Background: The management of ureterointestinal stricture in patients who have undergone urinary diversion can be challenging. Endourological techniques have been increasingly used in recent years for such strictures.
Objectives: We report our experience and evaluate our results on balloon antegrade dilatations for benign ureteroenteric anastomotic strictures after total cystectomy and urinary diversion by ileal conduit.
Patients and Methods: Between December 1990 and May 2009, 8 balloon dilatations were performed on 7 patients with a mean age of 56.6 years (range: 50 to 72) to treat ureterointestinal strictures. Strictures were dilated percutaneously via the antegrade approach under fluoroscopic control. A ureteral multi-hole catheter was left for 6 to 8 weeks. Success was defined as radiological resolution of obstruction and the ability to recover normal activity in the absence of flank pain, infection, or the need for ureteral stents or nephrostomy tubes.
Results: The development of strictures occurred a mean of 4.5 months after urinary diversion. Eight renal units were treated (5 left, 3 right), including 1 bilateral procedure. There were 6 complete and 2 partial strictures. The operative time did not exceed 45 minutes. No major complications were encountered during or after these procedures. The overall success rate was 43%. Three patients required open reimplantation. Six of 7 patients showed satisfactory outcomes and 1 patient was lost to follow-up.
Conclusions: Percutaneous balloon dilatation of benign ureteroenteric anastomotic strictures, after radical cystectomy and urinal diversion by ileal conduit, is a minimally invasive and effective treatment option providing durable results. Based on these results, we believe that the procedure should be considered as a first-line treatment, as surgical reimplantation is reserved for failure. The selection of patients with the most favorable prognostic factors leads to excellent results.
KEYWORDS: Urinary diversion, ileal conduit, ureteroenteric anastomosis, percutaneous dilatation, surgical anastomosis
CORRESPONDENCE: Sallami Satáa, MD, La Rabta Hospital-University, Tunis, Tunis, Tunisia ( )
CITATION: UroToday Int J. 2012 December;5(6):art 59.
DOI: http://dx.doi.org/10.3834/uij.1944-5784.2012.12.04
