[52] Treatment of uretero-ileal stenosis after dilatation catheter cystectomy: Monocentric study

Objective

To evaluate the treatment of uretero-ileal stenoses after dilatation catheter bladder tumour cystectomy in the Department of Urology, Ehu Oran, Algeria, as the dilatation catheter has been proposed as an alternative to open surgery in the treatment of uretero-ileal stenosis due to its low morbidity.

Methods

We performed a descriptive study on the results of balloon catheter treatment of uretero-ileal stenosis for a period of 4 years, from 2013 to 2016. Treatment consisted of catheterisation of antegrade or retrograde stenosis, dilatation of the stenosis with the balloon catheter, and then measurement of a mono-J catheter.

Results

During the period studied, we performed 92 cystectomies followed by 67 (72.82%) trans-ileal type bypasses. In all, 17 patients (25.3%) developed a stenosis, including eight left stenoses, five straight stenoses, and four bilateral stenoses. The average follow-up was 11.4 months. The average age was 58 years. Most patients had imaging at 3-months postoperatively. The pattern of discovery was fortuitous during an imaging examination for 11 patients (64.7%), emergency admission was evaluated at 35.2% for hyperalgic renal colic, acute renal failure with anuria and pyelonephritis. All patients had an emergency nephrostomy and were then scheduled for dilatation and placement of a mono-J probe. Nine stenoses (eight patients) were permeable with balloon dilatation and placement of a mono-J. In four patients the probe remained with an iterative nephrotomy change, and five patients had open surgery to re-stabilise the stenosis. Seven of the mono-J probes were placed antegrade. Six patients (75%) who received dilatation recurred and had monojector ablation.

Conclusion

The dilatation catheter procedure is a minimally invasive and effective therapeutic option to avoid complete stenosis that requires a substantial operative procedure. In our department, this option is considered the first-line treatment, the surgical re-implantation or disassembly of Bricker was reserved for complete waterproof stenosis.