Videosurgery
Endourological treatment of uretero-enteric benign stricture after radical cystectomy and kidney transplant
Angelo Territo1, Paolo Verri1, Alessandro Uleri1, Pietro Diana1, Andrea Gallioli1, Michael Baboudjian1-4, Josep Maria Gaya1, Francesco Sanguedolce1, Julia Aumatell1, Giuseppe Basile1, Alejandra Bravo1, Joan Palou1, Alberto Breda1
1Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
2Department of Urology, APHM, North Academic Hospital, Marseille, France
3Department of Urology, APHM, La Conception Hospital, Marseille, France
4Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
Citation: Territo A, Verri P, Uleri A, et al. Endourological treatment of uretero-enteric benign stricture after radical cystectomy and kidney transplant. www.ceju.online/journal/2022/endoscopic-ureteral-stricture-ureteroenteric-stricture-cystectomy-2249.php
Key Words: endoscopic • ureteral stricture • uretero-enteric stricture • cystectomy • kidney transplant

Benign ureteral stricture after radical cystectomy is a common post-operative complication. In case this scenario occurs in kidney-transplanted patients, the surgeon needs to face a challenging anatomy and the obligation of nephron preservation. We present a 76 year-old male that underwent open renal transplantation in 2019 and open radical cystectomy with ileal conduit in 2021 for a high-grade pT3N0M0 urothelial tumor. After four months, the patient presented with worsening renal function (glomerular filtration rate 21 mL/min/1.73 m2) and grade III–IV graft hydronephrosis at computed tomography scan. A nephrostomy tube was placed, and anterograde pyelography showed a <1 cm stricture of the distal ureter.

The surgical steps were the following. The patient was placed in supine position. Two Amplatz guidewires were placed through a dual lumen ureteral access catheter (5–10 Fr and a length of 24 cm) after nephrostomy tube removal. After positioning of a ureteral access sheath (10–12 Fr) an antegrade flexible-ureterorenoscopy was performed to reach and identify the stricture. Endoscopic balloon dilation was performed reaching a pressure of 30 atmospheres. After inspection, the stricture was incised with thulium laser (15–20 W) until exposure of periureteral fat. A second dilation was performed to ensure successful treatment. A uni-J ureteral catheter (8 Fr) was left for 1 week. After 30 days, anterograde pyelography (via nephrostomy tube) was carried out demonstrating the stenosis resolution.

In conclusion, the endoscopic treatment of ureter-enteric benign strictures in renal transplant patients after radical cystectomy is feasible and safe with optimal outcomes. Renal function preservation is the ultimate goal in these patients and the endourological approach represents an alternative effective technique.

Article history
Submitted: 22 November, 2022
Accepted: 27 November, 2022
Published online: 9 December, 2022
doi: 10.5173/ceju.2022.238
Corresponding author
Alessandro Uleri
email: alessandrouleri@outlook.it
Conflicts of interest:  The authors declare no conflicts of interest.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/).
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