Tien jaar ervaring met behandeling van ureteroileale stricturen door endo-urologische antegrade plaatsing van een wallstent

Stenosis of the uretero-ileal anastomosis following Bricker uretero- ileostomy is a late complication that arises in approximately 4-10% of cases. The classical management consists of laparotomy and reimplantation, most of the time leading to significant morbidity, prolonged hospitalization and lengthy recovery periods. Alternatively less invasive endo-urological treatment can be performed. However balloon-dilatation long-term results are disappointing and show great differences in results: 13-61%. Following good results in the biliary tree and vessels, Wallstents were used in urethra and ureter. Between 1989-1999 27 patients were treated for an ureteral-Bricker anastomosis stricture. In 22 patients, 23 Wallstents were placed after balloon-dilatation. With a mean follow up of 57 months (12-120) in 12 out of 22 patients the patency of the Wallstent stayed well without auxiliary measures. In 1 patient the stent fell out and could not be replaced. In the remaining 8 patients with auxiliary measures with a mean follow-up of 54 month (1/2-106 months) patency was established. However world-wide the experience with Wallstents treating ureteral strictures is limited, results are better than balloon-dilatation alone. Main complication is obstruction within the Wallstent, however this can be treated with YAG-laser fulguration.