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Albisinni S, Aoun F, Mjaess G, Abou Zahr R, Diamand R, Porpiglia F, Esperto F, Autorino R, Fiori C, Tubaro A, Roumeguère T, DE Nunzio C. Contemporary management of benign uretero-enteric strictures after cystectomy: a systematic review. Minerva Urol Nephrol 2021; 73:724-730. [PMID: 34308609 DOI: 10.23736/s2724-6051.21.04463-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Uretero-enteric stricture (UES) is a common post-operative complication after radical cystectomy with urinary diversion. The aim of this systematic review is to discuss the contemporary management of benign UES after cystectomy and to compare the different surgical approaches. EVIDENCE ACQUISITION A systematic review was performed from January 2000 through January 2021. Search engines used included PubMed, Embase and Medline databases. Search query was: ((ureteroileal OR uretero-ileal OR ureteroenteric OR ureteroenteric) AND (stricture OR stenosis)) AND (management OR treatment). Study selection followed the PRISMA statement. Studies tackling management of UES, either through open, endoscopic, laparoscopic or robot-assisted approaches, were included in our systematic review. EVIDENCE SYNTHESIS Forty-one studies were finally included in this systematic review. No prospective studies were found; all included studies were retrospective. Open surgical repair had a 78-100% success rate, a significant rate of complications, and a low recurrence rate (6-8%). Endourological management decreased complication rate, length-of-stay, and blood loss, with however lower success (15-50%) and higher recurrence rates (62%-91%) compared to open surgery. Robotic assisted surgery showed comparable success rates to open surgery (80-100%), while limiting the number of major complications and hospital length-of-stay. CONCLUSIONS Surgical management of UES remains challenging. Open surgery maintains a role given its high success rate, at the cost however of a significant morbidity. On the other hand, endourological procedures offer a favorable and low complication risk, but a low long-term success rate. Robotic-assisted surgery is emerging with a valid resolution of UES as it offers comparable success rates to an open approach, while reducing surgical morbidity. Head-to-head comparisons are awaited to confirm these findings.
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Affiliation(s)
- Simone Albisinni
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium -
| | - Fouad Aoun
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beyrouth, Liban
| | - Georges Mjaess
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beyrouth, Liban
| | - Rawad Abou Zahr
- Urology Department, University Clinics of Brussels, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Urology Department, University Clinics of Brussels, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Francesco Porpiglia
- Department of Urology, Ospedale San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy
| | | | | | - Cristian Fiori
- Department of Urology, Ospedale San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy
| | - Andrea Tubaro
- Urology Department, Sant'Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Thierry Roumeguère
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Cosimo DE Nunzio
- Urology Department, Sant'Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy
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