Abstract：
BACKGROUND: Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes.
METHODS: Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student\'s t test for independent groups or Mann-Whitney test. Statistical significance if P<.05.
RESULTS: The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Ureteric reimplantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%).
CONCLUSIONS: Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.
METHODS: Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student\'s t test for independent groups or Mann-Whitney test. Statistical significance if P<.05.
RESULTS: The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Ureteric reimplantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%).
CONCLUSIONS: Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.
摘要：
背景：输尿管回肠吻合术狭窄是根治性膀胱切除术和回肠导管或原位新膀胱形成后的常见并发症。我们根据尿流改道技术和手术方法（开放，腹腔镜或机器人辅助)。描述了严格管理，以及手术结果。
方法：对使用回肠（回肠导管或原位新膀胱）进行尿流改道的患者进行了长达6年的描述性回顾性研究。人口统计数据,合并症,手术方法,并发症,并收集结果。至少随访1年。组间比较对二分变量采用卡方检验。使用Studentt检验或Mann-Whitney检验比较独立组的定量变量。如果P<0.05，则具有统计学意义。
结果：该研究包括182名患者（男性84%，女性16%）。平均年龄68岁。膀胱切除术入路：腹腔镜（67/37%），机器人辅助(63/35%)，开放（43/24%）。尿改道：回肠导管（138/76％）和原位回肠新膀胱（44/24％）。输尿管再植入技术：Bricker（108/59%）和Wallace（47/26%）。输尿管回肠吻合口狭窄（50/27%）：双侧（26），左（16）和右（8）。根据膀胱切除术的狭窄：腹腔镜（23/46％），机器人辅助(16/32%)，开放（9/18%）。狭窄的治疗（33/18%）：输尿管再植（13），留置式肾造瘘术(13),内窥镜扩张术(4),肾输尿管切除术(2),子宫内膜切开术(1)。输尿管回肠再植入路：腹腔镜（5/38％），机器人辅助(6/46%)，开放（2/15%）。再植入后的结果：再狭窄（0/0%），再干预(3/23%)，对侧输尿管回肠狭窄（1/8％）。
结论：膀胱切除术的手术方式不会影响输尿管回肠狭窄的未来发展。腹腔镜和机器人辅助输尿管回肠再植术成功率高。
方法：对使用回肠（回肠导管或原位新膀胱）进行尿流改道的患者进行了长达6年的描述性回顾性研究。人口统计数据,合并症,手术方法,并发症,并收集结果。至少随访1年。组间比较对二分变量采用卡方检验。使用Studentt检验或Mann-Whitney检验比较独立组的定量变量。如果P<0.05，则具有统计学意义。
结果：该研究包括182名患者（男性84%，女性16%）。平均年龄68岁。膀胱切除术入路：腹腔镜（67/37%），机器人辅助(63/35%)，开放（43/24%）。尿改道：回肠导管（138/76％）和原位回肠新膀胱（44/24％）。输尿管再植入技术：Bricker（108/59%）和Wallace（47/26%）。输尿管回肠吻合口狭窄（50/27%）：双侧（26），左（16）和右（8）。根据膀胱切除术的狭窄：腹腔镜（23/46％），机器人辅助(16/32%)，开放（9/18%）。狭窄的治疗（33/18%）：输尿管再植（13），留置式肾造瘘术(13),内窥镜扩张术(4),肾输尿管切除术(2),子宫内膜切开术(1)。输尿管回肠再植入路：腹腔镜（5/38％），机器人辅助(6/46%)，开放（2/15%）。再植入后的结果：再狭窄（0/0%），再干预(3/23%)，对侧输尿管回肠狭窄（1/8％）。
结论：膀胱切除术的手术方式不会影响输尿管回肠狭窄的未来发展。腹腔镜和机器人辅助输尿管回肠再植术成功率高。
