title: Ureteroileal strictures after urinary diversion with an ileal segment-is there a place for endourological treatment at all?
abstract: OBJECTIVE
  We compared the long-term results of minimally invasive endourological intervention and open surgical revision in patients with a nonmalignant ureteroileal stricture.
  
  
  METHODS
  We retrospectively evaluated the records of 74 patients (85 renal units) treated for unilateral or bilateral nonmalignant ureteroileal strictures. Overall, 96 endourological and 35 open surgical procedures were performed. Balloon dilatation and Acucise® or Ho:YAG laser endoureterotomy were used as minimally invasive endourological interventions. Open surgical revision with stricture resection and open ureteroileal end-to-side-reanastomosis was the alternate therapy. Treatment success was defined as radiological normalization or improvement of upper urinary tract morphology combined with absent flank pain, infection, ureteral stents or percutaneous nephrostomies.
  
  
  RESULTS
  Median followup was 29 months (range 2 to 177). The overall success rate was 26% (25 of 96 cases) for endourological intervention vs 91% (32 of 35) for open surgical revision (p <0.001). Subgroup analysis showed a significant difference in the success rate of minimally invasive endourological interventions vs open surgical revision for strictures greater than 1 cm (3 of 52 cases or 6% vs 19 of 22 or 86%, p <0.001). The success rate of endourological and open surgical procedures for strictures 1 cm or less was 50% (22 of 44 cases) and 100% (13 of 13), respectively. After adjusting for multiple preoperative stricture characteristics, only stricture length was strongly and inversely associated with a successful outcome (p <0.001).
  
  
  CONCLUSIONS
  Open surgical revision produces better results than minimally invasive endourological intervention for ureteroileal strictures, particularly those greater than 1 cm. The success rate of endourological intervention is acceptable only for ureteroileal strictures 1 cm or less. Therefore, ureteroileal strictures greater than 1 cm should be primarily managed by open surgical revision.
authors: Department of Urology, University of Bern, Bern, Switzerland.
authors: Daniel
authors: D
authors: Schöndorf
authors: Susan
authors: S
authors: Meierhans-Ruf
authors: Bernhard
authors: B
authors: Kiss
authors: Gianluca
authors: G
authors: Giannarini
authors: George N
authors: GN
authors: Thalmann
authors: Urs E
authors: UE
authors: Studer
authors: Beat
authors: B
authors: Roth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D015653:Cystectomy; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*
keywords: anastomosis, surgical; constriction, pathologic; ileum; ureter; urinary diversion