[Endourologic treatment of benign uretero-intestinal stenosis in patients with definitive urinary diversion: 10-year experience].
OBJECTIVE
Ureterointestinal (U-I) anastomotic stricture is one of the most important complications after radical cystectomy, occurring in 4% to 8% of patients. We report our ten years experience in the endourological treatment of this condition.


METHODS
32 patients with U-I strictures were endourologically treated at our Institution. The endoscopic procedure provides for a percutaneous nephrostomy, the passage of the stenosis with a guide-wire, the incision and balloon dilation of the stricture and, finally, a ureteral double J stenting. Of the 28 successfully treated patients, 10 underwent balloon dilation alone and 18 both ureteral incision (with cold knife in 11 and hot knife in 7) and dilation.


RESULTS
The endourological approach failed in 4/32 (12.5%) patients: 3 failures were due to the inability to pass a guide-wire across the stricture, whilst in the remaining patient a serious intraoperative hemorrhage occurred. In 28/32 (87.5%) patients the endoscopic treatment was successful (a ureteral stent was positioned across the stenosis). However, long term results are less promising: at 6-90 month follow up, only 16 patients (57.1%) are free of strictures without ureteral stent, 10 (35.7%) need a permanent ureteral stent, 2 (7.2%) a percutaneous nephrostomy.


CONCLUSIONS
Due to the low morbidity of endoscopic procedures and to the high risks associated with open surgery, we believe that endourology should represent the first choice in the treatment of U-I strictures, reserving open surgery for endoscopic failures or complications. Moreover, endourological treatment with both incision and dilation is more effective than dilation alone (which should be performed only in very short and recent strictures).
Germinale
F
F
Clinica Urologica Luciano Giuliani, Università di Genova, Italia.
Stubinski
R
R
Giglio
M
M
D000368:Aged; D002404:Catheterization; D003251:Constriction, Pathologic / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D015607:Stents; D013997:Time Factors; D018666:Ureteroscopy; D014547:Urinary Diversion / Q000009:adverse effects*
Trattamento endourologico delle stenosi uretero-intestinali benigne in pazienti con derivazione urinaria definitiva: esperienza di 10 anni.