Pappas Paris, Stravodimos Konstantinos G, Kapetanakis Theodoros, Leonardou Poly, Koutallelis Georgios, Adamakis Ioannis, Constantinides Constantinos
Radiology Department, 'Laiko' General Hospital, University of Athens Medical School, 17 Ag. Thoma St, Goudi, 11527 Athens, Greece.
Int Urol Nephrol. 2008;40(3):621-7. doi: 10.1007/s11255-008-9349-4. Epub 2008 Mar 5.
Urinary diversion after radical cystectomy is commonly performed via an ileal conduit using the Bricker method. However, 4-8% of these cases are complicated with stricture formation at the ureterointestinal junction. Thus, this could eventually lead to hydronephrosis and kidney loss in neglected patients. Few data exist concerning the outcomes of patients with ureterointestinal junction strictures managed via a percutaneous approach and balloon dilatation of the stricture. The potential of managing these strictures, using a stent replacement strategy, was evaluated.
A total of 14 patients (10 male, 4 female; age range 24-72 years) were enrolled in the study. Mean follow-up time was 30.9 months. Invasive bladder cancer was diagnosed in 11, neurogenic bladder in 2 and shrunk bladder after external beam radiation for prostate cancer in 1 patient. They were all managed by radical cystectomy followed by Bricker ileal conduit. In 6 cases, ureterointestinal strictures bilaterally were discovered, whereas unilateral (left-sided) strictures were noted to the remaining 8 patients. All strictures were managed via a percutaneous approach and balloon dilatation. A double J stent was placed at the end of the procedure and was regularly replaced after an interval of 3-6 months.
A percutaneous nephrostomy was successfully placed in all patients. Double J stent insertion was possible in 18 of a total of 20 (90%) obstructed ureters. No major complications were observed in any of the cases while adequate renal function was preserved in all patients. Quality of life is not reported to be significantly compromised in any patient. Double J ureteral stent replacement is performed every 3-6 months in a retrograde fashion. One patient died in the follow-up period due to disease progression.
Placement of a double J stent via a percutaneous approach seems to have offered a viable option in the management of ureterointestinal strictures in this patient population. In addition, periodical retrograde replacement of the stent probably does not constitute a factor compromising quality of life. However, further studies are required to justify these primary clinical data.
根治性膀胱切除术后尿流改道通常采用Bricker法经回肠通道进行。然而，这些病例中有4 - 8%会并发输尿管肠吻合口狭窄。因此，这最终可能导致被忽视患者出现肾积水和肾脏丧失。关于经皮途径处理输尿管肠吻合口狭窄并对狭窄进行球囊扩张的患者的预后数据很少。本研究评估了使用支架置换策略处理这些狭窄的可能性。
本研究共纳入14例患者（男10例，女4例；年龄范围24 - 72岁）。平均随访时间为30.9个月。11例诊断为浸润性膀胱癌，2例为神经源性膀胱，1例因前列腺癌接受外照射后膀胱缩小。他们均接受了根治性膀胱切除术，随后行Bricker回肠通道术。6例患者双侧发现输尿管肠狭窄，其余8例患者为单侧（左侧）狭窄。所有狭窄均经皮途径处理并进行球囊扩张。手术结束时放置双J支架，并在3 - 6个月的间隔后定期更换。
所有患者均成功置入经皮肾造瘘管。20根梗阻输尿管中的18根（90%）成功插入双J支架。所有病例均未观察到重大并发症，所有患者的肾功能均得以保留。未报告任何患者的生活质量受到显著影响。双J输尿管支架每3 - 6个月逆行更换一次。1例患者在随访期间因疾病进展死亡。
经皮途径置入双J支架似乎为该患者群体中输尿管肠狭窄的处理提供了一个可行的选择。此外，定期逆行更换支架可能不会构成影响生活质量的因素。然而，需要进一步的研究来证实这些初步临床数据。
