No AccessJournal of UrologyAdult urology1 Jul 2007

Application of Self-Expandable Metal Stents for Ureteroileal Anastomotic Strictures: Long-Term Results

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    We report our long-term experience with the management of benign ureteroileal anastomotic strictures using self-expandable metal stents.

    Materials and Methods:

    A total of 16 male and 2 female patients with a mean ± SD age of 72 ± 7 years (range 66 to 78) with benign fibrotic strictures at the site of ureteroileal anastomosis underwent implantation of self-expandable metal stents with a nominal diameter of 6 to 8 mm. A total of 24 ureteroileal conduits were treated. The external nephrostomy tubes were removed after fluoroscopic validation of ureteral patency. Patients were followed with blood biochemistry, ultrasonography, urography and/or virtual endoscopy. Retrograde external-internal catheter insertion through the cutaneous stoma was performed in cases of recalcitrant stricture.


    The technical success rate of ureteroileal stricture crossing and stenting was 100% (24 of 24 cases). Mean followup was 21 months (range 7 to 50). The clinical success rate during the immediate post-stenting period was 70.8% (17 of 24 cases). The 1 and 4-year primary patency rates were 37.8% and 22.7%, respectively. Secondary interventions included repeat balloon dilation in 15 ureters, of which 8 also underwent subsequent coaxial stent placement. The 1 and 4-year secondary patency rates were 64.8% and 56.7%, respectively. Except in 2 patients who died external-internal Double-J® catheters continued to be inserted retrograde in 6 ureteroileal conduits. They are periodically exchanged to prevent mucous inspissation and stent encrustation.


    Metal stents served as the definitive treatment for stricture in more than half of the cases, whereas in the remainder the stents allowed the uncomplicated and regular exchange of Double-J catheters in retrograde fashion. This combined, less invasive treatment for ureteroileal anastomotic strictures may help patients avoid surgical revision and preserve quality of life.


    • 1 : Complications of radical cystectomy and urinary diversion: a retrospective review of 675 cases in 2 decades. J Urol1992; 148: 1401. LinkGoogle Scholar
    • 2 : Complications of ureteroileal conduit with radical cystectomy: review of 336 cases. J Urol1980; 124: 797. LinkGoogle Scholar
    • 3 : Percutaneous incision of stenotic uroenteric anastomoses with a cutting balloon catheter: long-term results. Radiology2000; 214: 358. Google Scholar
    • 4 : Endourological treatment of ureteroenteric anastomotic strictures: long-term followup. J Urol1991; 145: 723. LinkGoogle Scholar
    • 5 : Balloon catheter dilation of ureteroenteric strictures: long-term results. Radiology1988; 168: 385. Google Scholar
    • 6 : Ureteroileal anastomotic strictures: an innovative approach with metallic stents. J Urol1998; 160: 1270. LinkGoogle Scholar
    • 7 : Metallic self-expandable stenting of a ureteroileal stricture. AJR Am J Roentgenol1990; 155: 422. Google Scholar
    • 8 : Percutaneous placement of permanent metal stents for treatment of ureteroenteric anastomotic strictures. J Endourol2004; 18: 677. Google Scholar
    • 9 : Ureteroenteric anastomotic strictures: treatment with Palmaz permanent indwelling stents. J Urol1993; 150: 469. LinkGoogle Scholar
    • 10 : Metallic stents in gynecologic cancer: an approach to treat extrinsic ureteral obstruction. Eur Urol2000; 38: 35. Crossref, MedlineGoogle Scholar
    • 11 : Metal stents: a new treatment of malignant ureteral obstruction. J Urol1997; 158: 54. LinkGoogle Scholar
    • 12 : External-internal nephro-uretero-ileal stents in patients with an ileal conduit: long-term results. Urology2004; 63: 438. Google Scholar
    • 13 : Endourological management of ureteroileal anastomotic strictures: is it effective?. J Urol1987; 137: 390. LinkGoogle Scholar
    • 14 : Long-term results of endoureterotomy for benign ureteral and ureteroenteric strictures. J Urol1997; 158: 759. Google Scholar
    • 15 : A new treatment for urethral strictures. Lancet1988; 1: 1424. Google Scholar
    • 16 : Metallic ureteral stents versus endoureterotomy as a therapeutic approach for experimental ureteral stricture. J Vasc Interv Radiol2005; 16: 521. Google Scholar
    • 17 : Ureteral response to the placement of metallic stents: an animal model. J Urol1994; 151: 268. AbstractGoogle Scholar
    • 18 : Metallic stents for malignant and benign ureteric obstruction. BJU Int2000; 85: 227. Google Scholar
    • 19 : Fluoroscopy guided retrograde ureteral stent insertion in patients with a ureteroileal urinary conduit: method and results. J Urol2002; 167: 2049. LinkGoogle Scholar
    • 20 : Application of paclitaxel-eluting metal mesh stents within the pig ureter: an experimental study. Eur Urol2007; 51: 217. Google Scholar