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Minerva Urology and Nephrology 2021 Jul 26

DOI: 10.23736/S2724-6051.21.04463-3


lingua: Inglese

Contemporary management of benign uretero-enteric strictures after cystectomy: a systematic review

Simone ALBISINNI 1 , Fouad AOUN 2, Georges MJAESS 2, Rawad ABOU ZAHR 3, Romain DIAMAND 3, Francesco PORPIGLIA 4, Francesco ESPERTO 5, Riccardo AUTORINO 6, Cristian FIORI 4, Andrea TUBARO 7, Thierry ROUMEGUÈRE 1, Cosimo DE NUNZIO 7

1 Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; 2 Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beyrouth, Liban; 3 Urology Department, University Clinics of Brussels, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; 4 Department of Urology, Ospedale San Luigi Gonzaga, University of Turin, Orbassano, Turin, Italy; 5 Urology Department, Università Campus Biomedico, Rome, Italy; 6 Division of Urology, VCU Health Center, Richmond, VA, USA; 7 Urology Department, Sant’Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy

INTRODUCTION: Uretero-enteric stricture (UES) is a common post-operative complication after radical cystectomy with urinary diversion. The aim of this systematic review is to discuss the contemporary management of benign UES after cystectomy and to compare the different surgical approaches.
EVIDENCE ACQUISITION: A systematic review was performed from January 2000 through January 2021. Search engines used included PubMed, Embase and Medline databases. Search query was: ((ureteroileal OR uretero-ileal OR ureteroenteric OR ureteroenteric) AND (stricture OR stenosis)) AND (management OR treatment). Study selection followed the PRISMA statement. Studies tackling management of UES, either through open, endoscopic, laparoscopic or robot-assisted approaches, were included in our systematic review.
EVIDENCE SYNTHESIS: Forty-one studies were finally included in this systematic review. No prospective studies were found; all included studies were retrospective. Open surgical repair had a 78-100% success rate, a significant rate of complications, and a low recurrence rate (6-8%). Endourological management decreased complication rate, length-of-stay, and blood loss, with however lower success (15-50%) and higher recurrence rates (62%-91%) compared to open surgery. Robotic assisted surgery showed comparable success rates to open surgery (80-100%), while limiting the number of major complications and hospital length-of-stay.
CONCLUSIONS: Surgical management of UES remains challenging. Open surgery maintains a role given its high success rate, at the cost however of a significant morbidity. On the other hand, endourological procedures offer a favorable and low complication risk, but a low long-term success rate. Robotic-assisted surgery is emerging with a valid resolution of UES as it offers comparable success rates to an open approach, while reducing surgical morbidity. Head-to-head comparisons are awaited to confirm these findings.

KEY WORDS: Cystectomy; Stricture; Management

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