Successful dilatation of ureteroileal anastomotic stenosis using Grüntzig catheter

[Stricture recanalisation of the distal urether with various endoprothesis]

INTRODUCTION

Application of the metallic stents in the interventional uroradioligy is the result of continous development of the new generation methods percutaneous nephrostomy (PCN), ballon catheter dilatation (BCD), methal and covered stent application. Application of metal stents in the renal canal system was attempted in order to eliminate BCD and PCN--related limitations as well as poor therapeutic results of these methods in a number of etiopathogenic groups of urinary stasis. Years--long application of interventional uroradiology methods, until the development of metallic stengts had shown the following therapeutics facts: PCN is incapable to resolve the caus of urinary obstruction. Permanent good therapeutic BCD results mostly depend on pathohistological aspect of the stricture, metallic stents are most frequently the last choice in therapeutics approch to urinary tract obstructions and their application is directly dependent on previous therapeutics results accomplished by PCN and BCD. In therapeutical sequences new generation of covered stents have important place as method of selection in patients of irreversibile uroopstruction of distal ureter.

OBJECTIVE

The main goal of this study was to analize therapeutics results, advanteges and shortages of insercion plastics and opened metallic endoprothesis, and to analize results of covered methal applications on the contrary of using older interventional uroradiology methods.

METHOD

Sixthytwo patients with distal urether strictures threated in the Deparment of interventional uroradiology Institute od Radiology Clinical centre of Serbia in Belgrade, participated in the study. Results were analized with Person's 2-test, Fisher test and Student T-test.

RESULTS

In our study we had highly significant differences in comparison with number of patients and type of stents during the time after recanalization was reached. Also it was highly significant differences acorrding the type od used interventional uroradiology method that treated proliferation and the success of recanalization.

CONCLUSION

Application of covered temporary uretheral stents have number advanteges against using generation older permanent methal endoprothesis.

[Recanalization of uretero-intestinal anastomoses]

The authors present their own experience related to application of the metallic stents in treatment of ureteroenteric strictures. Over the period of approximately 3 years, we have implanted them in 27 patients (28 strictures). Due to the unsatisfactory therapeutic effects of the repeated balloon catheter dilatations and catheter prostheses the further course of treatment included placement of the metallic Strecker stents of 4-8 cm in length and 6-8 mm in diameter. Six months after the procedure, 58% of the procedures were assessed as satisfactory. After one year, 12 out of 28 were clinically efficient at long-term. The achieved effects were significantly better in comparison to older generation interventional radiology methods.

[Percutaneous-retrograde recanalization of ureteral stricture with a curved metal stent]

Our own experience in application of a combined percutaneous-retrograde approach for recanalization of the urethral structures in 4 patients in presented. Metallic guide is placed via the previously created percutaneous nephrostomy while dilatation or insertion of the metallic stent is performed retrogradely. The approach is used in the strictures in which percutaneou's placement of the recanalization balloon catheter into the stricture site was impossible. The method was successfully applied in all 4 cases in absence of any complications.

Long-term results of percutaneous balloon dilation for ureterointestinal anastomotic strictures

BACKGROUND

We determined the long-term result of our percutaneous antegrade balloon dilation technique performed for adult patients with ureterointestinal anastomotic stricture between 1992 and 1997.

METHODS

Balloon dilation was performed on 13 ureterointestinal anastomotic structures in 10 patients. After a nephrostomy was performed, a guide wire was introduced into the intestinal loop through the stenotic portion under direct observation using a ureterorenoscope. Dilation was performed using the Olbert balloon dilator (30-Fr) inserted along a guide wire into the stenotic portion. A 20-Fr or 22-Fr multihole catheter was left for approximately 6 weeks. No major complications were encountered during or after these procedures. After removal of the indwelling catheters, the progress of each patient was followed fo rat least 14 months.

RESULTS

Additional dilation was necessary in three of 10 patients for the recurrent stricture. The balloon dilation was ineffective in two patients with a long stenosis of the ureter or a previous history of radiation therapy for uterine cancer. Eight of 10 patients showed satisfactory outcomes during the mean follow-up period of 47.1 months.

CONCLUSIONS

Based on these results, we believe that the balloon dilation could be the first line of treatment for strictures of uro-digestive anastomosis, except for some patients with a long stenosis or a previous history of intrapelvic radiation.

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.

