Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain.
Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain.
Eur Urol. 2016 Sep;70(3):493-8. doi: 10.1016/j.eururo.2016.02.045. Epub 2016 Feb 28.
A ureteroileal anastomosis stricture (UAS) is one of the most frequent complications after radical cystectomy. Open surgical repair is the treatment of choice but is associated with morbidity.
To describe the efficacy and safety of laparoscopic management for benign secondary UAS.
DESIGN, SETTING, AND PARTICIPANTS: A review was performed of the 11 initial procedures performed at our academic center from December 2010 to December 2014, with mean follow-up of 38 mo (range 12-169). Patients included had benign ureteroileal strictures longer than 1cm.
A pure laparoscopic approach was systematically used, involving a two-step procedure for left and a one-step procedure for right ureteral stenosis.
Perioperative data were collected and complications were assessed using the Clavien-Dindo grading system. Outcomes and follow-up data were analyzed.
A descriptive statistical analysis was performed for 11 surgeries in ten patients. The median stricture length was 2.4cm. No conversion to open surgery was required. The mean blood loss was 180ml and the mean hospital stay was 10 d. Early complications included limited lymphorrhea (n=1), limited anastomotic leakage (n=2), and accidental descent of a ureteral catheter (n=1) that was replaced with radiologic intervention. The mean follow-up was 38 mo (range 12-169). No late complications were reported. After 1 yr of follow-up, six patients had good glomerular filtration rates, all patients were asymptomatic, and no stenotic relapses were detected.
This laparoscopic technique for the management of benign secondary UAS is feasible, with good results and without long-term complications. This minimally invasive approach reduces the morbidity associated with open surgery while retaining good success rates.
We describe a novel laparoscopic approach for patients with a ureteroileal anastomosis stricture after radical cystectomy to avoid the complications associated with open surgery. The surgery was found to be viable and safe with good long-term results.
输尿管- 肠吻合口狭窄（UAS）是根治性膀胱切除术后最常见的并发症之一。开放手术修复是首选治疗方法，但存在一定的发病率。
描述腹腔镜治疗良性继发性 UAS 的疗效和安全性。
设计、地点和参与者：对我们学术中心 2010 年 12 月至 2014 年 12 月期间进行的 11 例初始手术进行了回顾性分析，平均随访 38 个月（范围 12-169 个月）。纳入的患者为良性输尿管- 肠吻合口狭窄且长度超过 1cm。
系统采用纯腹腔镜方法，左侧采用两步法，右侧采用一步法治疗输尿管狭窄。
收集围手术期数据，并采用 Clavien-Dindo 分级系统评估并发症。分析结果和随访数据。
对 10 例患者的 11 例手术进行了描述性统计分析。中位狭窄长度为 2.4cm。无一例转换为开放手术。平均失血量为 180ml，平均住院时间为 10 天。早期并发症包括局限性淋巴漏（n=1）、局限性吻合口漏（n=2）和输尿管导管意外下降（n=1），通过放射介入更换导管。平均随访时间为 38 个月（范围 12-169 个月）。无晚期并发症报告。随访 1 年后，6 例患者肾小球滤过率良好，所有患者均无症状，未发现狭窄复发。
这种腹腔镜技术治疗良性继发性 UAS 是可行的，结果良好，无长期并发症。这种微创方法降低了与开放手术相关的发病率，同时保持了较高的成功率。
我们描述了一种新的腹腔镜方法，用于治疗根治性膀胱切除术后输尿管- 肠吻合口狭窄的患者，以避免与开放手术相关的并发症。该手术可行且安全，长期效果良好。
