The therapeutic analysis of benign uretero-ileal anastomotic stricture after radical cystectomy and urinary diversion.

The therapeutic analysis of benign uretero-ileal anastomotic stricture after radical cystectomy and urinary diversion. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The therapeutic analysis of benign uretero-ileal anastomotic stricture after radical cystectomy and urinary diversion. yixuan mou, Cenchao Yao, Zhenghong Liu, Pu Zhang, Xiaolong Qi, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4190650/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Benign uretero-ileal anastomotic stricture (UIAS) is a potentially serious complication following radical cystectomy (RC) and urinary diversion after RC. In order to preserve residual renal function and enhance prognosis, it is imperative to draw insights from experience and tailor individualized treatment strategies for different patients. Patients and methods: Between October 2014 to June 2021, 47 patients with benign UIAS underwent endoscopic management (n=19) or reimplantation surgery (n=28). The basic data, perioperative conditions and postoperative conditions of the two groups were compared and analyzed to evaluating the efficacy. Results: In the comparison of preoperative and postoperative clinical efficacy of the same group, the endoscopic group exhibited no significant differences in creatinine and blood urea nitrogen (BUN) levels before surgery or after extubation (P>0.05), but BUN and glomerular filtration rate (GFR) levels on the affected side showed significant differences before surgery and after extubation (P0.05). According to the data of postoperative clinical efficacy between the two groups, there was no significant difference in creatinine and BUN levels (P>0.05), but GFR values in the endoscopic treatment group decreased more than those in the laparoscopic reimplantation group (P<0.05). Additionally, the laparoscopic reimplantation group could remove the single J tube earlier than the endoscopic treatment group (P<0.05) with a lower recurrence rate of hydronephrosis after extubation (P<0.05), and hydronephrosis occurred earlier in the endoscopic treatment group (P<0.05). Conclusions: In our experience for the treatment of UIAS after RC combined with urinary diversion, laparoscopic reimplantation can fundamentally solve the problem of UIAS, remove the ureteral stent in a relatively short time after surgery, maintain the patency of the ureter for a long time, truly preserve the residual renal function, reduce the occurrence of ureteral restenosis and hydronephrosis, and demonstrate relatively better therapeutic outcomes in this research. Biological sciences/Cancer/Urological cancer Health sciences/Urology bladder cancer radical cystectomy benign uretero-ileal anastomotic stricture endoscopic treatment robotic and laparoscopic ureteral reimplantation Figures Figure 1 Figure 2 1 Introduction Radical cystectomy (RC) combined with urinary diversion (UD) is considered the gold standard and an effective method for treating high-risk non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) confined to organs. However, the complexity, high complications, and mortality rate associated with the procedure limit its advancement. Postoperative benign uretero-ileal anastomotic stricture (UIAS) is a serious complication, with an incidence ranging from 3–30% [ 1 – 4 ]. UIAS can lead to hydronephrosis, complicated urinary tract infections, stone formation, and renal impairment, significantly impacting prognosis and quality of life [ 5 ]. Various treatment methods for benign UIAS can be categorized into surgery and endoscopic surgery. Surgical approaches include open reimplantation, robot-assisted laparoscopic or conventional laparoscopic ureteral reimplantation. Endoscopic interventions involve balloon dilation or incision, with techniques such as ureteroscopic balloon dilation and endoscopic incision using holmium laser, monopolar instruments, or cold knife being commonly used [ 6 ]. As endoscopic techniques continue to improve, endoscopic management has become a frequently employed minimally invasive treatment modality. The choice between surgical and endoscopic approaches depends on factors such as the severity of the stricture, patient anatomy, and the surgeon's expertise. Each approach has its advantages and considerations, and the selection is often tailored to the specific characteristics of the individual case. Different treatment modalities for benign UIAS after RC combined with UD have been implemented at Zhejiang People's Hospital since October 2014, including endoscopic surgery (balloon dilation or holmium laser incision) and ureteral reimplantation (robotic or conventional laparoscopic). Laparoscopic ureteral reimplantation is known for its guaranteed success rate but is limited by its complexity and potential trauma. On the other hand, endoscopic surgery is considered less invasive and safer, but its ability to maintain long-term ureteral patency and delay the deterioration of renal function requires further research. Given the variety of available treatments, the choice of the optimal treatment modality for benign UIAS has become a significant topic. To contribute more evidence for making informed decisions, the hospital conducted a retrospective analysis of data from patients with benign UIAS after RC with UD, and compared the efficacy of the two approaches after the initial diagnosis. 