title: Anterograde percutaneous treatment of ureterointestinal strictures following urinary diversion.
abstract: OBJECTIVE
  The incidence of ureterointestinal strictures following urinary diversion ranges from 4 to 8%. Traditionally, the treatment consists of open ureteral reimplantation. During the last decade, however, percutaneous techniques have gained increased interest for treatment of these strictures. We evaluated the outcome of anterograde percutaneous treatment of ureterointestinal strictures after urinary diversion.
  
  
  METHODS
  Since 1985, we attempted treatment of 15 ureterointestinal strictures, either by percutaneous anterograde dilatation (n = 10) or cold-knife incision (n = 2). In 3 patients the stricture could not be passed with a guide wire, precluding percutaneous treatment. Anterograde dilatation was performed with semirigid fascial dilators in 6 patients and additionally with a Grüntzig balloon catheter in 4. Routinely, following a successful procedure, a 12-Fr multihole stent was left in place for 6 weeks.
  
  
  RESULTS
  Restenosis was seen in 4 patients 2, 2, 19, and 36 months, respectively following the procedure. In 8 patients no stenosis developed so far (follow-up 8-96 months). Morbidity after the procedure consisted of fever after nephrostomy puncture in 1 patient and stent occlusion in another. Both were managed conservatively.
  
  
  CONCLUSIONS
  Anterograde percutaneous treatment of ureterointestinal strictures after urinary diversion is a safe primary procedure with a permanent success rate in half of the patients (53%).
authors.affiliation: Department of Urology, Academic Hospital Nijmegen, The Netherlands.
authors.forename: A F
authors.initials: AF
authors.lastname: Bierkens
authors.forename: G O
authors.initials: GO
authors.lastname: Oosterhof
authors.forename: E J
authors.initials: EJ
authors.lastname: Meuleman
authors.forename: F M
authors.initials: FM
authors.lastname: Debruyne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002404:Catheterization / Q000379:methods; D003251:Constriction, Pathologic; D004106:Dilatation / Q000379:methods; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D015607:Stents; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000628:therapy*; D014547:Urinary Diversion