Use of a duodenoscope to manage complications at the ureteroileal anastomotic site after total urinary bladder resection and the Bricker procedure.
BACKGROUND
A novel flexible endoscopic technique is described for the treatment of ureteroileal strictures and leaks after the Bricker procedure.


METHODS
Seventeen patients with 24 ureteroileal complications (strictures, 22; leaks, 2) were treated under conscious sedation with a side-viewing duodenoscope. The ureter was cannulated and stent insertion, dilation, or both were performed.


RESULTS
Immediate technical success was achieved in 19 of the 24 (79.2%) ureteroileal complications. Treatment included stent placement alone in 12, dilation plus stent in 4, intraileal ureter resection plus stent with or without dilation in 3, and removal of ureteral calculi in 1. The procedure was unsuccessful in 5 (20.8%; failure to visualize ureteroileal anastomosis 4, unsuccessful cannulation 1). No major complications occurred. The 14 patients treated successfully were followed (mean 43 months, range 2-132 months) and a satisfactory outcome was observed in all. Partial stent displacement occurred in 2 patients and ureteral calculi developed in 2 patients. Three patients died with a stent in situ; no death was stent-related. Eleven patients are alive and asymptomatic, 5 with a stent in situ. In 6 patients, the stent was extracted after a mean of 36 months and all remained asymptomatic during a mean further follow-up of 41 months.


CONCLUSIONS
Treatment of ureteroileal anastomotic complications with a flexible duodenoscope and endoscopic techniques is safe, simple, and noninvasive with good success and excellent long-term results. This approach can be recommended as first-line therapy in patients with ureteroileal anastomotic complications.
Costamagna
Guido
G
Digestive Endoscopy Unit and the Department of Urology, Università Cattolica del Sacro Cuore, A. Gemelli University Hospital, Rome, Italy.
Shah
Saumil K
SK
Mutignani
Massimiliano
M
Tringali
Andrea
A
Alevras
Petros P
PP
Vamvakousis
Vasilios
V
Racioppi
Marco
M
D'Addessi
Alessandro
A
Perri
Vincenzo
V
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D015653:Cystectomy; D004106:Dilatation; D020698:Duodenoscopes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D015607:Stents; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000628:therapy*; D014547:Urinary Diversion