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Use of a long-term metal stent in complex uretero-ileal anastomotic stricture.

Kabir MN, Bach C, Kachrilas S, Zaman F, Junaid I, Buchholz N, Masood J - Arab J Urol (2011)

Bottom Line: This is technically challenging and has potential significant morbidity for the patient.We describe the technique and potential advantages of this minimally invasive method.This minimally invasive treatment option is of interest, as in contrast to other stents, it does not require routine change, and is resistant to corrosion and urothelial ingrowth, hence ensuring ease of exchange or removal if required.

View Article: PubMed Central - PubMed

Affiliation: Endourology and Stone Services, Barts and The London NHS Trust, West Smithfield, London EC1A 7BE, UK.

ABSTRACT
Uretero-ileal anastomotic stricture is a potentially serious late complication after ileal conduit formation, with a reported incidence of 3-9%. The standard management technique is open surgical revision of the anastomosis with reimplantation of the affected ureter. This is technically challenging and has potential significant morbidity for the patient. Advances in endourological techniques now offer a variety of less-invasive treatment options, like balloon dilatation or laser ureterotomy followed by stent insertion. What happens when such open and minimally invasive techniques fail? Recently, using a combined antegrade and retrograde approach, we inserted a novel, semi-permanent, dual-expansion thermo-expandable metallic alloy stent across a recurrent ileal-ureteric stricture. We describe the technique and potential advantages of this minimally invasive method. This minimally invasive treatment option is of interest, as in contrast to other stents, it does not require routine change, and is resistant to corrosion and urothelial ingrowth, hence ensuring ease of exchange or removal if required.

No MeSH data available.


Related in: MedlinePlus

Two wires passing through the stricture. The flexible cystoscope is placed inside the ileal conduit at the distal end of the stricture. Note the awkward, acute angle at the anastomotic stricture.
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f0010: Two wires passing through the stricture. The flexible cystoscope is placed inside the ileal conduit at the distal end of the stricture. Note the awkward, acute angle at the anastomotic stricture.

Mentions: This wire is exchanged for a stiffer wire, over which the anastomotic stricture is then balloon-dilated. A second guidewire is inserted through the stricture serving as a ‘safety wire’ (Fig. 2). The first ‘working wire’ is then used to guide the insertion system for the Memokath. If needed, slight traction on both ends can increase the rigidity and allow for increased radial force to pass the stricture with endoscopic instruments and devices. By flushing the thermolabile stent with hot sterile water, both ends expand, anchoring the stent proximally and distally of the stricture. A contrast-medium view confirms the position of the stent (Fig. 3). The dual-expansion version of the Memokath was used to reduce the risk of proximal migration of the stent into the dilated ureter above the stricture.


Use of a long-term metal stent in complex uretero-ileal anastomotic stricture.

Kabir MN, Bach C, Kachrilas S, Zaman F, Junaid I, Buchholz N, Masood J - Arab J Urol (2011)

Two wires passing through the stricture. The flexible cystoscope is placed inside the ileal conduit at the distal end of the stricture. Note the awkward, acute angle at the anastomotic stricture.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150572&req=5

f0010: Two wires passing through the stricture. The flexible cystoscope is placed inside the ileal conduit at the distal end of the stricture. Note the awkward, acute angle at the anastomotic stricture.
Mentions: This wire is exchanged for a stiffer wire, over which the anastomotic stricture is then balloon-dilated. A second guidewire is inserted through the stricture serving as a ‘safety wire’ (Fig. 2). The first ‘working wire’ is then used to guide the insertion system for the Memokath. If needed, slight traction on both ends can increase the rigidity and allow for increased radial force to pass the stricture with endoscopic instruments and devices. By flushing the thermolabile stent with hot sterile water, both ends expand, anchoring the stent proximally and distally of the stricture. A contrast-medium view confirms the position of the stent (Fig. 3). The dual-expansion version of the Memokath was used to reduce the risk of proximal migration of the stent into the dilated ureter above the stricture.

Bottom Line: This is technically challenging and has potential significant morbidity for the patient.We describe the technique and potential advantages of this minimally invasive method.This minimally invasive treatment option is of interest, as in contrast to other stents, it does not require routine change, and is resistant to corrosion and urothelial ingrowth, hence ensuring ease of exchange or removal if required.

View Article: PubMed Central - PubMed

Affiliation: Endourology and Stone Services, Barts and The London NHS Trust, West Smithfield, London EC1A 7BE, UK.

ABSTRACT
Uretero-ileal anastomotic stricture is a potentially serious late complication after ileal conduit formation, with a reported incidence of 3-9%. The standard management technique is open surgical revision of the anastomosis with reimplantation of the affected ureter. This is technically challenging and has potential significant morbidity for the patient. Advances in endourological techniques now offer a variety of less-invasive treatment options, like balloon dilatation or laser ureterotomy followed by stent insertion. What happens when such open and minimally invasive techniques fail? Recently, using a combined antegrade and retrograde approach, we inserted a novel, semi-permanent, dual-expansion thermo-expandable metallic alloy stent across a recurrent ileal-ureteric stricture. We describe the technique and potential advantages of this minimally invasive method. This minimally invasive treatment option is of interest, as in contrast to other stents, it does not require routine change, and is resistant to corrosion and urothelial ingrowth, hence ensuring ease of exchange or removal if required.

No MeSH data available.


Related in: MedlinePlus