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Interventional radiology methods of treating ureteral strictures developed on anastomoses after the radical cystectomy in Mainz Pouch II and ileal conduit derivation

Author(s): Maksimović H.M. | Marković B.B. | Pejčić T. | Hadži-Đokić J. | Marković Z. | Yachia D.

Journal: Acta Chirurgica Iugoslavica
ISSN 0354-950X

Volume: 54;
Issue: 4;
Start page: 83;
Date: 2007;
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Keywords: ureteroenteric anastomosis | strictures | ilealconduit | Mainz Pouch II | balloondilatation | stent

Objective of this work is to evaluate interventional radiology modalities such as balloon catheter dilation (BCD) and stent insertion, as minimally invasive methods in treatment uretero-enteral anastomotic strictures. Material and method: Retrospective study enrolled 26 patients (pts) in whom percutaneous BCD (17 pts) and metal stent implantation (9 pts) were done. Study was conducted from June 2005 till August 2007 and included total amount of 470 pts operated during 4 year period from 2003 till 2007. In 26 pts 35 ureteral units were treated, all of them in ambulatory conditions under oral analgosedation, monitored by fluoroscopy. Percutaneous BCD or stent implantation was performed in 24 pts and in 2 pts combined antegrade- retrograde approach for stent delivery, was applied. In all cases percutaneous nephrostomy (PCN) was left for 7 days period after procedure but in 6 units (5 pts) it remained permanent solution. First check up was done 7 days after by contrast media injection through nephrostomy tube prior to its extraction. Second control was done 30 days after by ultrasound exam and the last control (3 months after) by intravenous urography (IVU). Results: In our specimen 17pts had strictures unilaterally (65.4%) and in 9 pts (34.6%) it occurred bilaterally. First check up revealed 82.7% success of BCD, in 17.3% BCD was repeated with the final success rate of 73.5% (19/26). In four pts (26.5%) after BCD reobliteration happened and PCN was left. Patent ureteral lumen was observed in 6 pts (85.7%) with stent inserted while one pt underwent surgical reintervention. No significant difference between BCD and stent insertion success rate was noticed, based upon morphological parameters (ureteral lumen diameter, pelvicaliceal system dilatation) and serum creatinin level. Conclusion: BCD and stent insertion showed satisfactory results (following 3 months) in ureteroenteral anastomotic stricture recanalization. They include ambulatory conditions, ability to repeat procedure, without complications -excluding restenosis which finally can be surgically treated.
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