Skip to main content
BJR alerts
Full paper

The double wire technique: an improved method for treating challenging ureteroileal anastomotic strictures and occlusions

Published Online:https://doi.org/10.1259/bjr/72561092

Abstract

Up to 10% of patients who undergo ileal conduit urinary diversion may go on to develop ureteroileal anastomotic stenosis (UIAS); this can lead to recurrent urinary tract infections and deterioration in renal function. Classical management has been open revision of the anastomosis. We describe a novel technique that allows balloon dilatation and ureteral stent placement in a retrograde fashion. All patients in this study had undergone radical cystectomy and ileal conduit formation with Wallace type end-to-end refluxing uretero-intestinal anastomosis. After initial retrograde loopogram, a 6F MPA-1 catheter and an 0.035 inch extra stiff guide was passed to the distal ostium. Subsequently, a customised 8F bright tip MPA-1 guiding catheter was advanced over the guide wire which allowed effective splinting of the equipment to facilitate greater control of a second catheter and guide wire combination to access the stenotic or occluded anastomosis. Results show that a total of ten anastomoses were treated; nine anastomoses were successfully treated with a primary retrograde approach with no intra or post-procedural complications. After a mean follow-up of 19 months (5–33 months), as assessed by ascending loopograms, all anastomoses remained open. In conclusion, morbidity of open surgery has resulted in the popularization of endourological techniques in treating anastomotic stenoses. However, key to these endourological techniques is access to the anastomosis; typically, this has been via a percutaneously placed nephrostomy. The ideal route to the anastomosis is via a retrograde approach; we have illustrated a safe and successful novel technique that utilized two guidewires and a guiding catheter, allowing retrograde ureteral access.

References

  • 1 Sullivan JW, Grabstald H, Whitmore WF. Complications of ureteroileal conduit with radical cystectomy: review of 336 cases. J Urol 1980;124:797–801. Crossref Medline ISIGoogle Scholar

  • 2 Regan JB, Barrett DM. Stented versus nonstented ureteroileal anastomoses: is there a difference with regard to leak and stricture? J Urol 1985;134:1101–3. Crossref Medline ISIGoogle Scholar

  • 3 Gburek BM, Lieber MM, Blute ML. Comparison of Studer ileal neobladder and ileal conduit urinary diversion with respect to perioperative outcome and late complications. J Urol 1998;160:721–3. Crossref Medline ISIGoogle Scholar

  • 4 Kramolowsky EV, Clayman RV, Weyman PJ. Management of ureterointestinal anastomotic strictures: comparison of open surgical and endourological repair. J Urol 1988;139:1195–8. Crossref Medline ISIGoogle Scholar

  • 5 Clark PB. End-to-end ureteroileal anastomosis for ileal conduits. Br J Urol 1979;51:105–9. Crossref MedlineGoogle Scholar

  • 6 Vandenbroucke F, Van Poppel H, Vandeursen H, Oyen R, Baert L. Surgical versus endoscopic treatment of non-malignant uretero-ileal anastomotic strictures. BJU 1993;71:408–12. Crossref Medline ISIGoogle Scholar

  • 7 DiMarco DS, LeRoy AJ, Thieling S, Bergstralh EJ, Segura JW. Long-term results of treatment for ureteroenteric strictures. Urology 2001;58:909–13. Crossref Medline ISIGoogle Scholar

  • 8 Laven BA, O'Connor RC, Gerber GS, Steinberg GD. Long-term results of endoureterotomy and open surgical revision for the management of ureteroenteric strictures after urinary diversion. J Urol 2003;170:1226–30. Crossref Medline ISIGoogle Scholar

  • 9 Poulakis V, Witzsch U, de Vries R, Becht E. Antegrade percutaneous endoluminal treatment of non-malignant ureterointestinal anastomotic strictures following urinary diversion. Eur Urol 2001;39:308–15. Crossref Medline ISIGoogle Scholar

  • 10 Palascak P, Bouchareb M, Zachoval R, Urban M, Sauvain JL, Palascak R. Treatment of benign ureterointestinal anastomotic strictures with permanent ureteral Wallstent after Camey and Wallace urinary diversion: long-term follow-up. J Endourol 2001;15:575–80. Crossref Medline ISIGoogle Scholar

  • 11 Rapp DE, Laven BA, Steinberg GD, Gerber GS. Percutaneous placement of permanent metal stents for treatment of ureteroenteric anastomotic strictures. J Endourol 2004;18:677–81. Crossref Medline ISIGoogle Scholar

  • 12 Walther PJ, Robertson CN, Paulson DF. Lethal complications of standard self-retaining ureteral stents in patients with ileal conduit urinary diversion. J Urol 1985;133:851–3. Crossref Medline ISIGoogle Scholar

  • 13 Kramolowsky EV, Clayman RV, Weyman PJ. Endourological management of ureteroileal anastomotic strictures: is it effective? J Urol 1987;137:390–4. Crossref Medline ISIGoogle Scholar

  • 14 Barbaric ZL. Percutaneous nephrostomy for urinary tract obstruction. Am J Roentgenol 1984;143:803–9. Crossref Medline ISIGoogle Scholar

  • 15 Santoshi N, Nilesh P, Prakash S, Devendra D, Anand J, Srinivas V. A novel technique for ureteric access in ileal conduits. BJU Int 2003;91:423–4. Crossref Medline ISIGoogle Scholar

  • 16 Costamagna G, Shah SK, Mutignani M, Tringali A, Alevrus PP, Vamvakousis V, et al. Use of a duodenoscope to manage complications at the ureteroileal anastomotic site after total urinary bladder resection and the Bricker procedure. Gastrointest Endosc 2002;55:242–8. Crossref Medline ISIGoogle Scholar

  • 17 Applbaum YN, Diamond AB, Rappoport AS. Retrograde ureteral catheterization via the ileal conduit. Am J Roentgenol 1986;146:61–3. Crossref Medline ISIGoogle Scholar

  • 18 Banner MP, Amendola MA, Pollack HM. Anastomosed ureters: fluoroscopically guided transconduit retrograde catheterization. Radiology 1989;170:45–9. Crossref Medline ISIGoogle Scholar

  • 19 Drake MJ, Cowan NC. Fluoroscopy guided retrograde ureteral stent insertion in patients with a ureteroileal urinary conduit: method and results. J Urol 2002;167:2049–51. Crossref Medline ISIGoogle Scholar

Volume 80, Issue 950February 2007
Pages: 73-e57

© The British Institute of Radiology


History

  • ReceivedJune 20,2006
  • AcceptedAugust 15,2006
  • Published onlineJanuary 28,2014

Metrics