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Percutaneous Antegerade Ureteroscopy For Treatment Of Ureterointestinal Anastamotic Strictures
Natalia Hernandez1, Vernon M Pais Jr2, Gyan Pareek3, Dragan Golijanin3, Patrick Gomella4, Patrick Mufarrij5, Brian R Matlaga6, Brian H Eisner1
1Massachusetts General Hospital, Boston, MA;2Dartmouth Hitchcock Medical Center, Lebanon, NH;3Warren Alpert School of Medicine at Brown University, Providence, RI;4George Washington School of Medicine and Health Sciences, Washington, D.C., DC;5George Washington School of Medicine and Health Sciences, Washington, DC;6Brady Urological Institute, Johns Hopkins University, Baltimore, MD
Introduction: Few studies in the literature have examined the efficacy of percutaneous antegrade ureteroscopy with balloon dilation and/or laser incision for treatment of ureterointestinal anastamotic strictures after urinary diversion.
Materials & Methods: A multi-center retrospective review of longitudional medical records was performed. Statistical analysis was performed using the paired t-test.
Results: Twenty-six (26) percutaneous antegrade ureteroscopic procedures were performed with balloon dilation and/or laser incision of stricture. Mean patient age was 65.2 years (SD 27), mean time between urinary diversion and treatment for stricture was 44.4 days (SD 72), and mean follow-up time was 292.6 days (SD 252). Urinary diversion type was ileal conduit in 77% of cases, colon conduit in 11% of cases, Indiana Pouch in 8% of cases, and orthotopic neobladder in 4% of cases. Successful stricture treatment occurred in 24/26 cases (92.3%) and in 2 cases no treatment could be performed due to complete occlusion of the ureter. At most recent follow up, patients who underwent percutaneous antegrade ureteroscopy and stricture treatment demonstrated significant improvement in serum creatinine compared with before treatment (Cr after treatment = 1.3, Cr prior to treatment = 1.6, p = 0.04).
Conclusions: In patients with ureterointestinal anastamotic strictures, percutaneous antegrade ureteroscopy with balloon dilation and/or laser incision of stricture was accomplished in a majority of cases (>90%) and resulted in significant improvements in renal function. This minimally invasive procedure may be considered prior to more extensive reconstructive surgery in patients with ureteroinestinal anastamotic strictures after urinary diversion.
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