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Panach-Navarrete J, Valls-González L, Martínez-Jabaloyas JM. Endoureterotomy with the Lovaco technique for treatment of ureterointestinal strictures: outcomes in an experienced center and factors associated with procedural success or failure. Scand J Urol 2021; 56:59-65. [PMID: 34775899 DOI: 10.1080/21681805.2021.2002401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The study aimed to present the outcomes of an endoureterotomy series using the Lovaco technique for the treatment of ureterointestinal strictures. Factors influencing the success or failure of this technique were also determined. MATERIALS AND METHODS Data were collected from all endoureterotomies for ureterointestinal strictures performed in a single-center between 2017 and 2020. Clinical variables and characteristics of the stricture were recorded in each case, and success was defined as the complete resolution of ureterohydronephrosis. Univariate analysis was used to correlate the variables recorded with procedural success or failure. RESULTS A total of 25 patients were recruited: 16 with strictures on the left side, 5 on the right, and 4 bilateral. With the first endoureterotomy, 52% of the cases (13 patients) were resolved, and in patients undergoing a second intervention 64% success (16 patients) was achieved. Infectious complications occurred in 23.3% of surgeries. Stricture length, poor renal function, and left side involvement were associated with endoureterotomy failure. CONCLUSIONS Endoureterotomy with the Lovaco technique is a useful method in the setting of ureterointestinal strictures, achieving complete resolution of the obstruction in more than 60% of cases. Factors that can negatively affect the success of the procedure include stricture length, poor renal function, and left side involvement.
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Affiliation(s)
- Jorge Panach-Navarrete
- Department of Urology, University Clinic Hospital of Valencia. INCLIVA, Instituto de Investigación Sanitaria. Facultat de Medicina i Odontologia. Universitat de València, Valencia, Spain
| | - Lorena Valls-González
- Department of Urology, University Clinic Hospital of Valencia. INCLIVA, Instituto de Investigación Sanitaria. Facultat de Medicina i Odontologia. Universitat de València, Valencia, Spain
| | - José María Martínez-Jabaloyas
- Department of Urology, University Clinic Hospital of Valencia. INCLIVA, Instituto de Investigación Sanitaria. Facultat de Medicina i Odontologia. Universitat de València, Valencia, Spain
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Panach-Navarrete J, Negueroles-García M, Martínez-Jabaloyas JM. Retrograde endoureterotomy as a treatment option for impacted calculus in the ureterointestinal junction. Urologia 2021; 89:585-588. [PMID: 34519244 DOI: 10.1177/03915603211046167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In patients with a history of radical cystectomy and with intestinal diversion, urolithiasis in the upper urinary tract is a frequent event. MATERIAL AND METHODS We describe for the first time a case of retrograde endoureterotomy used to treat a calculus proximal to the ureterointestinal junction. RESULTS This technique is of interest when antegrade access is not possible. In our example, after passing the guidewire percutaneously, and externalize it through the stoma, the left meatus was reached with a resectoscope inserted through the ileal duct. After the use of a balloon to prevent migration of the calculus, a retrograde endoureterotomy was performed with a Collins knife and the stone removed. The patient's progress was satisfactory. CONCLUSION Endoscopic management of calculi in patients with intestinal diversion can be performed with different approaches. We recommend retrograde endoureterotomy as a feasible treatment option for the removal of impacted calculi at the ureterointestinal junction.
