation plus stent in 4, intraileal ureter resection plus stent with or without dilation in 3, and removal of ureteral calculi in 1. The procedure was unsuccessful in 5 (20.8%; failure to visualize ureteroileal anastomosis 4, unsuccessful cannulation 1). No major complications occurred. The 14 patients treated successfully were followed (mean 43 months, range 2-132 months) and a satisfactory outcome was observed in all. Partial stent displacement occurred in 2 patients and ureteral calculi developed in 2 patients. Three patients died with a stent in situ; no death was stent-related. Eleven patients are alive and asymptomatic, 5 with a stent in situ. In 6 patients, the stent was extracted after a mean of 36 months and all remained asymptomatic during a mean further follow-up of 41 months. CONCLUSION Treatment of ureteroileal anastomotic complications with a flexible duodenoscope and endoscopic techniques is safe, simple, and noninvasive with good success and excellent long-term results. This approach can be recommended as first-line therapy in patients with ureteroileal anastomotic complications.
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Affiliation(s)
- Guido Costamagna
- Digestive Endoscopy Unit and the Department of Urology, Università Cattolica del Sacro Cuore, A. Gemelli University Hospital, Rome, Italy
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Chang DT, Gupta M. Use of a laparoscopic insufflation port for ileal conduit endoscopy. Urology 1999; 53:412-3. [PMID: 9933066 DOI: 10.1016/s0090-4295(98)00429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We present an effective and simple technique for performing endoscopy of an ileal conduit. With a laparoscopic insufflation port in the stoma, a flexible cystoscope or ureteroscope can be inserted. The one-way valve of the port prevents leakage of irrigation fluid and allows the conduit to distend for optimal visualization. This technique is particularly useful when access to the upper urinary tracts is needed.
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Affiliation(s)
- D T Chang
- Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Barbalias GA, Liatsikos EN, Karnabatidis D, Yarmenitis S, Siablis D. Ureteroileal anastomotic strictures: an innovative approach with metallic stents. J Urol 1998; 160:1270-3. [PMID: 9751333 DOI: 10.1016/s0022-5347(01)62513-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE We report our experience with the use of self-expandable metallic stents to bypass anastomotic strictures after ureteroileal urinary diversion. MATERIALS AND METHODS We evaluated 3 men and 1 woman with invasive bladder carcinoma who underwent radical cystectomy and ileal conduit urinary diversion. Ureteroenteric anastomotic strictures developed after a mean of 16 months. Self-expandable metallic stents were successfully placed (bilaterally in 2) comprising 6 stented ureters that bypassed strictures. Mean patient age was 64 years and mean followup was 12 months. RESULTS No restenosis was observed in 3 patients during followup. The stricture recurred 1 month after stent placement in the remaining patient and additional intervention was necessary, consisting of placement of a totally coaxial overlapping metal stent. No sepsis or other complication was observed. One patient died of metastatic disease 12 months after stent placement. CONCLUSIONS We propose the use of metal stents as an adequate, safe and effective alternative treatment for anastomotic strictures after ureteroileal diversion.
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Affiliation(s)
- G A Barbalias
- Department of Urology, University of Patras, School of Medicine, Greece
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Affiliation(s)
- Michael J. Conlin
- Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Leonard G. Gomella
- Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Demetrius H. Bagley
- Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Sofras F, Kontothanassis D, Kouroupakis D. A "novel" surgical approach to ureteroileal anastomosis in patients with bricker urinary diversion. Int Urol Nephrol 1995; 27:151-5. [PMID: 7591571 DOI: 10.1007/bf02551312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We present a technique used in two patients with Bricker urinary diversion for the approach of ureteroileal anastomosis. The right lateral extraperitoneal approach provides fast access to the site, is virtually bloodless and appears to have no major complications. Although this method is extensively used by urologists, it does not appear in the literature on repairs of ureteroileal strictures.
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Affiliation(s)
- F Sofras
- Department of Urology, University of Athens Medical School, Sismanoglion Hospital, Greece
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Bissada NK. Endoscopic treatment of vesicoileal anastomotic stricture. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1994; 4:355-7. [PMID: 7833522 DOI: 10.1089/lps.1994.4.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 26-year-old man with anastomotic stricture at the junction of an ileal ureter and the bladder was managed successfully by endoureterotomy. Follow-up at 18 months indicated the absence of recurrent stricture. To our knowledge, endourologic management of an ileovesical anastomotic stricture has not been reported previously.
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Affiliation(s)
- N K Bissada
- Department of Urology, Medical University of South Carolina
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Sanders R, Bissada NK, Bielsky S. Ureteroenteric anastomotic strictures: treatment with Palmaz permanent indwelling stents. J Urol 1993; 150:469-70. [PMID: 8326581 DOI: 10.1016/s0022-5347(17)35517-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 70-year-old man with bilateral ureteroenteric anastomotic strictures and recurrent urinary tract sepsis that continued despite bilateral Double-J ureteral stents and nephrostomy tubes was successfully treated with bilateral Palmaz indwelling permanent stents.