2 Patients and methods 2.1 Patient Information After Institutional Review Board approval, the medical records of patients who developed benign UIAS after RC combined with UD (Ileal Conduit or orthotopic neobladder) admitted at Zhejiang Provincial People’s Hospital were retrospectively reviewed. All methods were performed in accordance with the relevant guidelines and regulations. From October 2014 to June 2021, a total of 47 patients were identified and divided into two groups: Group A (the endoscopic management group: endoscopic balloon dilation or endoscopic holmium laser incision), Group B (the laparoscopic reimplantation group: robot-assisted laparoscopic ureteral reimplantation or conventional laparoscopic ureteral reimplantation). All patients underwent preoperative biochemical, renal function, imaging examinations. 2.2 Study methods Patient demographics are given in Table 1 . Preoperative radiographic imaging (CT urography, ultrasound, renal ECT, etc.) was performed to verify the diagnosis and identify stricture length and location. Surgical approach (endoscopic management or reimplantation surgery) was dependent on stricture length, and discussion for patient informed consent. The degree of hydronephrosis were collected to analyze whether there were statistical differences between two groups. The hydronephrosis was divided into three degrades according to the imaging examinations: ①Mild hydronephrosis: normal thickness of renal parenchyma, separation of renal collecting system is between 2 to 3cm. ②Moderate hydronephrosis: the separation of renal collecting system is about 3 to 4cm, the pelvis and calyces are dilated, and the renal parenchyma is thinned. ③Severe hydronephrosis: the renal cortex is thinned, and the separation of the renal collecting system is more than 4cm. There were no significant statistical differences in gender, age, BMI, and preoperative creatinine, BUN, GFR, Hb levels between two groups (P>0.05). Preoperative imaging also showed that there was no significant statistical difference in the degree of hydronephrosis between two groups (P>0.05). Overall, 47 patients underwent endoscopic management (n=19) or reimplantation surgery (n=28). Endoscopic management group including endoscopic balloon dilation [7-8] and endoscopic holmium laser incision [9]. Following balloon dilation or initial incision, lumen patency of the stricture segment was assessed by antegrade pyelography and under direct vision. When the ureteroscope passed through the stenotic segment smoothly, single J-tube was inserted along the guidewire, then withdrew the guidewire and ureteroscope, sutured the skin. Postoperatively, the patient was meticulously monitored for bleeding, infection, and other symptoms, and the nephrostomy tube was removed after a CT review. Laparoscopic reimplantation group can be divided into robot-assisted laparoscopic ureteral reimplantation [10] or conventional laparoscopic ureteral reimplantation [11]. Under direct laparoscopy, 12mm, 8mm, 8mm, and 8mm Trocar were placed respectively at the left anterior axillary line flat umbilicus, right anterior axillary line flat umbilicus, left midclavicular line flat umbilicus, and right midclavicular line flat umbilicus under surveillance, as illustrated in Figure 1 . The ureter on the stenotic side was anastomosed to the new segment of the outflow tract with interrupted 4-0 absorbable sutures under tension-free and torsion, and a single-J tube of F6 was employed to drain the ureter. Additionally, a section of the greater omentum was dissected to cover and secure the lower part of the ureter on the stenotic side, ensuring adequate blood supply, as depicted in Figure 2 . Subsequently, the perioperative data including preoperative creatinine value, preoperative urea value, preoperative GFR value of the affected side, intraoperative bleeding, postoperative hospitalization time, postoperative feeding time, and the presence of intraoperative and postoperative blood transfusion were meticulously compiled. 