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

E Alonso Mediavilla; F Campos-Juanatey; G Azcárraga Aranegui; R Varea Malo; R Ballestero Diego; M Domínguez Esteban; E Ramos Barseló; S Zubillaga Guerrero; P Calleja Hermosa; J L Gutiérrez Baños

doi:10.1016/j.acuro.2021.06.001

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

Actas Urol Esp (Engl Ed). 2021 Jul 28:S0210-4806(21)00119-4. doi: 10.1016/j.acuro.2021.06.001. Online ahead of print.

[Article in English, Spanish]

Affiliations

¹ Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
² Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, España. Electronic address: felix.campos@scsalud.es.
³ Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, España.
⁴ Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, España; Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, España.

PMID: 34332809
DOI: 10.1016/j.acuro.2021.06.001

Abstract

Introduction: Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal 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% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal 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.

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