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Vol. 46. Issue 1.
Pages 49-56 (January - February 2022)
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Vol. 46. Issue 1.
Pages 49-56 (January - February 2022)
Original article
Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center
Estenosis de la anastomosis uréteroileal en derivaciones urinarias realizadas mediante abordaje abierto, laparoscópico y robótico. Incidencia y manejo en un centro de tercer nivel
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E. Alonso Mediavillaa, F. Campos-Juanateya,b,
Corresponding author
felix.campos@scsalud.es

Corresponding author.
, G. Azcárraga Araneguic, R. Varea Maloa, R. Ballestero Diegoa, M. Domínguez Estebana, E. Ramos Barselóa, S. Zubillaga Guerreroa, P. Calleja Hermosaa, J.L. Gutiérrez Bañosa,b,c
a Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
b Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, Spain
c Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain
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Tables (6)
Table 1. Demographics, comorbidities, and other variables by type of urinary diversion.
Table 2. Surgical data and complications according to type of urinary diversion.
Table 3. Incidence and treatment of ureteroenteric strictures according to type of urinary diversion.
Table 4. Approach and laterality of ureteroileal reimplantation.
Table 5. Demographic data, comorbidities, and other variables. Comparison of patients with and without stricture.
Table 6. Surgical data and complications. Comparison of patients with and without stenosis.
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Abstract
Introduction

Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes.

Material and methods

Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student’s t-test for independent groups or Mann-Whitney test. Statistical significance if P < .05.

Results

The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Uretericre implantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%).

Conclusion

Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.

Keywords:
Ureteral stricture
Urinary diversion
Reconstructive surgery procedures
Laparoscopy
Robot-assisted surgery
Resumen
Introducción

Las estenosis de anastomosis uréteroileal son complicaciones frecuentes en conductos ileales y neovejigas ortotópicas. Analizamos su incidencia en función del tipo de derivación urinaria y del abordaje quirúrgico (abierto, laparoscópico o robótico). Describimos su manejo y los resultados obtenidos.

Material y métodos

Estudio retrospectivo descriptivo durante 6 años en pacientes con derivación urinaria empleando íleon (conducto ileal o neovejiga ileal). Se recogen datos demográficos, comorbilidades, datos quirúrgicos (abordaje, complicaciones) y resultados. Seguimiento mínimo de 1 año. Comparación entre grupos, mediante test de Chi cuadrado en variables dicotómicas. Variables cuantitativas comparadas empleando T de Student para grupos independientes, o prueba de Mann-Whitney. Consideramos significación estadística P < .05.

Resultados

Incluimos 182 pacientes (84% varones y 16% mujeres). Edad media 68 años. Abordaje de cistectomía: laparoscópica (67/37%), robótica (63/35%), abierta (43/24%). Tipo de derivación: conducto ileal (138/76%) y neovejiga ileal ortotópica (44/24%). Tipo de reimplante: Bricker (108/59%) y Wallace (47/26%). Estenosis de anastomosis uréteroileal (50/27%): bilateral (26), izquierda (16) y derecha (8). Estenosis según abordaje de cistectomía: laparoscópica (23/46%), robótica (16/32%), abierta (9/18%). Tratamiento de estenosis (33/18%): reimplante uréteroileal (13), nefrostomía permanente (13), dilatación endoscópica (4), nefroureterectomía (2), endoureterotomía (1). Abordaje del reimplante: laparoscópico (5/38%), robótico (6/46%) y abierto (2/15%). Resultados tras reimplantes: reestenosis (0/0%), reintervención (3/23%), estenosis uréteroileal contralateral posterior (1/8%).

Conclusión

El tipo de abordaje empleado en la cistectomía no parece influir en la aparición de estenosis uréteroileales. Abordajes laparoscópicos y robóticos permiten su reparación con resultados favorables en un porcentaje elevado de pacientes.

Palabras clave:
Estenosis ureteral
Derivación urinaria
Procedimientos quirúrgicos reconstructivos
Laparoscopia
Cirugía asistida por robot

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