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CardioVascular and Interventional Radiology

Published in:

01-09-2007

Treatment of Ureterointestinal Anastomotic Strictures by Diathermal or Cryoplastic Dilatation

Authors: Franco Orsi, Silvia Penco, Victor Matei, Guido Bonomo, Paolo Della Vigna, Lorenzo Monfardini, Ottavio De Cobelli

Published in: CardioVascular and Interventional Radiology | Issue 5/2007

Abstract

Background

Ureterointestinal anastomotic strictures (UAS) complicate 10–15% of surgeries for urinary diversion and are the main cause of deterioration in renal function. Treatments are surgical revision, management with autostatic stent, balloon dilatation, endoscopic incision, and percutaneous transrenal diathermy (Acucise). A new option is cryoplastic dilatation (Polar-Cath).

Purpose

To assess the feasibility, complications, and preliminary results of UAS treatment using the Acucise and Polar-Cath systems.

Methods

Nineteen UAS, diagnosed by ultrasonography or computed tomography and sequential renal scintigraphy, occurred in 15 cancer patients after radical cystectomy and urinary diversion. Fifteen were managed with balloon diathermy and 4 by balloon cryoplasty in a three-stage procedure—percutaneous nephrostomy, diathermal or cryoplastic dilatation, and transnephrostomic control with nephrostomy removal—each separated by 15 days. All patients gave written informed consent.

Results

Dilatations were successful in all cases. The procedure is simple and rapid (about 45 min) under fluoroscopic control and sedation. Procedural complications occurred in 1 (5%) patient with UAS after Wallace II uretero-ileocutaneostomy: a common iliac artery lesion was induced by diathermal dilatation, evident subsequently, and required surgical repair. Patency with balloon diathermy was good, with two restenoses developing over 12 months (range 1–22) of follow-up. With balloon cryoplastic dilatation, one restenosis developed in the short term; follow-up is too brief to assess the long-term efficacy.

Conclusion

Our short-term results with diathermal and cryoplastic dilatation to resolve UAS are good. If supported by longer follow-up, the techniques may be considered as first-choice approaches to UAS. Surgery should be reserved for cases in which this minimally invasive technique fails.

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Title: Treatment of Ureterointestinal Anastomotic Strictures by Diathermal or Cryoplastic Dilatation
Authors: Franco Orsi
Silvia Penco
Victor Matei
Guido Bonomo
Paolo Della Vigna
Lorenzo Monfardini
Ottavio De Cobelli
Publication date: 01-09-2007
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 5/2007
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-007-9048-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Treatment of Ureterointestinal Anastomotic Strictures by Diathermal or Cryoplastic Dilatation

Abstract

Background

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Purpose

Methods

Results

Conclusion

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