Effect of balloon dilation of ureter on upper tract dynamics and ureteral wall morphology

Sixteen male Yucatan minipigs underwent balloon dilation of the right ureterovesical junction (UVJ) and lower ureter to twice its normal caliber. With the bladder open, bilateral upper tract dynamics measurements under different perfusion rates (0.5, 2, and 4 ml/min) were recorded predilation, immediately after dilation, and 1, 2, 3, 4, and 6 weeks after dilation. Immediate and late antegrade nephrostograms, suprapubic cystograms, and right antegrade nephrostograms (oblique view) were taken. In the chronic experiment, no difference in renal pelvic pressure (Ppvs) was detectable between the control and dilated sides immediately after dilation. Only at 4 ml/min was there a statistically significant increase in the Ppvs of the dilated ureter 1 week after dilation when compared with the controls. At 2 weeks, this obstructive change had disappeared. At 3, 4, and 6 weeks, Ppvs of the dilated ureter declined progressively in comparison with the control side, but the difference was not statistically significant. At 6 weeks, Ppvs of the dilated ureter decreased significantly compared with predilation readings only at 4 ml/min. Immediate antegrade radiologic evaluation revealed that 69% of the experimental animals had no extravasation, while 31% showed variable degrees of extravasation, which disappeared completely on late antegrade nephrostograms (6 weeks). Grade 2 reflux occurred in 33% of the experimental animals at 1 week and had disappeared at 6 weeks. Histologic examinations at 1, 2, and 3 weeks revealed a nonhomogeneous pattern of ureteral damage, ranging from total rupture to much less dramatic injury.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

Acute mechanical dilation of the ureter: an experimental study

Forty-three kidney donor ureters were mechanically dilated in vitro with Van Buren sounds to an average of 21.2F. Thirty-three of these ureters, with an average pre-dilation diameter of 11.3F, could be dilated an additional average of 10.6F. The average dilated/nondilated diameter ratio in these ureters was 1.9. These experimental data suggest an undilated pelvic ureteral diameter and a manually dilated ureteral diameter of approximately the same size cited in the clinical literature.

Percutaneous management of benign ureteral strictures and fistulas

The percutaneous methods of management of benign ureteral strictures or fistulas have developed as a natural evolution of percutaneous nephrostomy and angiographic techniques. We review our 5-year experience, which includes 18 patients with 19 benign ureteral strictures and 12 patients with ureteral fistulas. In the majority of the patients the ureteral strictures occurred at sites of surgical reconstruction or endoscopic manipulation. All fistulas resulted from surgical injury. In 10 of the 12 patients (82 per cent) the fistulas healed without development of a stricture or need for further intervention. Patients with short ureteral strictures had a high incidence of success and they usually were the best candidates for percutaneous manipulation. The long strictures usually were of longer duration and they were less likely to be managed successfully percutaneously. Failure of percutaneous dilation did not impede subsequent surgical management. Percutaneous management often is a reasonable initial step in the treatment of ureteral strictures and fistulas.

The role of dilatation in bilharzial ureters

Endoscopic dilatation of bilharzial ureteric strictures was carried out in 35 men and four women. The procedure had to be repeated in 10 patients after 2 months and three patients have required regular dilatation every 4 months for the last 2 years. The selection of patients is important since they should have neither an active lesion nor a stenotic calcific one.

Endourological reconstruction of posterior urethral disruption

While conventional methods of urethroplasty for posterior urethral disruption usually are successful technically, they may be associated with complications and often require the expertise of a specialist. Therefore, the option of an endourological approach to the treatment of the obliterated posterior urethra would be highly desirable if a comparable surgical outcome could be achieved. We describe a closed controlled method of posterior urethral reconstruction following traumatic avulsion of the posterior urethra. Urethral continuity was re-established by endoscopic identification of the true prostatic outlet, its fixation with an angiography wire and a Goodwin sound, retrograde visual urethrotomy through the fibrotic segment and balloon dilation of the entire posterior channel. Postoperative anatomical and functional results were excellent, and were achieved with much less risk and cost to the patient than those of a perineal or transpubic urethroplasty.

Transluminal balloon dilation of ureteral strictures

Ureteral strictures are uncommon problems in urological practice. The nonvascular application of the Grüntzig balloon catheter is proposed as an alternative to surgery in some of these patients. We treated 6 ureteral strictures in 5 patients by balloon dilation with an 83 per cent success rate.

Ureteral balloon dilatation and stone basketing

Dilatation of the ureter with a specially designed angioplasty balloon below large impacted ureteral calculi enhances the possibility of successful cystoscopic stone extraction. Current techniques, results, and conclusions are reviewed.