title: Management of benign ureteral strictures following radical cystectomy and urinary diversion for bladder cancer.
abstract: OBJECTIVE
  Ureteral obstruction due to benign strictures is a significant complication of radical cystectomy and urinary diversion for bladder cancer that can lead to renal function loss and infection related morbidity. Treatment may be performed surgically or with minimally invasive techniques. We describe the 10-year experience at our department with various treatment modalities for post-cystectomy benign strictures.
  
  
  METHODS
  The study group consisted of 28 patients treated for benign ureteral strictures following radical cystectomy for bladder cancer. Their medical records were reviewed for clinical presentation, diagnostic procedures, treatment and long-term outcome.
  
  
  RESULTS
  The study group represented 12.7% of all 221 patients treated at our department with radical cystectomy for bladder cancer in 1994 to 2004. Ureteral strictures were asymptomatic in 71.4% of cases. Median time to diagnosis was 7.0 months and 75% of the patients were diagnosed within year 1 after cystectomy. Treatment consisted of stenting, dilation and open surgical revision with removal of the strictured segment and reanastomosis. Median followup was 62.5 months. The stenting procedures served as the long-term definitive treatment in 45% of cases, whereas balloon dilation uniformly failed. Although open surgical revision was technically challenging, it had a long-term success rate of 93%.
  
  
  CONCLUSIONS
  Benign ureteral strictures commonly occur during postoperative year 1 and they are usually asymptomatic. Early diagnosis and prompt drainage are required to prevent consequent renal parenchymal loss and infectious complications. Although minimally invasive procedures are viable treatment alternatives, open surgical revision is still the preferred long-term definitive treatment.
authors.affiliation: Department of Urology, Rabin Medical Center, Beilinson Campus, Petach Tikva and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. raanantal@gmail.com
authors.forename: Raanan
authors.initials: R
authors.lastname: Tal
authors.forename: Bezalel
authors.initials: B
authors.lastname: Sivan
authors.forename: Daniel
authors.initials: D
authors.lastname: Kedar
authors.forename: Jack
authors.initials: J
authors.lastname: Baniel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D015653:Cystectomy; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009403:Nephrostomy, Percutaneous; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion