Optimizing decision-making process of benign uretero-enteric anastomotic stricture treatment after radical cystectomy.
Radical cystectomy
Ureteral stricture
Uretero-enteric anastomosis
Urinary diversion
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
Mar 2023
Mar 2023
Historique:
received:
16
12
2022
accepted:
14
01
2023
medline:
11
4
2023
pubmed:
2
2
2023
entrez:
1
2
2023
Statut:
ppublish
Résumé
To identify preoperative predictors of endo-urological treatment (EUT) failure while promoting a new diagnostic and therapeutic pathway for benign uretero-enteric anastomosis stricture (UES) management after radical cystectomy (RC). We relied on a prospectively maintained database including 96 individuals (122 renal units) who developed a benign UES at our institution between 1990 and 2018. UES was classified into two different types according to morphology: FP1 (i.e., sharp or duckbill) and FP2 (i.e., flat or concave). EUT feasibility, success rate, as well as intra and postoperative complications were recorded. Uni- and multivariable logistic regression analysis (MVA) assessed for predictors of EUT failure. Overall, 78 (63.9%) and 32 (26.3%) cases were defined as FP1 and FP2, respectively. EUT was not feasible in 33 (27.1%) cases. After a median follow-up of 50 (IQR 5-240) months, successful treatment was reached only in 15/122 (12.3%) cases. EUT success rates raised when considering short (< 1 cm) (16.8%), FP1 morphology (16.7%) strictures, or the combination of these characteristics (22.4%). Overall, 5 (5.2%) cases had CD ≥ III complications. FP2 (OR: 1.91, 95%CI 1.21-5.31, p = 0.03) and stricture length ≥ 1 cm (OR: 9.08, 95%CI 2.09-65.71, p = 0.009) were associated with treatment failure at MVA. Endoscopic treatment for benign UES after RC is feasible but harbors a low success rate. Stricture length and radiological morphology of the stricture are related to endoscopic treatment failure. Surgeons should be aware of the stricture features during the preoperative decision-making process to choose the optimal candidate for endoscopic treatment.
Identifiants
pubmed: 36725730
doi: 10.1007/s00345-023-04298-y
pii: 10.1007/s00345-023-04298-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
733-738Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Anderson CB, Morgan TM, Kappa S, Moore D, Clark PE, Davis R et al (2013) Ureteroenteric anastomotic strictures after radical cystectomy-does operative approach matter? J Urol 189:541–547. https://doi.org/10.1016/J.JURO.2012.09.034
doi: 10.1016/J.JURO.2012.09.034
pubmed: 23260561
Tal R, Sivan B, Kedar D, Baniel J (2007) Management of benign ureteral strictures following radical cystectomy and urinary diversion for bladder cancer. J Urol 178:538–542. https://doi.org/10.1016/J.JURO.2007.03.142
doi: 10.1016/J.JURO.2007.03.142
pubmed: 17570422
Shah SH, Movassaghi K, Skinner D, Dalag L, Miranda G, Cai J et al (2015) Ureteroenteric strictures after open radical cystectomy and urinary diversion: the University of Southern California experience. Urology 86:87–91. https://doi.org/10.1016/J.UROLOGY.2015.03.014
doi: 10.1016/J.UROLOGY.2015.03.014
pubmed: 25987494
Large MC, Cohn JA, Kiriluk KJ, Dangle P, Richards KA, Smith ND et al (2013) The impact of running versus interrupted anastomosis on ureterointestinal stricture rate after radical cystectomy. J Urol 190:923–927. https://doi.org/10.1016/J.JURO.2013.02.091
doi: 10.1016/J.JURO.2013.02.091
pubmed: 23454159
Minervini R, Pagni R, Mariani C, Morelli A, Morelli G, Minervini A (2010) Effects on renal function of obstructive and nonobstructive dilatation of the upper urinary tract in ileal neobladders with refluxing ureteroenteric anastomoses. Eur J Surg Oncol 36:287–291. https://doi.org/10.1016/J.EJSO.2009.09.003
doi: 10.1016/J.EJSO.2009.09.003
pubmed: 19796914
Laven BA, O’Connor RC, Gerber GS, Steinberg GD (2003) Long-term results of endoureterotomy and open surgical revision for the management of ureteroenteric strictures after urinary diversion. J Urol 170:1226–1230. https://doi.org/10.1097/01.JU.0000086701.68756.8F
doi: 10.1097/01.JU.0000086701.68756.8F
pubmed: 14501730
Milhoua PM, Miller NL, Cookson MS, Chang SS, Smith JA, Herrell SD (2009) Primary endoscopic management versus open revision of ureteroenteric anastomotic strictures after urinary diversion–single institution contemporary series. J Endourol 23:551–555. https://doi.org/10.1089/END.2008.0230
doi: 10.1089/END.2008.0230
pubmed: 19193136
Schöndorf D, Meierhans-Ruf S, Kiss B, Giannarini G, Thalmann GN, Studer UE et al (2013) Ureteroileal strictures after urinary diversion with an ileal segment-is there a place for endourological treatment at all? J Urol 190:585–590. https://doi.org/10.1016/J.JURO.2013.02.039
doi: 10.1016/J.JURO.2013.02.039
pubmed: 23454401
Territo A, Verri P, Uleri A et al (2022) Endourological treatment of uretero-enteric benign stricture after radical cystectomy and kidney transplant. Cent Eur J Urol. https://doi.org/10.5173/CEJU.2022.238
doi: 10.5173/CEJU.2022.238
Ahmed YE, Hussein AA, May PR, Ahmad B, Ali T, Durrani A et al (2017) Natural history, predictors and management of ureteroenteric strictures after robot assisted radical cystectomy. J Urol 198:567–574. https://doi.org/10.1016/J.JURO.2017.02.3339
doi: 10.1016/J.JURO.2017.02.3339
pubmed: 28257782
Touiti D, Gelet A, Deligne E, Fassi-Fehri H, Benrais H, Martin X et al (2002) Treatment of uretero-intestinal and ureterovesical strictures by Acucise® balloon catheter. Eur Urol 42:49–55. https://doi.org/10.1016/S0302-2838(02)00070-2
doi: 10.1016/S0302-2838(02)00070-2
pubmed: 12121730
Singal RK, Denstedt JD, Razvi HA, Chun SS (1997) Holmium:YAG laser endoureterotomy for treatment of ureteral stricture. Urology 50:875–880. https://doi.org/10.1016/S0090-4295(97)00511-6
doi: 10.1016/S0090-4295(97)00511-6
pubmed: 9426717
Emiliani E, Breda A (2015) Laser endoureterotomy and endopyelotomy: an update. World J Urol 33:583–587. https://doi.org/10.1007/S00345-014-1405-3
doi: 10.1007/S00345-014-1405-3
pubmed: 25246158
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.SLA.0000133083.54934.AE
doi: 10.1097/01.SLA.0000133083.54934.AE
pubmed: 15273542
pmcid: 1360123
Van Son MJ, Lock MTWT, Peters M, van de Putte EEF, Meijer RP (2019) Treating benign ureteroenteric strictures: 27-year experience comparing endourological techniques with open surgical approach. World J Urol 37:1217–1223. https://doi.org/10.1007/S00345-018-2475-4
doi: 10.1007/S00345-018-2475-4
pubmed: 30232554