Risk of Uretero-Intestinal Anastomotic Stricture in Orthotopic Bladder Substitution

Summary:

If one accepts that antirefluxive ureteral reimplantation in low pressure intestinal reservoirs is necessary, an important question is which antirefluxeive technique has the lowest stenosis rate? We retrospectively analyzed our data from 106 patients who underwent orthotopic bladder substituion using the techniques according to Hautmann and Studer. 74 patients were operated on with the Hautmann technique. Out of 142 reimplanted renal units, anastomotic stricture occurred in 29 ureters (20.4 %). In 1 further patient obstruction occurred due to local tumor recurrence. 83.3 % of these obstructions arose during the first year following surgery. In 32 patients operated on with a slightly modified Studer technique, 63 ureters were reimplanted, and obstruction occurred only in 2 (3.2%) renal units in 1 patient. It is probable that obstruction in this patient was caused by local tumor recurrence. Thus, it can be concluded that the bladder substitution technique according to Studer greatly diminishes the risk of occurrence of ureterointestinal anastomotic stricture compared to the LeDuc technique in the Hautmann procedure.

Key words:

Bladder substitution - Urinary diversion - Complications - Obstructive nephropathy - Ureterointestinal implantation - Anastomotic stricture