Treating benign ureteroenteric strictures: 27-year experience comparing endourological techniques with open surgical...

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Ureteroenteric strictures are a complication following urinary diversion procedures.
• Treatment options include open surgical revision and endourological techniques.
• Choosing the optimal treatment requires evaluating efficacy, safety, and patient factors.

Purpose of the Study:

• To compare the efficacy and outcomes of open surgical anastomotic revision versus endourological techniques for treating ureteroenteric strictures.
• To assess patency rates, duration of patency, complication rates, and impact on renal function.

Main Methods:

• Retrospective review of 76 patients with ureteroenteric strictures treated between 1989 and 2016.
• Analysis of 161 procedures: 26 open revisions and 135 endourological treatments (balloon dilation, Wallstent, laser vaporization).
• Median follow-up of 34 months, with 60-month patency rates analyzed.

Main Results:

• Open surgery demonstrated significantly higher patency rates (69% vs. 27%) and longer patency duration (15.5 vs. 5 months) at 60 months (p=0.003 and p=0.014, respectively).
• Endourology was associated with shorter hospital stays (2 vs. 14 days, p<0.001) and lower complication rates, though not statistically significant (p=0.528).
• Mean estimated glomerular filtration rate improved more with open surgery (+17 vs. +8.1, p=0.024).

Conclusions:

• Open surgical revision is superior to endourological treatment for ureteroenteric strictures regarding long-term patency.
• Endourological techniques offer a safe, less invasive alternative for patients unfit for open surgery, potentially delaying or avoiding it.
• Further research may explore patient selection criteria for optimizing outcomes with each approach.