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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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Campschroer T, Lock MT, Lo RT, Bosch JR. The Wallstent: long-term follow-up of metal stent placement for the treatment of benign ureteroileal anastomotic strictures after Bricker urinary diversion. BJU Int 2014; 114:910-5. [DOI: 10.1111/bju.12729] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Thijs Campschroer
- Department of Urology; University Medical Center Utrecht; Utrecht The Netherlands
| | - M.T.W. Tycho Lock
- Department of Urology; University Medical Center Utrecht; Utrecht The Netherlands
- Department of Urology; Central Military Hospital Dr. A. Mathijsen; Utrecht The Netherlands
| | - Rob T.H. Lo
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - J.L.H. Ruud Bosch
- Department of Urology; University Medical Center Utrecht; Utrecht The Netherlands
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Use of a long-term metal stent in complex uretero-ileal anastomotic stricture. Arab J Urol 2011; 9:251-3. [PMID: 26579307 PMCID: PMC4150572 DOI: 10.1016/j.aju.2011.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 08/05/2011] [Accepted: 08/06/2011] [Indexed: 11/20/2022] Open
Abstract
Uretero-ileal anastomotic stricture is a potentially serious late complication after ileal conduit formation, with a reported incidence of 3-9%. The standard management technique is open surgical revision of the anastomosis with reimplantation of the affected ureter. This is technically challenging and has potential significant morbidity for the patient. Advances in endourological techniques now offer a variety of less-invasive treatment options, like balloon dilatation or laser ureterotomy followed by stent insertion. What happens when such open and minimally invasive techniques fail? Recently, using a combined antegrade and retrograde approach, we inserted a novel, semi-permanent, dual-expansion thermo-expandable metallic alloy stent across a recurrent ileal-ureteric stricture. We describe the technique and potential advantages of this minimally invasive method. This minimally invasive treatment option is of interest, as in contrast to other stents, it does not require routine change, and is resistant to corrosion and urothelial ingrowth, hence ensuring ease of exchange or removal if required.
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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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Garg T, Guralnick ML, Langenstroer P, See WA, Hieb RA, Rilling WS, Sudakoff GS, O'Connor RC. Resonance® Metallic Ureteral Stents Do Not Successfully Treat Ureteroenteric Strictures. J Endourol 2009; 23:1199-201; discussion 1202. [PMID: 19530950 DOI: 10.1089/end.2008.0454] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tullika Garg
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Peter Langenstroer
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William A. See
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert A. Hieb
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William S. Rilling
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gary S. Sudakoff
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - R. Corey O'Connor
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
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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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Liatsikos EN, Kagadis GC, Karnabatidis D, Katsanos K, Papathanassiou Z, Constantinides C, Perimenis P, Nikiforidis GC, Stolzenburg JU, Siablis D. Application of Self-Expandable Metal Stents for Ureteroileal Anastomotic Strictures: Long-Term Results. J Urol 2007; 178:169-73. [PMID: 17499298 DOI: 10.1016/j.juro.2007.03.061] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE We report our long-term experience with the management of benign ureteroileal anastomotic strictures using self-expandable metal stents. MATERIALS AND METHODS A total of 16 male and 2 female patients with a mean+/-SD age of 72+/-7 years (range 66 to 78) with benign fibrotic strictures at the site of ureteroileal anastomosis underwent implantation of self-expandable metal stents with a nominal diameter of 6 to 8 mm. A total of 24 ureteroileal conduits were treated. The external nephrostomy tubes were removed after fluoroscopic validation of ureteral patency. Patients were followed with blood biochemistry, ultrasonography, urography and/or virtual endoscopy. Retrograde external-internal catheter insertion through the cutaneous stoma was performed in cases of recalcitrant stricture. RESULTS The technical success rate of ureteroileal stricture crossing and stenting was 100% (24 of 24 cases). Mean followup was 21 months (range 7 to 50). The clinical success rate during the immediate post-stenting period was 70.8% (17 of 24 cases). The 1 and 4-year primary patency rates were 37.8% and 22.7%, respectively. Secondary interventions included repeat balloon dilation in 15 ureters, of which 8 also underwent subsequent coaxial stent placement. The 1 and 4-year secondary patency rates were 64.8% and 56.7%, respectively. Except in 2 patients who died external-internal Double-J catheters continued to be inserted retrograde in 6 ureteroileal conduits. They are periodically exchanged to prevent mucous inspissation and stent encrustation. CONCLUSIONS Metal stents served as the definitive treatment for stricture in more than half of the cases, whereas in the remainder the stents allowed the uncomplicated and regular exchange of Double-J catheters in retrograde fashion. This combined, less invasive treatment for ureteroileal anastomotic strictures may help patients avoid surgical revision and preserve quality of life.
