Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
Cancer Med. 2024 Sep;13(17):e70229. doi: 10.1002/cam4.70229.
Benign uretero-ileal anastomotic stricture (UIAS) is a potentially serious complication that can arise after radical cystectomy (RC) and subsequent urinary diversion. To preserve residual renal function and improve prognosis, it is crucial to derive insights from experience and tailor individualized treatment strategies for different patients.
From October 2014 to June 2021, a total of 47 patients with benign UIAS underwent endoscopic management (n = 19) or reimplantation surgery (n = 28). The basic data, perioperative conditions, and postoperative outcomes of the two groups were compared and analyzed to evaluate efficacy.
Comparing preoperative and postoperative clinical efficacy within the same group, the endoscopic group showed no significant differences in creatinine and blood urea nitrogen (BUN) levels before surgery or after extubation (p > 0.05). However, significant differences were observed in glomerular filtration rate (GFR) levels on the affected side before surgery and after extubation (p < 0.05). In contrast, the laparoscopic reimplantation group did not exhibit significant differences in creatinine, BUN, or GFR levels of affected side before surgery and after extubation (p > 0.05). Postoperative clinical efficacy showed no significant difference in creatinine and BUN levels between the two groups (p > 0.05). However, GFR values of affected side in the endoscopic treatment group decreased more than those in the laparoscopic reimplantation group (p < 0.05). Additionally, the laparoscopic reimplantation group was able to remove the single-J tube earlier than the endoscopic treatment group (p < 0.05), had a lower recurrence rate of hydronephrosis after extubation (p < 0.05), and experienced a later onset of hydronephrosis compared to the endoscopic treatment group (p < 0.05).
Based on our experience in treating UIAS following RC combined with urinary diversion, laparoscopic reimplantation effectively addresses the issue of UIAS, allowing for the removal of the ureteral stent relatively soon after surgery. This approach maintains long-term ureteral patency, preserves residual renal function, reduces the risk of ureteral restenosis and hydronephrosis, and has demonstrated superior therapeutic outcomes in this study.
良性输尿管-回肠吻合口狭窄（UIAS）是根治性膀胱切除术（RC）和随后的尿流改道后可能出现的严重并发症。为了保留残余肾功能并改善预后，从经验中获得见解并为不同患者制定个体化治疗策略至关重要。
2014 年 10 月至 2021 年 6 月，共 47 例良性 UIAS 患者接受内镜治疗（n=19）或再植入手术（n=28）。比较两组患者的基本资料、围手术期情况和术后结果，评估疗效。
同一组内比较术前和术后临床疗效，内镜组术前和拔管后血肌酐（Scr）和血尿素氮（BUN）水平无显著差异（p＞0.05）。但术前和拔管后患侧肾小球滤过率（GFR）水平有显著差异（p＜0.05）。腹腔镜再植入组术前和拔管后 Scr、BUN、患侧 GFR 水平无显著差异（p＞0.05）。术后两组 Scr 和 BUN 水平无显著差异（p＞0.05）。但内镜治疗组患侧 GFR 值下降较腹腔镜再植入组更明显（p＜0.05）。此外，腹腔镜再植入组较内镜治疗组更早拔除单 J 管（p＜0.05），拔管后肾积水复发率较低（p＜0.05），肾积水发生时间较内镜治疗组较晚（p＜0.05）。
基于我们在 RC 联合尿流改道术治疗 UIAS 的经验，腹腔镜再植入术有效地解决了 UIAS 问题，术后可相对较早地取出输尿管支架。这种方法保持了长期的输尿管通畅性，保留了残余肾功能，降低了输尿管再狭窄和肾积水的风险，并在本研究中显示出更好的治疗效果。
