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Getting out of a tight spot: an overview of ureteroenteric anastomotic strictures

Nature Reviews Urology volume 13, pages 447–455 (2016)Cite this article

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Key Points

  • Ureteroenteric anastomotic stricture is a well-known complication of radical cystectomy and urinary diversion and is associated with serious sequelae that can lead to loss of kidney function, infectious complications, and the need for additional procedures

  • The exact aetiology of benign ureteroenteric anastomotic strictures, although unclear, is most likely the result of ischaemia at the anastomotic region

  • Diagnosis can be achieved using retrograde contrast studies, CT scan, or MAG3 renography

  • The gold-standard treatment for ureteroenteric anastomotic strictures is open repair with excision of the strictured segment and reimplantation of the ureter, although this procedure is often challenging and associated with considerable morbidity

  • Endourological techniques have the advantages of reduced blood loss, postoperative pain, and length of hospitalization; however, they lack the long-term patency rates achieved with open revision, and patients often require repeated procedures to maintain patency

  • As stricture length is associated with recurrence, endourological techniques should be reserved for patients with strictures of ≤1 cm in length and for those not suitable for open repair

Abstract

Radical cystectomy and urinary diversion is the gold-standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer. Ureteroenteric anastomotic stricture is a well-known complication of urinary diversion and is associated with serious sequelae that lead to total or partial loss of kidney function, infectious complications, and the need for additional procedures. Although the exact aetiology of benign ureteroenteric anastomotic strictures is unclear, they most likely occur secondary to ischaemia at the anastomotic region. Diagnosis can be achieved using retrograde contrast studies, CT scan or MAG3 renography. Open revision remains the gold-standard treatment for ureteroenteric anastomotic strictures; however, endourological techniques are being increasingly used and, in select patients, might be the optimal approach.

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Figure 1: Mobilization of the left ureter to the right side of the abdomen through a tunnel in the sigmoid mesocolon.
Figure 2: Le Duc nonrefluxing anastomosis.
Figure 3: Bricker refluxing anastomosis.
Figure 4: Wallace refluxing anastomosis.
Figure 5
Figure 6: A suggested schematic for follow-up after cystectomy and urinary diversion.
Figure 7: Endourological techniques for the management of ureteroenteric anastomotic strictures.

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  1. Department of Urology, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK

    Niyati Lobo, Arun Sahai, Ramesh Thurairaja & Muhammad Shamim Khan

  2. King's College London School of Medicine, Guy's Campus, London, SE1 1UL, UK

    Sophie Dupré

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N.L. and S.D. researched data for the article and N.L., S.D., R.T. and M.S.K. wrote the article. All authors contributed substantially to the discussions of content and were involved in the review and/or editing of the manuscript before submission.

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Lobo, N., Dupré, S., Sahai, A. et al. Getting out of a tight spot: an overview of ureteroenteric anastomotic strictures. Nat Rev Urol 13, 447–455 (2016). https://doi.org/10.1038/nrurol.2016.104

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