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Affiliation(s)
- R Sanders
- Division of Urologic Oncology, Medical University of South Carolina, Charleston 29425
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Murray KH, Wilkinson ML. Endoscopic transurostomy diathermy anastomotomy. A combined approach to uretero-ileal stenoses. BRITISH JOURNAL OF UROLOGY 1993; 72:23-5. [PMID: 8149173 DOI: 10.1111/j.1464-410x.1993.tb06450.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Uretero-ileal stenosis is a recognised complication of ileal conduit urinary diversion. Two patients are described in whom a combination of fibreoptic conduitoscopy with standard endoscopic "biliary" sphincterotomy was used to treat anastomotic strictures. The technique of endoscopic transurostomy diathermy anastomotomy allowed the salvage of 3 renal units without the need for laparotomy or long-term indwelling ureteric stents.
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Affiliation(s)
- K H Murray
- Department of Urology, Guy's Hospital, London
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Vandenbroucke F, Van Poppel H, Vandeursen H, Oyen R, Baert L. Surgical versus endoscopic treatment of non-malignant uretero-ileal anastomotic strictures. BRITISH JOURNAL OF UROLOGY 1993; 71:408-12. [PMID: 8499983 DOI: 10.1111/j.1464-410x.1993.tb15982.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The classical treatment of uretero-ileal anastomotic strictures after Bricker uretero-ileostomy is open surgical revision. Recent progress in endourology has provided a number of alternatives. The success rate of these endoscopic techniques is less than the success rate of the open surgical revision.
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GERMINALE F, BOTTINO P, CAVIGLIA C, TOGNONI P, DURAND F, GIULIANI L. Endourologic Treatment of Ureterointestinal Strictures. J Endourol 1992. [DOI: 10.1089/end.1992.6.439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Meretyk S, Clayman RV, Kavoussi LR, Kramolowsky EV, Picus DD. Endourological treatment of ureteroenteric anastomotic strictures: long-term followup. J Urol 1991; 145:723-7. [PMID: 2005687 DOI: 10.1016/s0022-5347(17)38435-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In 1987 we reported our initial experience with an endosurgical incisional approach to ureteroenteric anastomotic strictures (that is endoureterotomy). We have extended that initial report to encompass 15 patients with 19 ureteroenteric strictures followed for an average of 2.5 years. In all cases an endosurgical approach was well tolerated, blood loss was less than 50 cc and hospital stay averaged 3.5 days. A 16 to 22F external stent was left in place for 4 to 6 weeks postoperatively in 14 strictures. A permanent external 12F catheter was left in 5 strictures due to the presence of metastatic disease (4) and a complete dense stricture (1). The only major complication was a ureteroenteric fistula that healed over a ureteral stent without any open surgical intervention. Among 14 ureteroenteric strictures in which the stent was removed, the ureteroenteric area has remained patent in 8 (57%) with an average followup of 28.6 months (range 9 to 57 months). Failures were associated with metastatic disease in 2 cases, generalized debility in 2 and unexplained in 2. In this series an endosurgical approach to ureteroenteric strictures provided long-term satisfactory management of the problem in the majority of patients with benign and malignant disease. By current standards, only 1 patient (7%) would have been considered a candidate for open surgical repair.
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Affiliation(s)
- S Meretyk
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri
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Kramolowsky EV, Clayman RV, Weyman PJ. Management of ureterointestinal anastomotic strictures: comparison of open surgical and endourological repair. J Urol 1988; 139:1195-8. [PMID: 3373585 DOI: 10.1016/s0022-5347(17)42857-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The established treatment for ureterointestinal anastomotic strictures is open surgical revision. In an effort to evaluate the efficacy of endourological surgery for this problem, we compared 7 patients (9 strictures) who underwent open revision to 6 patients (7 strictures) who underwent endoscopic incision and balloon dilation of the stricture. The success rate (that is patent ureter and no stent) was 89 per cent for the open revision group and 71 per cent (5 of 7) for the endoscopic group. All open revisions required use of general anesthesia, while 3 of the endoscopic procedures were performed with the patient under assisted local anesthesia. The endoscopic group had markedly shorter hospitalization, decreased blood loss, diminished patient discomfort and no postoperative complications. While the endoscopic procedure for ureteroileal anastomotic strictures is less successful than open revision, the lower morbidity, decreased cost and shorter hospital stay associated with the endourological approach favor its use over open revision. For elderly patients who fail initial endoscopic revision and for patients with metastatic transitional cell cancer, placement of an indwelling stent is a reasonable alternative. Given these guidelines, less than 30 per cent of the patients who suffer a ureteroileal anastomotic stricture will require open surgical revision.
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Affiliation(s)
- E V Kramolowsky
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City
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HORGAN J, CUBELLI VINCENT, LEE WONJ, SMITH ARTHURD. Endourologic Stenting of Ureteroileal Anastomotic Stricture: Cope Modification. J Endourol 1987. [DOI: 10.1089/end.1987.1.275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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