title: Primary endoscopic management versus open revision of ureteroenteric anastomotic strictures after urinary diversion--single institution contemporary series.
abstract: OBJECTIVE
  To review our institutional experience in the management of ureteroenteric strictures by primary endoscopic intervention or primary open revision.
  
  
  METHODS
  Between January 2000 and December 2007, 28 patients with ureteroenteric strictures underwent endoscopic management (n = 21) or open revision (n = 7). Strictures were characterized with regard to length and side as well as time to failure between the two groups. Success was defined as symptomatic improvement and evidence of patency on follow-up radiologic imaging.
  
  
  RESULTS
  Of all study patients, 78.6% were symptomatic on presentation. Endoscopic intervention (balloon dilation, electroincision, or holmium endoureterotomy) was successful in six patients for an overall success rate of 27% with a median follow-up of 21 months. Open revision was successful in 87.5% (7 of 8) patients for whom initial endoscopic surgery had failed. The success rate of primary open revision was 71.4% (5 of 7 patients) with a mean follow-up of 18.1 months. For the entire series, left-sided strictures were more common than right sided strictures; however, side and stricture length were not found to be significant (P > 0.05) with regard to patency. Functional renal imaging studies were performed in 42.9% of all study patients postoperatively.
  
  
  CONCLUSIONS
  Endoscopic management continues to have success rates that remain lower than that of open revision. Left-sided strictures remain more common than right-sided strictures; however, side and stricture length were not found to be statistically significant in our series. The lack of consistent postoperative functional renal studies highlights the importance of diligent monitoring and warrants further study to develop a surveillance algorithm.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA. paulmilhoua@hotmail.com
authors.forename: Paul M
authors.initials: PM
authors.lastname: Milhoua
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Miller
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: S Duke
authors.initials: SD
authors.lastname: Herrell
mesh_terms: D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D003710:Demography; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D014547:Urinary Diversion