Department of Urology, University Hospital of Brussels, Hôpital Erasme, University of Brussels, Brussels, Belgium -
Hôpital Erasme, Brussels, Belgium -
Minerva Urol Nephrol. 2021 Dec;73(6):724-730. doi: 10.23736/S2724-6051.21.04463-3. Epub 2021 Jul 26.
Uretero-enteric stricture (UES) is a common postoperative complication after radical cystectomy with urinary diversion. The aim of this systematic review was to discuss the contemporary management of benign UES after cystectomy and to compare the different surgical approaches.
A systematic review was performed from January 2000 to January 2021. Search engines used included PubMed, Embase and Medline databases. Search query were: (["ureteroileal" OR "uretero-ileal" OR "ureteroenteric" OR "uretero-enteric"] AND ["stricture" OR "stenosis"]) AND ("management" OR "treatment"). Study selection followed the PRISMA statement. Studies tackling management of UES, either through open, endoscopic, laparoscopic or robot-assisted approaches, were included in our systematic review.
Forty-one studies were finally included in this systematic review. No prospective studies were found; all included studies were retrospective. Open surgical repair had 78-100% success rate, a significant rate of complications, and a low recurrence rate (6-8%). Endourological management decreased complication rate, length-of-stay, and blood loss, with lower success (15-50%) and higher recurrence rates (62-91%) compared to open surgery. Robotic assisted surgery showed comparable success rates to open surgery (80-100%), while limiting the number of major complications and hospital length-of-stay.
Surgical management of UES remains challenging. Open surgery maintains a role given its high success rate, at the cost of a significant morbidity. On the other hand, endourological procedures offer a favorable and low complication risk, but a low long-term success rate. Robotic-assisted surgery is emerging with a valid resolution of UES as it offers comparable success rates to an open approach, while reducing surgical morbidity. Head-to-head comparisons are awaited to confirm these findings.
输尿管-肠狭窄（UES）是根治性膀胱切除术和尿流改道后的常见术后并发症。本系统评价的目的是讨论膀胱切除术后良性 UES 的当代治疗方法，并比较不同的手术方法。
从 2000 年 1 月至 2021 年 1 月进行了系统评价。使用的搜索引擎包括 PubMed、Embase 和 Medline 数据库。搜索查询为：（["ureteroileal" OR "uretero-ileal" OR "ureteroenteric" OR "uretero-enteric"] AND ["stricture" OR "stenosis"]) AND ("management" OR "treatment")。研究选择遵循 PRISMA 声明。本系统评价纳入了通过开放、内镜、腹腔镜或机器人辅助方法治疗 UES 的研究。
本系统评价最终纳入 41 项研究。未发现前瞻性研究；所有纳入的研究均为回顾性研究。开放性手术修复的成功率为 78-100%，并发症发生率高，复发率低（6-8%）。与开放性手术相比，内镜管理可降低并发症发生率、住院时间和失血量，成功率较低（15-50%），复发率较高（62-91%）。机器人辅助手术显示出与开放性手术相当的成功率（80-100%），同时限制了主要并发症和住院时间的数量。
UES 的手术治疗仍然具有挑战性。开放性手术因其高成功率而保持一定作用，但代价是较高的发病率。另一方面，内镜手术具有良好的低并发症风险，但长期成功率较低。机器人辅助手术正在出现，作为一种有效的 UES 解决方案，它提供了与开放性方法相当的成功率，同时降低了手术发病率。需要进行头对头比较来证实这些发现。
