尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.     

尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.     

尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.     

尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.     

尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.     

尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.     

尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.     

尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.     

尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.     

尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.     

尿流改道术后输尿管肠代膀胱吻合口狭窄的腔内治疗

目的 探讨腔内技术治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的临床应用价值.方法 膀胱癌尿流改道术后输尿管肠代膀胱吻合口狭窄患者9例,狭窄段长度1～3 cm,均采用腔内技术治疗,顺行经皮肾处理8例,逆行输尿管镜处理1例;术中使用高压气囊配合筋膜扩张器扩张,术后留置双J管.结果 随访0.5～5.0年.1例吻合口闭锁患者术后3个月仍为重度积水,患者拒绝开放手术而长期留置肾造瘘管;8例患者肾积水减轻,再次逆行扩张狭窄段并留置双J管,其中5例经2～3次扩张换管,拔除双J管后复查肾积水稳定于轻度状态;3例拔除双J管后腰痛不适,需要长期留置双J管.结论 尿流改道术后输尿管肠代膀胱吻合口狭窄腔内技术治疗效果良好,可避免开放手术的风险.     

Treatment of ureteral anastomotic strictures with reimplantation and survival after cystectomy and urinary diversion

Objective

To examine whether long-term renal function and overall survival outcomes vary according to management approach for ureteral anastomotic stricture (UAS) after cystectomy and urinary diversion.

腔内治疗尿流改道术后输尿管肠代膀胱吻合口狭窄的护理

对7例尿流改道术后输尿管肠代膀胱吻合口狭窄患者行腔内治疗,未发生大出血、输尿管撕裂、肾衰竭等严重并发症。随访3~25个月(平均14.0个月),6例经2~3次扩张换管,拔出双J管后肾积水稳定于轻度状态;1例拔管后腰痛不适而长期留置双J管。提出术前做好心理护理和充分的术前准备,术后加强对出血、肾功能、输尿管撕裂等并发症的观察和护理,注重出院指导,对促进患者顺利恢复具有重要意义。     

Antegrade percutaneous endoluminal treatment of non-malignant ureterointestinal anastomotic strictures following urinary diversion

OBJECTIVE: We report our experience on antegrade percutaneous incision of ureterointestinal anastomosis strictures after urinary diversion. MATERIALS AND METHODS: Since 1994, we have evaluated retrospectively 18 patients with 22 ureterointestinal anastomosis strictures (UAS), who were treated with cold-knife incision. After placement of an 8-french nephrostomy tube, a 0.035-inch guide wire bypassed the stricture under guidance of a centrally opened (5-french) ureter catheter. A wire-mounted cold-knife was pulled through the strictured area retrogradely under fluoroscopic control. Routinely, following the incision, an 8-french external stent was left in place for 6-8 weeks. RESULTS: After stent removal as a primary procedure, the ureteroenteric area has remained patent in 14 of 19 (74%) UAS. In 3 cases undergoing a secondary or repeated procedure, treatment failed. The average follow-up was 23.5 (range 12-39) months. Failures were associated with radiogenic injury of the ureter in 5 UAS and unexplained in 2. No complication was observed. CONCLUSION: Percutaneous endourological management of UAS with the cold-knife incision, when used as a primary treatment, is a safe and effective alternative to open surgical repair and should be considered as an initial approach.     

Percutaneous management of benign ureteroileal anastomotic strictures after ileal conduit urinary diversion

We report our experience with the endourological treatment of 4 patients with 5 benign ureteroileal anastomotic strictures after ileal conduit urinary diversion. The treatment was successful in 4 of the 5 renal units without restenosis with a mean follow up of 10 months. The strictures were dilated by ureteral dilators and/or balloon dilation catheters using guide wires through percutaneous nephrostomies in an antegrade fashion. A 9 or 12 Fr. percutaneous splint catheter or a 12 Fr. double pig tail catheter was placed for 3-8 weeks after a successful dilation. Two renal units underwent repeated dilations. In 1 renal unit, a guide wire was hardly passed through the stricture and the treatment was unsuccessful. No serious complications were encountered. Percutaneous endourological managements of ureteroileal anastomotic strictures seemed to be quite versatile techniques which should be tried as the initial approach in many cases.     

Management of benign ureteral strictures following radical cystectomy and urinary diversion for bladder cancer

PURPOSE: 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. MATERIALS AND 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.     

Management of ureterointestinal anastomotic strictures: comparison of open surgical and endourological repair

The established treatment for ureterointestinal anastomotic strictures is open surgical revision. In an effort to evaluate the efficacy of endourological surgery for this problem, we compared 7 patients (9 strictures) who underwent open revision to 6 patients (7 strictures) who underwent endoscopic incision and balloon dilation of the stricture. The success rate (that is patent ureter and no stent) was 89 per cent for the open revision group and 71 per cent (5 of 7) for the endoscopic group. All open revisions required use of general anesthesia, while 3 of the endoscopic procedures were performed with the patient under assisted local anesthesia. The endoscopic group had markedly shorter hospitalization, decreased blood loss, diminished patient discomfort and no postoperative complications. While the endoscopic procedure for ureteroileal anastomotic strictures is less successful than open revision, the lower morbidity, decreased cost and shorter hospital stay associated with the endourological approach favor its use over open revision. For elderly patients who fail initial endoscopic revision and for patients with metastatic transitional cell cancer, placement of an indwelling stent is a reasonable alternative. Given these guidelines, less than 30 per cent of the patients who suffer a ureteroileal anastomotic stricture will require open surgical revision.     

Endoureterotomy by intraluminal invagination for nonmalignant ureterointestinal anastomotic strictures: description of a new surgical technique and long-term followup

PURPOSE: We describe a new surgical endoscopic technique for nonmalignant ureterointestinal anastomotic strictures. This procedure involving endoureterotomy by intraluminal invagination (the Lovaco technique) is performed by adopting a combined percutaneous antegrade and endoscopic retrograde approach. The results obtained by this technique are reviewed with long-term followup. MATERIALS AND METHODS: A total of 25 ureterointestinal anastomotic strictures were subjected to endoureterotomy by intraluminal invagination, including 12 left, 7 right and 3 bilateral cases. Surgical success was defined by radiological improvement and/or the ability to recover normal activity in the absence of flank pain, infection, or the need for ureteral stents or nephrostomy tubes. RESULTS: At a median followup of 51 months (range 2 to 145) the success rate for endoureterotomy by intraluminal invagination was 80% (20 of 25 ureterointestinal anastomotic strictures). No complications were recorded in the patients following endoureterotomy. CONCLUSIONS: This new endoureterotomy technique for ureterointestinal strictures following urinary diversion can be applied to any type of urinary diversion. It allows direct visualization of the stricture and stricture tissue biopsy. Intraluminal invagination makes it possible to increase the distance between the stricture, and the retroperitoneal vessels and bowels. The technique provides the control required to ensure full-thickness and full-length stricture incision. The success rate is high and it persists after long-term followup.