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Affiliation(s)
- Evangelos N Liatsikos
- Department of Urology, School of Medicine, University of Patras, and Laikon General Hospital, Athens, Greece.
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Watterson JD, Sofer M, Wollin TA, Nott L, Denstedt JD. Holmium: Yag Laser Endoureterotomy For Ureterointestinal Strictures. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65179-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- James D. Watterson
- From the Division of Urology, University of Western Ontario, London, Ontario, Canada
| | - Mario Sofer
- From the Division of Urology, University of Western Ontario, London, Ontario, Canada
| | - Timothy A. Wollin
- From the Division of Urology, University of Western Ontario, London, Ontario, Canada
| | - Linda Nott
- From the Division of Urology, University of Western Ontario, London, Ontario, Canada
| | - John D. Denstedt
- From the Division of Urology, University of Western Ontario, London, Ontario, Canada
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Costamagna G, Shah SK, Mutignani M, Tringali A, Alevras PP, Vamvakousis V, Racioppi M, D'Addessi A, Perri V. Use of a duodenoscope to manage complications at the ureteroileal anastomotic site after total urinary bladder resection and the Bricker procedure. Gastrointest Endosc 2002; 55:242-8. [PMID: 11818933 DOI: 10.1067/mge.2002.120888] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND A novel flexible endoscopic technique is described for the treatment of ureteroileal strictures and leaks after the Bricker procedure. METHODS Seventeen patients with 24 ureteroileal complications (strictures, 22; leaks, 2) were treated under conscious sedation with a side-viewing duodenoscope. The ureter was cannulated and stent insertion, dilation, or both were performed. RESULTS Immediate technical success was achieved in 19 of the 24 (79.2%) ureteroileal complications. Treatment included stent placement alone in 12, dilation plus stent in 4, intraileal ureter resection plus stent with or without dilation in 3, and removal of ureteral calculi in 1. The procedure was unsuccessful in 5 (20.8%; failure to visualize ureteroileal anastomosis 4, unsuccessful cannulation 1). No major complications occurred. The 14 patients treated successfully were followed (mean 43 months, range 2-132 months) and a satisfactory outcome was observed in all. Partial stent displacement occurred in 2 patients and ureteral calculi developed in 2 patients. Three patients died with a stent in situ; no death was stent-related. Eleven patients are alive and asymptomatic, 5 with a stent in situ. In 6 patients, the stent was extracted after a mean of 36 months and all remained asymptomatic during a mean further follow-up of 41 months. CONCLUSION Treatment of ureteroileal anastomotic complications with a flexible duodenoscope and endoscopic techniques is safe, simple, and noninvasive with good success and excellent long-term results. This approach can be recommended as first-line therapy in patients with ureteroileal anastomotic complications.
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Affiliation(s)
- Guido Costamagna
- Digestive Endoscopy Unit and the Department of Urology, Università Cattolica del Sacro Cuore, A. Gemelli University Hospital, Rome, Italy
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Mao AW, Gao ZD, Xu JY, Yang RJ, Xiao XS, Jiang TH, Jiang WJ. Treatment of malignant digestive tract obstruction by combined intraluminal stent installation and intra-arterial drug infusion. World J Gastroenterol 2001; 7:587-92. [PMID: 11819837 PMCID: PMC4688681 DOI: 10.3748/wjg.v7.i4.587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the palliative treatment of malignant obstrution of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs.
METHODS: A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus, stomach, duodenum and jejunum), per anal (colon and rectum) and percutaneous transhepatic (biliary) installation of metallic stent. Among them, 203 cases received drug infusion by cannulation of tumor supplying artery with Seldinger’s technique.
RESULTS: Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8-43 weeks among those with intra-arterial drug infusion, which was later than 4-26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3-105) weeks, which was significantly longer than 13 (3-24) weeks of the latter group.
CONCLUSION: Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.
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Affiliation(s)
- A W Mao
- Department of Interventional Radiology, Shanghai S.T, Luke's Hospital, 768 Yu Yuan Road, Shanghai 200050, China.
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Darcy M. New Interventions in Kidneys, Ureters, and Bladder. J Vasc Interv Radiol 2001. [DOI: 10.1016/s1051-0443(01)70087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
Orthotopic bladder augmentation and substitution has been established as the standard procedure for urinary diversion in many institutions, with current studies reporting mainly on continence rates and procedure-associated complications, such as the risk of impairment of neobladder function by local tumor recurrences in the small pelvis. Similarly, in other types of continent diversion, such as continent cutaneous diversion and rectal reservoirs, current interest is primarily directed towards minimization of surgery-associated complications.
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Affiliation(s)
- R Stein
- Department of Urology, University of Mainz, School of Medicine, Germany.
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