title: Application of self-expandable metal stents for ureteroileal anastomotic strictures: long-term results.
abstract: OBJECTIVE
  We report our long-term experience with the management of benign ureteroileal anastomotic strictures using self-expandable metal stents.
  
  
  METHODS
  A total of 16 male and 2 female patients with a mean+/-SD age of 72+/-7 years (range 66 to 78) with benign fibrotic strictures at the site of ureteroileal anastomosis underwent implantation of self-expandable metal stents with a nominal diameter of 6 to 8 mm. A total of 24 ureteroileal conduits were treated. The external nephrostomy tubes were removed after fluoroscopic validation of ureteral patency. Patients were followed with blood biochemistry, ultrasonography, urography and/or virtual endoscopy. Retrograde external-internal catheter insertion through the cutaneous stoma was performed in cases of recalcitrant stricture.
  
  
  RESULTS
  The technical success rate of ureteroileal stricture crossing and stenting was 100% (24 of 24 cases). Mean followup was 21 months (range 7 to 50). The clinical success rate during the immediate post-stenting period was 70.8% (17 of 24 cases). The 1 and 4-year primary patency rates were 37.8% and 22.7%, respectively. Secondary interventions included repeat balloon dilation in 15 ureters, of which 8 also underwent subsequent coaxial stent placement. The 1 and 4-year secondary patency rates were 64.8% and 56.7%, respectively. Except in 2 patients who died external-internal Double-J catheters continued to be inserted retrograde in 6 ureteroileal conduits. They are periodically exchanged to prevent mucous inspissation and stent encrustation.
  
  
  CONCLUSIONS
  Metal stents served as the definitive treatment for stricture in more than half of the cases, whereas in the remainder the stents allowed the uncomplicated and regular exchange of Double-J catheters in retrograde fashion. This combined, less invasive treatment for ureteroileal anastomotic strictures may help patients avoid surgical revision and preserve quality of life.
authors.affiliation: Department of Urology, School of Medicine, University of Patras, and Laikon General Hospital, Athens, Greece. liatsikos@yahoo.com
authors.forename: Evangelos N
authors.initials: EN
authors.lastname: Liatsikos
authors.forename: George C
authors.initials: GC
authors.lastname: Kagadis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karnabatidis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Katsanos
authors.forename: Zafiria
authors.initials: Z
authors.lastname: Papathanassiou
authors.forename: Constantinos
authors.initials: C
authors.lastname: Constantinides
authors.forename: Petros
authors.initials: P
authors.lastname: Perimenis
authors.forename: George C
authors.initials: GC
authors.lastname: Nikiforidis
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Stolzenburg
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Siablis
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D002404:Catheterization; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D019233:Retreatment; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology; D014515:Ureteral Diseases / Q000628:therapy*; D014547:Urinary Diversion