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Ureteroileal strictures following urinary diversion with an ileal segment: is there a place for endourological treatment at all?

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Published:25th Mar 2020
Purpose: To compare the long-term results of minimally invasive endourological intervention versus open surgical revision in patients with nonmalignant ureteroileal stricture. Materials and Methods: Retrospective evaluation of 74 patients treated for unilateral or bilateral nonmalignant ureteroileal strictures of 85 renal units. Overall, 96 endourological and 35 open surgical procedures were performed. Balloon dilatation, endoureterotomy by Acucise´┐Ż or Ho:Yag laser were used as minimally invasive endourological interventions. Open surgical revision with resection of the stricture and open ureteroileal end-to-side-reanastomosis was the alternate treatment modality. Treatment success was defined as radiological normalization or improvement of upper urinary tract morphology combined with the absence of flank pain, infection, ureteral stents or percutaneous nephrostomies. Results: Median follow-up was 29 months (range: 2-177 mos). Overall success rate was 26% (25/96) for endourological interventions versus 91% (32/35) for open surgical revisions (p<0.001). subgroup analysis showed a significant difference in the success rate of minimally invasive endourological interventions (3 52; 6%) versus open surgical revision (19 22; 86%) for strictures>1cm (p<0.001). success rates for strictures ?1cm for endourological and open surgical procedures were 50% (22 44) and 100% (13 13), respectively. adjusting for multiple preoperative stricture characteristics, only stricture length was strongly and inversely associated with successful outcome (p><0.001). conclusions: open surgical revision produces better results than minimally invasive endourological intervention for treatment of ureteroileal strictures, particularly for strictures>1cm. Only for ureteroileal strictures ?1cm the success rate for endourological intervention is acceptable. Therefore, ureteroileal strictures >1cm should be primarily treated by open surgical revision.

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