Treating benign ureteroenteric strictures: 27-year experience comparing endourological techniques with open surgical approach

• Published in: World journal of urology Vol. 37; no. 6; pp. 1217 - 1223
• Main Authors: van Son, M. J., Lock, M. T. W. T., Peters, M., van de Putte, E. E. Fransen, Meijer, R. P.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2019; Springer Nature B.V
• Subjects: Anastomosis, Surgical - adverse effects; Aneurysms; Balloon treatment; Colon - surgery; Constriction, Pathologic - surgery; Female; Glomerular filtration rate; Humans; Ileum - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Oncology; Original; Original Article; Patients; Postoperative Complications - surgery; Renal function; Reoperation; Retrospective Studies; Risk factors; Stricture; Surgery; Time Factors; Ureter - surgery; Ureteral Diseases - surgery; Urinary Diversion - adverse effects; Urologic Surgical Procedures - methods; Urology; Stenosis; Urinary diversion; Endoscopy; Re-implantation; Anastomosis
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-018-2475-4

Purpose
To compare open surgical anastomotic revision with endourological techniques for the treatment of ureteroenteric strictures in patients with urinary diversions.
Methods
All records of patients treated for ureteroenteric strictures in our clinic between 1989 and 2016 were retrospectively reviewed. In 76 patients, 161 completed procedures were analyzed: 26 open revisions vs. 135 endourological treatments, including balloon dilation, Wallstent and/or laser vaporization.
Results
Median follow-up was 34 months. At 60 months, patency rates were 69% (95% CI 52–92%) after open vs. 27% (95% CI 19–39%) after endo-treatment (
p
 = 0.003); median patency duration was 15.5 vs. 5 months, respectively (
p
 = 0.014). Eventually, 15% of patients required open surgery after primary endo-treatment and 21% received endoscopic re-treatment after primary open surgery. Cox regression analysis revealed no confounding factors among the risk factors added to the model. Complication rates were higher after open surgery (27% Clavien 2, 12% Clavien 3–4 vs. 5% Clavien 1–2, 3% Clavien 3,
p
 = 0.528). Median postoperative hospital stay was 14 days (open) vs. 2 days (endo),
p
 < 0.001. Mean estimated glomerular filtration rate improved with + 17 (open) vs. + 8.1 (endo),
p
 = 0.024. Renal function was compromised in 8% of patients in the open surgery group vs. 6% in the endo-treatment group.
Conclusions
In these patients, in terms of patency and patency duration, open surgery was superior to endourology. Nevertheless, endourological treatments offer a safe and less-invasive alternative to delay or avoid open surgery, especially in patients who are unfit for open surgery.