Faculty Collaboration Database

Long-term results of endoureterotomy and open surgical revision for the management of ureteroenteric strictures after urinary diversion. J Urol 2003 Oct;170(4 Pt 1):1226-30

Date

09/23/2003

Pubmed ID

14501730

DOI

10.1097/01.ju.0000086701.68756.8f

Scopus ID

2-s2.0-0041691086 (requires institutional sign-in at Scopus site)   82 Citations

Abstract

PURPOSE: Prior studies have demonstrated that while endoureterotomy offers a reasonable initial treatment option, open anastomotic revision should remain the gold standard for managing ureteroenteric strictures. However, to our knowledge the results of contemporary endoureterotomy series have not been compared with those of open anastomotic revision, and no study has assessed the morbidity or success rate of secondary open anastomotic revision after failed endoureterotomy.

MATERIALS AND METHODS: Between May 1997 and August 2002 a total of 31 renal units in 22 patients were treated for ureteroenteric strictures after radical cystectomy and urinary diversion. A total of 16 renal units were treated endoscopically, including 9 on the left and 7 on the right side, and open revision was performed in 15 renal units, including 9 on the left and 6 on the right side. Success was defined as radiological improvement and/or the ability to return to full activity in the absence of flank pain, infection, or the need for ureteral stents or nephrostomy tubes.

RESULTS: At a median followup of 35 months (range 17 to 62) for endoureterotomy and 34 months (range 5 to 54) for open revision the success rate of endoureterotomy and open revision was 50% (8 of 16 renal units) and 80% (12 of 15), respectively. One of the 3 patients in whom open revision failed underwent prior pelvic external beam radiation and the other 2 underwent prior endoureterotomies. Overall interventions for right strictures were more successful 85% or 11 of 13 cases than those on the left side (50% or 9 of 18) (p = 0.037). Average operative time was longer and average estimated blood loss was higher in patients treated with open repair after failed endoureterotomy (p = 0.009 and 0.016, respectively). No complications developed in patients following endoureterotomy.

CONCLUSIONS: Open revision remains the gold standard for the management of ureteroenteric strictures. Left strictures are considerably more resistant to management. Patients with left anastomotic strictures should be cautioned that endoureterotomy might have a lower success rate, and failure may limit the success and increase the morbidity of subsequent open anastomotic revision.

Author List

Laven BA, O'Connor RC, Gerber GS, Steinberg GD

Author

Robert Corey O'Connor MD Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Constriction, Pathologic
Female
Follow-Up Studies
Humans
Male
Middle Aged
Reoperation
Retrospective Studies
Time Factors
Ureter
Ureteroscopy
Urinary Diversion