Ureterointestinal Strictures Following Bricker Ileal Conduit: Management Via A Percutaneous Approach

Main Category: Urology / Nephrology
Article Date: 15 Nov 2008 - 1:00 PDT

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UroToday.com - Despite the short-term solution a conventional endourological technique will offer in cases of ureterointestinal anastomosis stricture, there still remains the issue of long-term restenosis to be addressed. Poulakis et al.(1) reported a restenosis rate of 26% - in a mean follow-up of 23.5 months, while Laven et al. (2) observed a success rate of 57% when treating ureterointestinal strictures using antegrade endoureterotomy with holmium laser.

We elaborated on the concept of a "permanent" ureteral stent probably able to function as a radical solution maintaining a patent lumen; or at least demonstrating lower restenosis rates than conventional ureterointestinal anastomoses.

In this small series, one patient presented stent occlusion earlier than the three month interval initially set for elective stent replacement. However, the potential hazard of serious urinary tract infection (which we observed twice immediately post-operatively and 3 times during follow-up) poses additional concerns, of which the patient must be adequately informed.

A second issue of special concern was the potential compromise in the patients' quality of life originating from the frequent hospital or office visits for stent replacement. Interestingly none of the patients expressed frustration when interviewed about this issue. All patients considered the inconvenience related to these visits of minor importance compared to that caused by their initial disease (mainly bladder cancer). Again, it would be unwise to extrapolate this result to larger scale populations. These patients were informed that they would be undergoing a different approach, deviating from conventional treatments. By itself, this fact is probably capable of raising the 'threshold' of tolerance for these interventions' side effects.

Anterograde dilation of such stenoses is already reported elsewhere. The definition of success for these studies versus our work is different though. "Success" was defined by our group as the proper insertion of the stent and the maintenance of a patent stent lumen. Others defined success as the uneventful manipulations in the ureterointestinal junction and the maintenance of a patent lumen without the presence of the stent - or after its removal.

Ultimately it is the biological behaviour of the stent and its capacity to drain urine without adverse effects that was under evaluation, and still is.

REFERENCES

1. Poulakis V, Witzsch U, de Vries R, Becht E. Antegrade percutaneous endoluminal treatment of non-malignant ureterointestinal anastomotic strictures following urinary diversion. Eur Urol. 200; 39:308-15.
2. Laven BA, O'Connor RC, Steinberg GD, Gerber GS. Long-term results of antegrade endoureterotomy using the holmium laser in patients with ureterointestinal strictures. Urology 200; 58:924-9

Written by Pappas P1, Stravodimos K.G2, Kapetanakis T2, Leonardou P1, Koutallelis G2, Adamakis I2, and Constantinides C2 as part of Beyond the Abstract on UroToday.com

1. Radiology Department, Laiko General Hospital, 17 Ag. Thoma St, Goudi, Athens, Greece
2. 1st Urology Department, Laiko General Hospital, 17 Ag. Thoma St, Goudi, Athens, Greece. University of Athens Medical School, Athens, Greece

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