Endoscopic management of ureterointestinal strictures after radical cystectomy

PURPOSE: To summarize the status of endoscopic treatment for ureterointestinal anastomotic strictures after radical cystectomy. MATERIALS AND METHODS: We reviewed the English-language literature identified by PubMed and MEDLINE to evaluate the efficacy of various treatment options for these strictures. RESULTS: Cumulative success rates from multiple studies analyzing patency after balloon dilation, endoureterotomy, and metal stenting specifically for ureteroenteric strictures were 18%, 63%, and 83%, respectively. Studies have not clearly shown any significant advantage over any specific cutting modality. The use of metal stents appears promising but is still fraught with complications of tissue ingrowth and recurrent obstruction. Clinical factors that appear to be associated with a poor prognosis are age >60 years, left-sided strictures, length >1 cm, stenting <4 weeks, and poor function in the affecting kidney. CONCLUSION: Ureteroenteric strictures remain the most challenging and difficult of all ureteral strictures to treat. An evolution of technology has helped advance the therapeutic options available. Given the rarity of this condition, limited study designs, and small numbers of patients, conclusive statements regarding the optimal treatment for this condition are difficult. Given its patency rates and possible complications, endoureterotomy should be considered the initial treatment of choice in properly selected patients.