Ureteroileal Strictures After Urinary Diversion with an Ileal Segment—Is There a Place for Endourological Treatment at All?

Schöndorf, Daniel; Meierhans-Ruf, Susan; Kiss, Bernhard; Giannarini, Gianluca; Thalmann, George N.; Studer, Urs E.; Roth, Beat (2013). Ureteroileal Strictures After Urinary Diversion with an Ileal Segment—Is There a Place for Endourological Treatment at All? Journal of urology, 190(2), pp. 585-590. Elsevier 10.1016/j.juro.2013.02.039

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Purpose We compared the long-term results of minimally invasive endourological intervention and open surgical revision in patients with a nonmalignant ureteroileal stricture. Materials and Methods We retrospectively evaluated the records of 74 patients (85 renal units) treated for unilateral or bilateral nonmalignant ureteroileal strictures. Overall, 96 endourological and 35 open surgical procedures were performed. Balloon dilatation and Acucise® or Ho:YAG laser endoureterotomy were used as minimally invasive endourological interventions. Open surgical revision with stricture resection and open ureteroileal end-to-side-reanastomosis was the alternate therapy. Treatment success was defined as radiological normalization or improvement of upper urinary tract morphology combined with absent flank pain, infection, ureteral stents or percutaneous nephrostomies. Results Median followup was 29 months (range 2 to 177). The overall success rate was 26% (25 of 96 cases) for endourological intervention vs 91% (32 of 35) for open surgical revision (p <0.001). Subgroup analysis showed a significant difference in the success rate of minimally invasive endourological interventions vs open surgical revision for strictures greater than 1 cm (3 of 52 cases or 6% vs 19 of 22 or 86%, p <0.001). The success rate of endourological and open surgical procedures for strictures 1 cm or less was 50% (22 of 44 cases) and 100% (13 of 13), respectively. After adjusting for multiple preoperative stricture characteristics, only stricture length was strongly and inversely associated with a successful outcome (p <0.001). Conclusions Open surgical revision produces better results than minimally invasive endourological intervention for ureteroileal strictures, particularly those greater than 1 cm. The success rate of endourological intervention is acceptable only for ureteroileal strictures 1 cm or less. Therefore, ureteroileal strictures greater than 1 cm should be primarily managed by open surgical revision.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology

UniBE Contributor:

Schöndorf, Daniel Julian; Meierhans, Susan; Kiss, Bernhard; Giannarini, Gianluca; Thalmann, George; Studer, Urs and Roth, Beat

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-5347

Publisher:

Elsevier

Language:

English

Submitter:

Katharina Morgenegg

Date Deposited:

23 Apr 2014 11:00

Last Modified:

05 Nov 2015 10:42

Publisher DOI:

10.1016/j.juro.2013.02.039

Uncontrolled Keywords:

ureter, urinary diversion, ileum, constriction, pathologic, anastomosis, surgical

BORIS DOI:

10.7892/boris.43733

URI:

https://boris.unibe.ch/id/eprint/43733

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