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PP-03

The Wallstent®: 23 years of experience in the treatment of benign ureteroenteric anastomotic strictures after Bricker deviation

Saturday, 29 June, 2013 - 11:05
Board 1

Poster Presenter: T. Locktcampsch@umcutrecht.nl

The Wallstent®: 23 years of experience in the treatment of benign ureteroenteric anastomotic strictures after Bricker deviation

 

Introduction

Stenosis of the uretero-ileal (UI) anastomosis following Bricker deviation is seen in 4-10% of all cases. Many minimal invasive techniques (balloon dilatation, double-J-stenting or laser endoureterotomy, cold and hot knife incision) have been described, but long-term results are disappointing with failure rates up to 80%. Especially in unfit patients (ASA ≥ 2) positioning of a Wallstent® under local anaesthesia is an attractive alternative. We describe our experience with the Wallstent® in benign obstruction and compare results with data available from a literature search.

 

Methods

From 1989, of all patients with benign UI-strictures and end-to-side anastomosis, we retrospectively collected data on clinical history, complications, auxiliary measures and patency rates and compared these with available data from literature.

 

Results

A total of 47 patients underwent 54 Wallstent® procedures (mean age: 63 yrs). Placement of the Wallstent was possible in 100% of the patients and without auxiliary treatment the patency remained well in 14 patients (mean follow-up time 46 months). In 16 patients due to stent obstruction (hyperplastic reaction or encrustation) or migration a second treatment (laser vaporization and/or balloon dilatation) was performed with success. Combined (primary and secondary) patency rates were therefore 58.8% (30/51 Wallstents®, mean follow-up time 55.4 months), comparable with patency rates between 36 and 100% described in literature with a wide variety in number of cases and much shorter follow-up period.

 

Conclusion

To our knowledge this is the longest follow-up and largest series of Wallstent® stenting in benign UI obstructions. We proved that in selected cases, in experienced hands, to preserve quality of life, placement of a Wallstent could lead to a permanent desobstruction in approximately 6 out of 10 patients with UI anastomotic stricture.