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

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.

Keywords: Anastomosis; Ileum conduit; Memokath; PCNL, percutaneous nephrolithotomy; Stent; Stricture.

Figure 1

Nephrostogram to visualize the position of the stricture marked with a circle.

Figure 2

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.

Figure 3

Both ends of the stent are expanded and a subsequent contrast-medium study using a ureteric catheter confirms the good position of stent.