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Ureteroenteric anastomotic revision as initial management of stricture after urinary diversion
Author(s) -
Gin Greg E,
Ruel Nora H,
Parihar Jaspreet S,
Warner Jonathan N,
Yuh Bertram E,
Yamzon Jonathan,
Wilson Timothy G,
Lau Clayton S,
Chan Kevin G
Publication year - 2017
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.13323
Subject(s) - medicine , urinary diversion , anastomosis , surgery , hydronephrosis , retrospective cohort study , complication , stent , stenosis , urinary system , urethral stricture , percutaneous nephrostomy , percutaneous , cystectomy , urethra , bladder cancer , cancer
Objective To report our experience with ureteroenteric anastomotic revision as initial treatment of stricture after urinary diversion. Methods An institutional review board‐approved retrospective study was carried out. A total of 41 patients who underwent primary ureteroenteric anastamotic revision were identified between 2007 and 2015. Data analyzed included patient characteristics, type of diversion, estimated blood loss, operative time, change in renal function, length of stay, postoperative complications and time with nephrostomy/stent. Success of revision was defined as an improvement in hydronephrosis on radiographic imaging and/or reflux during pouchogram. Predictors of length of stay and complications were analyzed using analysis of covariance. Results A total of 50 renal units were revised with a success rate of 100%. The median length of stay was 6 days (2–16 days). There were a total of 15 complications (one major, 14 minor) in 14 patients (33% 30‐day complication rate). The most common were wound infection ( n = 4) and arrhythmia ( n = 4). Robotic revision ( n = 5) had a median length of stay of 3 days (2–4) with no complications. Conclusions Primary ureteroenteric anastomotic revisions have an excellent success rate at an experienced center and might obviate the need for multiple interventions. Open revision is associated with mostly minor complications. Robotic revision might reduce the morbidity of open revision in select cases.