Advances in Endosurgery

A "novel" surgical approach to ureteroileal anastomosis in patients with bricker urinary diversion

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.

Surgical versus endoscopic treatment of non-malignant uretero-ileal anastomotic strictures

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.

Percutaneous balloon dilation of ureteral strictures after failed surgical repair in children

We attempted treatment of long-standing strictures of ureterovesical or ureterosigmoid anastomosis in 6 children by percutaneous balloon dilation. The 4 girls and 2 boys were between 2 and 19 years old (mean age 9 years) at the time of dilation. Obstruction occurred at the ureterosigmoid anastomosis in 3 patients and at the ureterovesical junction in 3. Obstruction was confirmed by diuresis renography, antegrade pyelography and pressure perfusion studies. An attempt at dilation was unsuccessful for 1 patient. For the remaining 5 patients the ureter has remained patent for a followup period of 7 to 18 months (mean 12 months). Percutaneous balloon dilation of established ureterointestinal and ureterovesical obstruction after failed surgical repair can be successful. The hospital stay is reduced and major surgery with its accompanying morbidity is avoided. If balloon dilation is unsuccessful, surgical repair remains an option. Balloon dilation should be seriously considered as an initial form of treatment in this group of patients.