Antegrade percutaneous endoluminal treatment of non-malignant ureterointestinal anastomotic strictures following urinary diversion.
OBJECTIVE
We report our experience on antegrade percutaneous incision of ureterointestinal anastomosis strictures after urinary diversion.


METHODS
Since 1994, we have evaluated retrospectively 18 patients with 22 ureterointestinal anastomosis strictures (UAS), who were treated with cold-knife incision. After placement of an 8-french nephrostomy tube, a 0.035-inch guide wire bypassed the stricture under guidance of a centrally opened (5-french) ureter catheter. A wire-mounted cold-knife was pulled through the strictured area retrogradely under fluoroscopic control. Routinely, following the incision, an 8-french external stent was left in place for 6-8 weeks.


RESULTS
After stent removal as a primary procedure, the ureteroenteric area has remained patent in 14 of 19 (74%) UAS. In 3 cases undergoing a secondary or repeated procedure, treatment failed. The average follow-up was 23.5 (range 12-39) months. Failures were associated with radiogenic injury of the ureter in 5 UAS and unexplained in 2. No complication was observed.


CONCLUSIONS
Percutaneous endourological management of UAS with the cold-knife incision, when used as a primary treatment, is a safe and effective alternative to open surgical repair and should be considered as an initial approach.
Department of Urology and Pediatric Urology, Nordwest Hospital, Steinbacher Hohl 2-26, Johann-Wolfgang-Goethe-University, D-60488 Frankfurt, Germany. Poulakis@em.uni-frankfurt.de
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V
Poulakis
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Witzsch
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R
de Vries
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Becht
D000368:Aged; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D018666:Ureteroscopy; D014547:Urinary Diversion / Q000009:adverse effects*