PERCUTANEOUS TRANSRENAL ELECTRO-INCISION OF URETEROINTESTINAL ANASTOMOTIC STRICTURES - LONG-TERM RESULTS AND COMPARISON OF FLUOROSCOPIC ANDENDOSCOPIC GUIDANCE

Purpose: We determined the long-term outcome of a new technique for in cising ureterointestinal anastomotic strictures using a transrenal per cutaneously inserted papillotome. Procedures using fluoroscopic and en doscopic guidance were compared. Materials and Methods: Of 33 stenoses incised in 30 patients 15 were in ileal conduit diversions and 15 wer e in enterocystoplasties. The papillotome was inserted percutaneously over a guide wire into the stenosis, and then deflected and gently wit hdrawn under fluoroscopic (11 cases) or endoscopic (22) guidance using a flexible pediatric gastroscope or a lateral duodenoscope inserted r etrograde into the ileal loop or neobladder. Air filling provided an e xcellent view of the stenotic area. Operative time did not exceed 45 m inutes. The only major complication was damage to a right internal ili ac artery. Results: Followup data were available for 31 stenoses, with 27 followed for longer than 12 months after stent removal. Of the ste noses 22 are completely patent (actuarial long-term patency rate 71%), 3 showed partial improvement and 6 recurred requiring further treatme nt. Conclusions: Combined endoscopic and fluoroscopic guidance is pref erable to fluoroscopy alone. The technique is simple if the endoscope is inserted retrograde. Long-term results are satisfactory and we beli eve that incision should be the initial approach to strictures of uro- digestive anastomoses.