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Affiliation(s)
- Jorge Panach-Navarrete
- Department of Urology, University Clinic Hospital of Valencia; INCLIVA, Institute for Health Research; Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - María Negueroles-García
- Department of Urology, University Clinic Hospital of Valencia; INCLIVA, Institute for Health Research; Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - José María Martínez-Jabaloyas
- Department of Urology, University Clinic Hospital of Valencia; INCLIVA, Institute for Health Research; Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Ericson KJ, Thomas LJ, Zhang JH, Knorr JM, Khanna A, Crane A, Zampini AM, Murthy PB, Berglund RK, Pascal-Haber G, Lee BHL. Uretero-Enteric Anastomotic Stricture Following Radical Cystectomy: A Comparison of Open, Robotic Extracorporeal, and Robotic Intracorporeal Approaches. Urology 2020; 144:130-135. [PMID: 32653565 DOI: 10.1016/j.urology.2020.06.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/21/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the incidence of benign uretero-enteric anastomotic strictures between open cystectomy, robotic cystectomy with extracorporeal urinary diversion, and robotic cystectomy with intracorporeal urinary diversion. The effect of surgeon learning curve on stricture incidence following intracorporeal diversion was investigated as a secondary outcome. PATIENTS AND METHODS Patients who underwent radical cystectomy at an academic hospital between 2011 and 2018 were retrospectively reviewed. The primary outcome, incidence of anastomotic stricture over time, was assessed by a multivariable Cox proportional hazards regression. A Cox regression model adjusting for sequential case number in a surgeon's experience was used to assess intracorporeal learning curve. RESULTS Nine hundred sixty-eight patients were included: 279 open, 382 robotic extracorporeal, and 307 robotic intracorporeal. Benign stricture incidence was 11.3% overall: 26 (9.3%) after open, 43 (11.3%) after robotic extracorporeal, and 40 (13.0%) after robotic intracorporeal. An intracorporeal approach was associated with anastomotic stricture on multivariable analysis (HR 1.66; P = .05). After 75 intracorporeal cases, stricture incidence declined from 17.5% to 4.9%. Higher sequential case volume was independently associated with reduced stricture incidence (Hazard Ratio per 10 cases: 0.90; P = .02). CONCLUSION An intracorporeal approach to urinary reconstruction following robotic radical cystectomy was associated with an increased risk of benign uretero-enteric anastomotic stricture. In surgeons' early experience with intracorporeal diversion the difference in stricture incidence was more pronounced compared to alternative approaches; however, increased intracorporeal case volume was associated with a decline in stricture incidence leading to a modest difference between the 3 surgical approaches overall.
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Affiliation(s)
- Kyle J Ericson
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH.
| | - Lewis J Thomas
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH
| | - Jj H Zhang
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH
| | - Jacob M Knorr
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Abhinav Khanna
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH
| | - Alice Crane
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH
| | - Anna M Zampini
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH
| | - Prithvi B Murthy
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH
| | - Ryan K Berglund
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH
| | - Georges Pascal-Haber
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH
| | - Byron H L Lee
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH
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Hu W, Su B, Xiao B, Zhang X, Chen S, Tang Y, Liu Y, Fu M, Li J. Simultaneous antegrade and retrograde endoscopic treatment of non-malignant ureterointestinal anastomotic strictures following urinary diversion. BMC Urol 2017; 17:61. [PMID: 28789635 PMCID: PMC5549397 DOI: 10.1186/s12894-017-0252-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/03/2017] [Indexed: 11/17/2022] Open
Abstract
Background The 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. Methods From 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. Results With 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. Conclusions The 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.
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Affiliation(s)
- Weiguo Hu
- Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Boxing Su
- Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Bo Xiao
- Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Xin Zhang
- Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Song Chen
- Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Yuzhe Tang
- Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Yubao Liu
- Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Meng Fu
- Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Jianxing Li
- Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China.
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Outcomes Following First-line Endourologic Management of Ureteroenteric Anastomotic Strictures After Urinary Diversion: A Single-center Study. Urology 2016; 102:38-42. [PMID: 27765587 DOI: 10.1016/j.urology.2016.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/01/2016] [Accepted: 10/03/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the outcomes of patients following a first-line systematic endourologic procedure used to treat ureteroenteric anastomotic strictures (UEAS). MATERIALS AND METHODS All data from patients treated using a first-line endourologic approach for UEAS between 2010 and 2015 were reviewed retrospectively. The following data were analyzed: age, type of urinary diversion, initial symptoms, surgical endoscopic approach (antegrade or retrograde), pre- and postoperative creatinine levels, and postoperative complications and outcomes. Follow-up visits occurred at 6 weeks, 3 months, and 6 months postoperatively, and at least annually thereafter. RESULTS A total of 27 patients (median age: 62.5 years) were included. Overall, 28 UEAS were treated endoscopically (ileal conduit: n = 25; neobladder: n = 3). Most UEAS developed following radical cystectomy for bladder cancer (n = 19). Overall, the endoscopic approach was successful in 20 cases (71.4%). The UEAS length was >1 cm in 21 cases (75%). All UEAS of <1 cm were treated successfully (n = 7). There were three grade II and five grade III complications. The median follow-up period was 25 months. The median creatinine levels before surgery and at last follow-up were 1.3 mg/dL and 0.9 mg/dL, respectively. CONCLUSION An endourologic procedure is a reasonable option for first-line treatment for UEAS and has promising functional outcomes and limited morbidity.
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Endourological Treatment of Nonmalignant Upper Urinary Tract Complications After Urinary Diversion. Urology 2010; 76:1302-8. [DOI: 10.1016/j.urology.2010.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 02/19/2010] [Accepted: 03/01/2010] [Indexed: 11/19/2022]
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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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LiteratureWatch. July-December 2005. J Endourol 2006; 20:362-8. [PMID: 16724911 DOI: 10.1089/end.2006.20.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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