Ileal ureter replacement for patients with long ureteral strictures after Allium stent failure: the initial experience.

PURPOSE: To present the initial experience and clinical outcomes of ileal ureteric replacement (IUR) for complex ureteral stricture after treatment failure of Allium stents.

METHODS

From June 2020 to July 2022, a total of eight patients underwent IUR for complex ureteral strictures after treatment failure of Allium stents across three tertiary centers. Surgical approaches included open (n = 3), laparoscopic (n = 2), and robot-assisted (n = 3). The clinical data and follow-up results were prospectively collected.

RESULTS

A total of eight patients were enrolled, including seven women and one man, with a mean age of 47.8 years. The median dwelling time of Allium stents was 12.5 months. Reasons for Allium stent failure included recurrent urinary tract infection (UTI), stent migration, unrelieved hydronephrosis and stent calculus. The median stricture length was 15 cm. Four patients underwent unilateral IUR and four underwent bilateral IUR, with a median harvested ileal segment length of 25 cm. The median operation time was 261 min and the median estimated blood loss was 75mL. During a median follow-up of 24 months, ureteral patency was achieved in all patients. The mean eGFR was 71.2 ± 34.5 preoperatively and 65.9 ± 23.9 mL/min/1.73m² at the last follow-up (p = 0.394). Two patients in the open surgery group experienced major complications, specifically ileus and incisional hernia. Long-term minor complications included UTI (n = 5) and metabolic acidosis (n = 2).

CONCLUSION

Allium stents should be applied with caution and strict indications. For patients experiencing stent failure, IUR serves as a viable salvage option for managing long and complex ureteral strictures.