ANTEROGRADE PERCUTANEOUS TREATMENT OF URETEROINTESTINAL STRICTURES FOLLOWING URINARY-DIVERSION

Objective: The incidence of ureterointestinal strictures following uri nary diversion ranges from 4 to 8%. Traditionally, the treatment consi sts of open ureteral reimplantation. During the last decade, however, percutaneous techniques have gained increased interest for treatment o f these strictures. We evaluated the outcome of anterograde percutaneo us treatment of ureterointestinal strictures after urinary diversion. Methods: Since 1985, we attempted treatment of 15 ureterointestinal st rictures, either by percutaneous anterograde dilatation (n = 10) or co ld-knife incision (n = 2). In 3 patients the stricture could not be pa ssed with a guide wire, precluding percutaneous treatment. Anterograde dilatation was performed with semirigid fascial dilators in 6 patient s and additionally with a Gruntzig balloon catheter in 4. Routinely, f ollowing a successful procedure, a 12-Fr multihole stent was left in p lace for 6 weeks. Results: Restenosis was seen in 4 patients 2, 2, 19, and 36 months, respectively following the procedure. In 8 patients no stenosis developed so far (follow-up 8-96 months). Morbidity after th e procedure consisted of fever after nephrostomy puncture in 1 patient and stent occlusion in another. Both were managed conservatively. Con clusion: Anterograde percutaneous treatment of ureterointestinal stric tures after urinary diversion is a safe primary procedure with a perma nent success rate in half of the patients (53%).