Strategies for management of ureteroenteral anastomotic stricture in patients after radical cystectomy and Bricker urinary diversion, "Beyond the Abstract," by Yinghao Sun, MD and Zhensheng Zhang, MD

BERKELEY, CA (UroToday.com) - Ureteroenteral anastomotic stricture is one of the most common complications after open radical cystectomy, especially following a Bricker procedure. According to our experience, the incidence rate of such complication is approximately 14% two years after Bricker diversion. So far, there has been a lack of prevention for ureteroenteral anastomotic stricture due to possible ischemia or necrosis of the distal ureter after the procedure.

For decades we have strived to seek proper management for this complication. In the present study, a minimally-invasive flexible cystoscope was applied for the retrograde placement of single-J stent for the management of ureteroenteral anastomotic stricture, and a significant symptom relieve was found in 8 out of 11 patients up to 66-months follow up.

Two major advantages of flexible cystoscope were noted during our practice. Firstly, in compare with other traumatic procedures such as open surgery and anterograde urteroscopy, the present method is less invasive and might be easier to carry out. Secondly, flexible cystoscope provides less of a blind spot within the ileal conduit which differs from the normal urinary bladder in morphology and anatomic location.

Nonetheless, one must aware of the following tips when performing this procedure.

  1. It is important to keep moderate conduit filling to ensure a clear vision and avoid false passage or even perforation.
  2. Attention must be paid to the landmarks such as the dead end of the conduit and the icosahedrons morphology change.
  3. If stricture recurred after removal of the stent, the placement of the stent could be prolonged to 3 months. Regular follow-ups and replacement of the stent are suggested.
  4. Balloon dilation to expand the tract is highly recommended if patients could afford the expense.
  5. The surgeon who performed the radical cystectomy may be the ideal one to solve this complication, because it could be easier to find the ureteroenteral anastomosis.

Though with limited number of patients in this preliminary study, we were able to demonstrate that retrograde placement of single-J stent with flexible cystoscope was a safe and repeatable method for ureteroenteral anastomotic stricture following radical cystectomy. We are expecting multi-center study with large sample size in the near future.

Written by:
Yinghao Sun, MD and Zhensheng Zhang, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.

Progressive ureteral dilations and retrograde placement of single-J stent guided by flexible cystoscope for management of ureteroenteral anastomotic stricture in patients after radical cystectomy and Bricker urinary diversion - Abstract

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