Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center

Autores de IDIVAL

• Eneko Alonso Mediavilla

  Autor

• 

  Félix Campos Juanatey

  Autor

• Raquel Varea Malo

  Autor

• 

  Roberto Ballestero Diego

  Autor

• 

  Mario Dominguez Esteban

  Autor

• Enrique Ramos Barselo

  Autor

• Sergio Zubillaga Guerrero

  Autor

• Paola Calleja Hermosa

  Autor

• 

  José Luís Gutiérrez Baños

  Autor

Autores ajenos al IDIVAL

• Azcárraga Aranegui G

Unidades

• Hospital Universitario Marqués de Valdecilla

• INVESTIGACIÓN E INNOVACIÓN EN CIRUGÍA

  

  Investigador Responsable

  Marcos Gómez Ruiz

Abstract

Introduction: Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and Heal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. Material and methods: Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t test for independent groups or Mann-Whitney test. Statistical significance if P<.05. Results: The study included 182 patients (84% mates and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: neat conduit (138/76%) and orthotopic ileal neobladder (44/24%). Ureteric reimplantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). Conclusion: Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates. (C) 2021 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Keywords

• Estenosis ureteral; Derivación urinaria; Procedimientos quirúrgicos reconstructivos; Laparoscopia; Cirugía asistida por robot; Ureteral stricture; Urinary diversion; Reconstructive surgery procedures; Laparoscopy; Robot-assisted surgery