V10-03: USEFULNESS OF ENDOUROLOGY IN DIAGNOSIS AND TREATMENT OF URETEROINTESTINAL DIVERSION DISEASES
VideoIntroductions and Objectives
Patients with ureterointestinal diversion after radical cystectomy are susceptible of developing different diseases in that location. Endourological techniques permit diagnosis and treatment of ureterointestinal diversion diseases as lithiasis, tumors and ureterointestinal anastomotic strictures. In these patients, we can also explore and treat upper urinary tract lesions.
In the context of ureterointestinal diversion lithiasis formation is unusual, but it is favored when urine drainage is slowed. Endoscopic examination permits direct visualization of the stones to complement imaging , evaluation of association with other lesions, intracorporeal lithotripsy if necessary and extraction for compositional analysis . In our experience we have noticed that lithiasis formation is more frequent specially around a foreign body such as metal suture used in elaboration of urinary diversion. Ureterointestinal nonmalignant anastomotic stricture is a late complication of difficult solution with conventional endourological techniques. In this cases we can perform endoureterotomy by intraluminal invagination adopting a combined percutaneous antegrade and endoscopic retrograde approach. Endoscopic approach also allows direct visualization and biopsy of suspicious lesions in the ureterointestinal diversion. Tumor recurrence in the urinary diversion is rare, it is more frequent in the anastomotic area and requires an individualized treatment. Endoscopical resection of de lesions is feasible, with the aim of establishing histological diagnosis prior to definitive treatment. In the same procedure we can also access the upper urinary tract in order to search for tumor or suspicious associated urothelial lessions, and it also permits the treatment of nonmalignant diseases such as lithiasis or ureteral strictures.
Endourology permits the diagnosis and tratment of several diseases of ureteroileal diversion with good results and minimal invasion.
In selected patients and with adequate training, endourology may offer a great spectrum of possibilities in diagnosis and treatment of patients with urinary diversion diseases.