Percutaneous incision of stenotic uroenteric anastomoses with a cutting balloon catheter: long-term results.
OBJECTIVE
To describe the technique and results of incision of strictures in anastomotic urinary diversions with a commercially available cutting balloon catheter.


METHODS
Thirty-seven stenoses were treated in 32 patients. Most (28 [88%]) of the patients had undergone surgery for bladder cancer 17.7 months +/- 17.4 (SD) (range, 3-72 months) before incision. Thirteen patients had undergone ileal conduit diversion, and nineteen had undergone enterocystoplasty. All stenoses were shorter than 3 cm. The presence of adjacent ileal loops and/or iliac vessels was assessed with computed tomography before incision. The cutting wire was oriented anteriorly or anterolaterally, and the balloon was inflated with diluted contrast material during the incision. A Kaplan-Meier survival curve was constructed to illustrate the success rates over time.


RESULTS
No major complications occurred. Twelve (32%) stenoses recurred in nine patients 15 months +/- 10 (range, 6-36 months) after stent removal; the failure rate was 53% (eight of 15 stenoses) for ileal conduits and 18% (four of 22 stenoses) for enterocystoplasties. Late failure (>12 months) was observed in four patients. The patency of the other 25 stenoses (23 patients) was checked 25 months +/- 11 after stent removal (range, 5-43 months). The actuarial patency rate was 77% at 1 year, 68% at 2 years, and 62% at 3 years.


CONCLUSIONS
Cutting balloon incision is a safe and simple alternative to surgery, particularly when the urinary diversion is enterocystoplasty.
Cornud
F
F
Department of Radiology, Hôpital Necker, Paris, France. frcornud@club-internet.fr
Chrétien
Y
Y
Hélénon
O
O
Casanova
J M
JM
Correas
J M
JM
Bonnel
D
D
Méjean
A
A
Moreau
J F
JF
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002404:Catheterization / Q000295:instrumentation*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000601:surgery; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007084:Iliac Vein / Q000000981:diagnostic imaging; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012008:Recurrence; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects* / Q000145:classification
D003287:Contrast Media