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Abdalla A, Cohn JA, Simhan J. Unraveling the Complexities of Uretero-Enteric Strictures: A Modern Review. Curr Urol Rep 2024; 25:287-297. [PMID: 39138815 DOI: 10.1007/s11934-024-01222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review article is to provide a contemporary overview of benign uretero-enteric anastomotic stricture (UAS) management and outcomes. RECENT FINDINGS In this article, we will review the most recent studies investigating UAS and evaluate etiology, potential risk factors, presentation, diagnosis, and management options, along with personal insight gained from our experience with managing this challenging reconstructive complication. Benign UAS is a relatively common long-term complication of intestinal urinary diversion, affecting approximately 1 in 10 patients. It is thought to be caused by ureteral tissue ischemia and fibrosis at the anastomotic site. Risk factors appear to include any that increase the likelihood of leak or ischemia; it is not clear if anastomotic approach impacts risk for stricture as well. Management options are varied and include endourologic, open, and robotic approaches. Endoscopic approaches may be less morbid but are considerably less effective than reconstruction performed after a period of ureteral rest.
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Affiliation(s)
- A Abdalla
- Department of Urology, Albert Einstein Medical Center, Philadelphia, PA, 19141, USA
| | - Joshua A Cohn
- Department of Urology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - J Simhan
- Department of Urology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
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Della Corte M, Cerchia E, Fiori C, Mandaletti M, Ruggiero E, Porpiglia F, Catti M, Gerocarni Nappo S. JJ stent dislodgement in the distal ureter: how to recover it in preschool children? Minerva Urol Nephrol 2024; 76:116-119. [PMID: 38015551 DOI: 10.23736/s2724-6051.23.05550-7] [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: 11/29/2023]
Abstract
Double-J ureteral stents are usually placed after various urological procedures. The dislodgement of their distal ringlet is a rare complication, whose retrieval is arduous in younger children, due to the small ureteral caliber. We propose our innovative endoscopic approach to recover the dislodged JJ stent. Under 8-9.8 Ch cystoscopy, the ureteral meatus is gently cannulated with a 00.18″ guidewire, then a balloon catheter Passeo 18 3-4 mm (Biotronik, Lake Oswego, OR, USA) is coaxially inserted. A pneumatic dilatation of the vesical-ureteral junction is performed up to 8 atmospheres for 5 minutes under direct vision. Consequently, the ureteral meatus allows the cystoscope passage, and the JJ-stent can be recovered thanks to endoscopic grasping forceps. A mono-J stent is then left in place for 24 hours. Four patients aged 8 months - 4 years have been successfully treated with this approach after that JJ migration was found intraoperatively or during ultrasonography. No intra- or postoperative complications occurred. Postoperative hospital stay was prolonged for one day. During 29.5 medium follow-up no clinical or ultrasonographic signs of vesical-ureteral reflux ensued. Our cystoscopic approach is effective and safe to ensure a prompt endoscopic JJ retrieval without changing neither surgical approach nor the anesthesiological support. We believe that all the pediatric urology centers should know the procedure and have small size balloon catheter available.
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Affiliation(s)
- Marcello Della Corte
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy -
| | - Elisa Cerchia
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
| | - Cristian Fiori
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Martina Mandaletti
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
| | - Elena Ruggiero
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
| | - Francesco Porpiglia
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Massimo Catti
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
| | - Simona Gerocarni Nappo
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
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Ghodoussipour S, Ahmadi N, Goh A, Alemozaffar M, Nabavizadeh R, Gallucci M, Simone G, Tuderti G, Gill I, Desai M, Zhao LC, Aron M. Robotic Repair of Ureteroenteric Stricture Following Radical Cystectomy: A Multi-Institutional Experience. Urology 2022; 161:125-130. [PMID: 35007620 PMCID: PMC9982748 DOI: 10.1016/j.urology.2021.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the safety, feasibility and durability of robotic reimplantation of ureteroenteric stricture after radical cystectomy. MATERIALS AND METHODS A retrospective multi-institutional review was performed for all patients undergoing robotic repair of ureteroenteric stricture from January 2010 to January 2019. Functional outcomes and complications were followed and data were analyzed with SPSS statistical software. RESULTS A total of 46 patients and 58 renal units were identified, of which 15 had right sided, 19 left sided and 12 patients had bilateral strictures. Presentation of stricture was asymptomatic in 14 (30.4%) patients. Symptomatic presentations included infection in 22 (47.8%), worsening renal function in 11 (23.9%) and pain in 3 (6.5%) patients. Median time from cystectomy to diagnosis of stricture was 5 months (1-40). Median stricture length was 1.5 cm (range 0.5-10). All strictures were of benign etiology except for 4 (6.9%), which were due to malignancy. Overall, 49 (84.5%) ureters underwent primary re-implantation, while 9 (15.5%) required Boari-like advancement flaps prior to re-implantation. Median operative time was 190 min (range 45-540) with median estimated blood loss of 50 mL (range 25-2000) and median length of stay of 2 days (range 1-33, IQR 2-4). Seven (15.2%) patients experienced complications; 3 (6.5%) were low grade and 4 (8.7%) high grade. With median follow up of 18 months (range 1-51) the stricture recurrence rate was 8.6%. CONCLUSION Robotic reimplantation of ureteroenteric strictures following radical cystectomy is safe and feasible in experienced centers with high success rates.
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Affiliation(s)
- Saum Ghodoussipour
- Rutgers Robert Wood Johnson Medical School and Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | - Alvin Goh
- Methodist Hospital, Houston, Texas, USA,Memorial Sloan Kettering Cancer Center, New York, USA
| | | | | | | | | | | | - Inderbir Gill
- USC Institute of Urology, Los Angeles, California, USA
| | - Mihir Desai
- USC Institute of Urology, Los Angeles, California, USA
| | - Lee C. Zhao
- New York University Langone Health, New York, USA
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