Tal Raanan, Sivan Bezalel, Kedar Daniel, Baniel Jack
Department of Urology, Rabin Medical Center, Beilinson Campus, Petach Tikva and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Urol. 2007 Aug;178(2):538-42. doi: 10.1016/j.juro.2007.03.142. Epub 2007 Jun 14.
Ureteral obstruction due to benign strictures is a significant complication of radical cystectomy and urinary diversion for bladder cancer that can lead to renal function loss and infection related morbidity. Treatment may be performed surgically or with minimally invasive techniques. We describe the 10-year experience at our department with various treatment modalities for post-cystectomy benign strictures.
The study group consisted of 28 patients treated for benign ureteral strictures following radical cystectomy for bladder cancer. Their medical records were reviewed for clinical presentation, diagnostic procedures, treatment and long-term outcome.
The study group represented 12.7% of all 221 patients treated at our department with radical cystectomy for bladder cancer in 1994 to 2004. Ureteral strictures were asymptomatic in 71.4% of cases. Median time to diagnosis was 7.0 months and 75% of the patients were diagnosed within year 1 after cystectomy. Treatment consisted of stenting, dilation and open surgical revision with removal of the strictured segment and reanastomosis. Median followup was 62.5 months. The stenting procedures served as the long-term definitive treatment in 45% of cases, whereas balloon dilation uniformly failed. Although open surgical revision was technically challenging, it had a long-term success rate of 93%.
Benign ureteral strictures commonly occur during postoperative year 1 and they are usually asymptomatic. Early diagnosis and prompt drainage are required to prevent consequent renal parenchymal loss and infectious complications. Although minimally invasive procedures are viable treatment alternatives, open surgical revision is still the preferred long-term definitive treatment.
良性狭窄导致的输尿管梗阻是膀胱癌根治性膀胱切除术及尿流改道的一种严重并发症，可导致肾功能丧失及感染相关的发病率增加。治疗可通过手术或微创技术进行。我们描述了本科室采用多种治疗方式处理膀胱切除术后良性狭窄的10年经验。
研究组由28例因膀胱癌行根治性膀胱切除术后出现良性输尿管狭窄而接受治疗的患者组成。回顾他们的病历以了解临床表现、诊断方法、治疗及长期结果。
研究组占1994年至2004年在本科室接受膀胱癌根治性膀胱切除术的所有221例患者的12.7%。71.4%的输尿管狭窄病例无症状。诊断的中位时间为7.0个月，75%的患者在膀胱切除术后1年内被诊断出来。治疗包括支架置入、扩张以及切除狭窄段并重新吻合的开放性手术修复。中位随访时间为62.5个月。45%的病例中支架置入术作为长期确定性治疗，而球囊扩张均失败。尽管开放性手术修复在技术上具有挑战性，但其长期成功率为93%。
良性输尿管狭窄常见于术后第1年，且通常无症状。需要早期诊断和及时引流以防止随后的肾实质损失和感染性并发症。尽管微创方法是可行的治疗选择，但开放性手术修复仍是首选的长期确定性治疗方法。
