OBJECTIVES: One of the most frequent complications of urinary diversions is the stenosis of the urereral-neobladder anastomosis (3-14%).In this video we present our antegrade-retrograde endourological technique in the treatment of ureteral-neobladder strictures. MATERIALS AND METHODS: 7 patients with monolateral stenosis of the ureteral-neobladder anastomosis (5 left and 2 right) underwent a radical cystectomy and an orthotopic ileal neobladder "Padovana" with a Le DucCamey ureteral anastomosis (5 months to 2 years before). With the patient in prone position, percutaneous puncture of the lower calix is carried oui. A stiff guide wire is passed through the nephrostomy tube down in the ureter reaching the stricture which is by-passed. This is the crucial point of our technique because if you can't by-pass the stricture with the guide wire is better not to force this manouvre and proceed with open surgery. Once the guide wire is rolled up in the neobladder, the patient is placed in lithotomy position. The guide wire is recovered on the exterior of the urethra in order to obtain an easily manoeuvreable wire through the entire urinary tract. A 21Ch cystoscope is mounted onto the guide wire, the anastomosis is reached and an opening wide enough to introduce a CH 11.5 ureteroscope into the ureter is made with a cold blade knife. A second guide wire is positioned in order to leave in the neobladder 2 double-J stents which keep the anastomosis open during scarring,The stents are removed after 28 days. RESULTS: the results were the following: complete recanahzation of the anastomosis in 6 patients. 1 patient had another stricture 3 months later and underwent a new anastomosis with interposing ileal loop. CONCLUSIONS: although the follow-up is short the results are encouraging. We believe Ihat the peculiarity of this technique is the percutaneous kidney-urethral bypass. With the guide wire kept taut, the ureteroscope slides smoothly forward to force the anastomotic stricture.
|Number of pages||1|
|Journal||British Journal of Urology|
|Issue number||SUPPL. 2|
|Publication status||Published - 1997|
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