Treatment of ureterointestinal anastomotic strictures by diathermal or cryoplastic dilatation.
BACKGROUND
Ureterointestinal anastomotic strictures (UAS) complicate 10-15% of surgeries for urinary diversion and are the main cause of deterioration in renal function. Treatments are surgical revision, management with autostatic stent, balloon dilatation, endoscopic incision, and percutaneous transrenal diathermy (Acucise). A new option is cryoplastic dilatation (Polar-Cath).


OBJECTIVE
To assess the feasibility, complications, and preliminary results of UAS treatment using the Acucise and Polar-Cath systems.


METHODS
Nineteen UAS, diagnosed by ultrasonography or computed tomography and sequential renal scintigraphy, occurred in 15 cancer patients after radical cystectomy and urinary diversion. Fifteen were managed with balloon diathermy and 4 by balloon cryoplasty in a three-stage procedure--percutaneous nephrostomy, diathermal or cryoplastic dilatation, and transnephrostomic control with nephrostomy removal--each separated by 15 days. All patients gave written informed consent.


RESULTS
Dilatations were successful in all cases. The procedure is simple and rapid (about 45 min) under fluoroscopic control and sedation. Procedural complications occurred in 1 (5%) patient with UAS after Wallace II uretero-ileocutaneostomy: a common iliac artery lesion was induced by diathermal dilatation, evident subsequently, and required surgical repair. Patency with balloon diathermy was good, with two restenoses developing over 12 months (range 1-22) of follow-up. With balloon cryoplastic dilatation, one restenosis developed in the short term; follow-up is too brief to assess the long-term efficacy.


CONCLUSIONS
Our short-term results with diathermal and cryoplastic dilatation to resolve UAS are good. If supported by longer follow-up, the techniques may be considered as first-choice approaches to UAS. Surgery should be reserved for cases in which this minimally invasive technique fails.
Orsi
Franco
F
Unit of Interventional Radiology, European Institute of Oncology, Via Ripamonti 435, Milan 20141, Italy.
Penco
Silvia
S
Matei
Victor
V
Bonomo
Guido
G
Vigna
Paolo Della
PD
Monfardini
Lorenzo
L
De Cobelli
Ottavio
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002404:Catheterization / Q000009:adverse effects; D003251:Constriction, Pathologic; D017679:Cryotherapy / Q000009:adverse effects; D015653:Cystectomy; D003972:Diathermy / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D010865:Pilot Projects; D015641:Radiography, Interventional; D012008:Recurrence; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D014547:Urinary Diversion / Q000009:adverse effects*; D014567:Urography