Ureteroileal strictures after urinary diversion with an ileal segment-is there a place for endourological treatment at all?

Détails

ID Serval
serval:BIB_1F349EA81449
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Ureteroileal strictures after urinary diversion with an ileal segment-is there a place for endourological treatment at all?
Périodique
The Journal of urology
Auteur(s)
Schöndorf D., Meierhans-Ruf S., Kiss B., Giannarini G., Thalmann G.N., Studer U.E., Roth B.
ISSN
1527-3792 (Electronic)
ISSN-L
0022-5347
Statut éditorial
Publié
Date de publication
08/2013
Peer-reviewed
Oui
Volume
190
Numéro
2
Pages
585-590
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article
Publication Status: ppublish
Résumé
We compared the long-term results of minimally invasive endourological intervention and open surgical revision in patients with a nonmalignant ureteroileal stricture.
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.
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).
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.
Mots-clé
Adult, Aged, Aged, 80 and over, Anastomosis, Surgical, Cystectomy, Decompression, Surgical, Female, Humans, Ileum/surgery, Laser Therapy/methods, Male, Middle Aged, Minimally Invasive Surgical Procedures, Postoperative Complications/diagnostic imaging, Postoperative Complications/surgery, Reoperation, Retrospective Studies, Treatment Outcome, Ultrasonography, Ureteral Obstruction/diagnostic imaging, Ureteral Obstruction/surgery, Urinary Diversion/methods, anastomosis, surgical, constriction, pathologic, ileum, ureter, urinary diversion
Pubmed
Web of science
Création de la notice
08/01/2021 16:31
Dernière modification de la notice
09/01/2021 7:26
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