Endourological management of uretero-ileal anastomosis stricture after cystectomy and Vescica Ileale Padovana (V.I.P.) orthotopic neobladder reconstruction

Abstract

Aim: To report an endourology management of uretero-ileal anastomosis stricture after cystectomy and orthotopic neobladder reconstruction (Vescica Ileale Padovana, VIP). Materials and methods: A nephrostomy was placed to provide a route of access for an anterograde canalization and a secure and working guide placement. These were than taken with a cystoscopy grasp and pulled out through the neobladder. Laser endoureterotomy of the stricture over a stiff working guide wire was than performed. A DJ stent was then placed in order to protect the urinary flow for the first month after surgery. Results: No immediate and late complications occurred during a follow up of 1 year according to the Clavien Dindo classification. The patient continued to be asymptomatic with a renal function stable over the years. Discussion: Endourological management of uretero-ileal anastomosis stricture after cystectomy and orthotopic neobladder (VIP) is safe and reproducible. It may avoid the difficulties and complications of invasive surgery and has durable results.

Keywords

• Ureteric stricture
• Ureteral obstruction
• Neobladder
• Uretero-ileal anastomosis
• Laser
• Laser endoureterotomy