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• W2133318943 abstract "No AccessJournal of UrologyAdult Urology1 Apr 2008Open Surgical Repair of Ureteral Strictures and Fistulas Following Radical Cystectomy and Urinary Diversionis accompanied byDeconstructing Reconstructive Urology Lambda Msezane, W. Stuart Reynolds, Rishi Mhapsekar, Glenn Gerber, and Gary Steinberg Lambda MsezaneLambda Msezane More articles by this author , W. Stuart ReynoldsW. Stuart Reynolds More articles by this author , Rishi MhapsekarRishi Mhapsekar More articles by this author , Glenn GerberGlenn Gerber More articles by this author , and Gary SteinbergGary Steinberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2007.11.083AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Open surgery after cystectomy can be a challenge. We report the incidence of postoperative urinary diversion-enteric fistula and ureteral strictures in patients undergoing radical cystectomy, and discuss the diagnosis and management of these complications, including our surgical approach to these patients. Materials and Methods: We preformed a retrospective review of 553 patients undergoing radical cystectomy and urinary diversion for bladder cancer between April 1999 and January 2007. Patients in whom a ureteral stricture or fistula developed were identified by serial laboratory and imaging evaluations. A chart review was preformed to identify symptoms, time to stricture or fistula development, radiological findings, type of diversion, estimated blood loss and whether the original anastomosis was stented. Management and outcomes were assessed. Results: Of 553 patients reviewed ureteral stricture developed in 41 (7.4%) with a mean followup of 20.2 months (range 1 to 98). Strictures developed in 11% (31 of 272) of the orthotopic ileal neobladder, 2.5% (6 of 236) of ileal conduit and 8% (4 of 45) of Indiana pouch cases. Open repair led to an overall success rate of 87%. Urinary diversion-enteric fistula developed in 12 (2.2%) of the 553 patients with a mean followup of 28.4 months (range 3 to 94), all of whom had undergone orthotopic neobladder diversion. No patient had recurrence after surgical repair of the fistula. Conclusions: Open revision remains the gold standard management for ureteral strictures and urinary diversion-enteric fistulas occurring after radical cystectomy. The addition of the chimney modification to the orthotopic neobladder facilitates surgical repair. References 1 : Long-term results of treatment for ureteroenteric strictures. Urology2001; 58: 909. Google Scholar 2 : Long term results of endoureterotomy and open surgical revision for the management of ureteroenteric stricture after urinary diversion. J Urol2003; 170: 1226. Link, Google Scholar 3 : The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol1999; 161: 422. Link, Google Scholar 4 : Long-term complications related to the modified Indiana pouch. Urology2002; 60: 603. Google Scholar 5 : Entero-pouch fistula: a rare complication of right colon continent urinary diversion. J Urol1995; 154: 364. Link, Google Scholar 6 : Twenty years experience with an ileal orthotopic low pressure bladder substitute–lessons to be learned. J Urol2006; 176: 161. Link, Google Scholar 7 : Neobladder-vaginal fistula after cystectomy and orthotopic neobladder construction. BJU Int2004; 94: 1092. Google Scholar 8 : Technique of Hautmann ileal neobladder with chimney modification: interim results in 50 patients. J Urol2000; 163: 47. Link, Google Scholar 9 : Distal ureteral replacement with tubularized porcine small intestine submucosa. Urology2002; 60: 697. Google Scholar 10 : Management of ureterointestinal anastomotic strictures: comparison of open surgical and endourological repair. J Urol1988; 139: 1195. Link, Google Scholar 11 : Surgical versus endoscopic treatment of non-malignant uretero-ileal anastomotic strictures. Br J Urol1993; 71: 408. Google Scholar 12 : Long-term results of endoureterotomy for benign ureteral and ureteroenteric strictures. J Urol1997; 158: 759. Google Scholar 13 : Conservative management of neobladder-enteric fistula. Urology1999; 54: 336. Google Scholar Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois© 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited bySmith Z, Johnson S, Golan S, McGinnis J, Steinberg G and Smith N (2018) Fistulous Complications following Radical Cystectomy for Bladder Cancer: Analysis of a Large Modern CohortJournal of Urology, VOL. 199, NO. 3, (663-668), Online publication date: 1-Mar-2018.Schöndorf D, Meierhans-Ruf S, Kiss B, Giannarini G, Thalmann G, Studer U and Roth B (2018) Ureteroileal Strictures After Urinary Diversion with an Ileal Segment—Is There a Place for Endourological Treatment at All?Journal of Urology, VOL. 190, NO. 2, (585-590), Online publication date: 1-Aug-2013.Related articlesJournal of Urology15 Feb 2008Deconstructing Reconstructive Urology Volume 179Issue 4April 2008Page: 1428-1431 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordsurinary diversionurethral stricturecystectomyfistulaMetricsAuthor Information Lambda Msezane More articles by this author W. Stuart Reynolds More articles by this author Rishi Mhapsekar More articles by this author Glenn Gerber More articles by this author Gary Steinberg More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W2133318943 title "Open Surgical Repair of Ureteral Strictures and Fistulas Following Radical Cystectomy and Urinary Diversion" @default.
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