Wishahi Mohamed, Elganzoury Hossam, Elkhouly Amr
Department of Urology, Theodor Bilharz research Institute, Cairo, Egypt.
Int Braz J Urol. 2015 Jul-Aug;41(4):796-803. doi: 10.1590/S1677-5538.IBJU.2013.0086.
Uretero-ileal anastomotic stricture (UIAS) is a urological complication after ileal neobladder, the initial management being endourological intervention. If this fails or stricture recurs, surgical intervention will be indicated.
From 1994 to 2013, 129 patients were treated for UIAS after unsuccessful endourological intervention. Unilateral UIAS was present in 101 patients, and bilateral in 28 patients; total procedures were 157. The previous ileal neobladder techniques were Hautmann neobladder, detubularized U shape, or spherical shape neobladder.
Dipping technique was performed in 74 UIAS. Detour technique was done in 60 renal units. Ileal Bladder flap was indicated in 23 renal units. Each procedure ended with insertion of double J, abdominal drain, and indwelling catheter.
Follow-up was done for 12 to 36 months. Patency of the anastomosis was found in 91.7 % of cases. Thirteen patients (8.3%) underwent antegrade dilatation and insertion of double J.
After endourological treatment for uretero-ileal anastomotic failure, basically three techniques may be indicated: dipping technique, detour technique, and ileal bladder flap. The indications are dependent on the length of the stenotic/dilated ureteral segment. Better results for long length of stenotic ureter are obtained with detour technique; for short length stenotic ureter dipping technique; when the stenotic segment is 5 cm or more with a short ureter, the ileal tube flap is indicated. The use of double J stent is mandatory in the majority of cases. Early intervention is the rule for protecting renal units from progressive loss of function.
输尿管-回肠吻合口狭窄（UIAS）是回肠新膀胱术后的一种泌尿外科并发症，初始治疗为腔内泌尿外科干预。若此方法失败或狭窄复发，则需进行手术干预。
1994年至2013年期间，129例患者在腔内泌尿外科干预失败后接受了UIAS治疗。101例患者为单侧UIAS，28例为双侧UIAS；共进行了157次手术。先前的回肠新膀胱技术包括豪特曼新膀胱、去管化U形或球形新膀胱。
74例UIAS采用浸渍技术。60个肾单位采用绕道技术。23个肾单位采用回肠膀胱瓣技术。每次手术结束时均置入双J管、腹腔引流管和留置导尿管。
随访12至36个月。91.7%的病例吻合口通畅。13例患者（8.3%）接受了顺行扩张并置入双J管。
腔内泌尿外科治疗输尿管-回肠吻合失败后，基本上可采用三种技术：浸渍技术、绕道技术和回肠膀胱瓣技术。适应证取决于狭窄/扩张输尿管段的长度。对于长段狭窄输尿管，绕道技术效果更佳；对于短段狭窄输尿管，浸渍技术效果更佳；当狭窄段为5 cm或更长且输尿管较短时，宜采用回肠管瓣技术。大多数情况下必须使用双J支架。早期干预是保护肾单位避免功能逐渐丧失的原则。