2.3 Data analysis Statistical analyses were performed using SPSS 26.0 software. Continuous variables were analyzed with the Student t test, and the Fisher exact test was used to analyze categorical data with P < 0.05 considered statistically significant. 3 Results 3.1 Perioperative data The perioperative data revealed significant disparities between the two groups in terms of surgical time (P<0.05), intraoperative bleeding volume (P<0.05), postoperative hospital stay (P<0.05) and postoperative feeding time (P<0.05). However, regarding the intraoperative and postoperative blood transfusion, there were 19 cases without transfusion and 0 cases with transfusion in group A, 26 cases without transfusion and 2 cases with transfusion in group B, with no significant statistical difference between the two groups (P>0.05). Detailed data are presented in Table 2 . 3.2 Clinical efficacy analysis 3.2.1 Intra-group comparison Creatinine value, urea value, and GFR are pivotal indicators for evaluating renal function, and the efficacy of the two treatment modalities can be assessed based on preoperative and postoperative indicators. In Group A, there was no statistically significant difference in creatinine and urea values before and after endoscopic treatment (P>0.05), while a statistically significant difference was observed in GFR on the affected side before and after surgery (P<0.05). This indicates that creatinine and urea values did not exhibit a significant decrease after endoscopic treatment, and the GFR on the affected side decreased, suggesting that endoscopic treatment did not substantially enhance renal function after extubation, and the renal function on the affected side continued to decline. In Group B, the postoperative creatinine value, urea value, and GFR of the affected side did not exhibit significant changes after laparoscopic reimplantation treatment (P>0.05), which suggests that laparoscopic reimplantation can enhance renal function and alleviate hydronephrosis to some extent. The lack of a significant decrease in total creatinine and urea biochemical values may be attributed to the fact that the renal function on the affected side did not experience significant damage, and the contralateral side played a compensatory role. 3.3.2 Inter-group comparison Evaluating the clinical efficacy of the two groups before and after extubation, including comparing the extubation time and the recurrence of hydronephrosis after extubation, to select out the most effective treatment method. Postoperative imaging examinations are commonly utilized to determine stenosis or hydronephrosis recurrence after surgery. The comparison of D-values in creatinine and urea did not reveal a statistically significant difference between the two groups (P>0.05). However, the D-value in GFR on the affected side exhibited a statistically significant difference (P<0.05). While there was no significant difference in creatinine and urea values between the two groups, the endoscopic treatment group showed a greater decrease in GFR values compared to the laparoscopic reimplantation group, indicating a continued decline in renal function. Moreover, there was a statistically significant difference in the extraction time of the single-J tube between the two groups (P<0.05). Telephone follow-up and electronic medical records revealed that 4 patients in group A and 2 patients in group B still had the single-J tube in place. The observation of hydronephrosis after extubation and the time of its occurrence showed a statistical difference between the two groups (P<0.05). In summary, while there was no significant difference in creatinine and urea values, the endoscopic treatment group exhibited a greater decline in GFR values, a longer duration of single-J tube retention, and a higher incidence of recurrent hydronephrosis after extubation compared to the laparoscopic reimplantation group. In conclusion, endoscopic treatment provides only temporary relief for hydronephrosis without addressing ureteral stenosis for an extended period. The renal function on the affected side continues to decline, and there is a high incidence of restenosis. On the other hand, laparoscopic reimplantation offers a more effective solution for maintaining ureteral patency, preserving residual renal function, alleviating hydronephrosis, and exhibiting a lower incidence of restenosis. 3 Discussion Complications following RC combined with UD surgery are reported to have an incidence ranging from 25–35% [ 12 ]. Benign UIAS is a common complication with a reported incidence of 2.7–10%, with a median diagnosis time of 7–18 months after surgery [ 13 ]. Patients with benign UIAS may be asymptomatic or exhibit mild symptoms such as obstruction, infection, or stones [ 3 , 14 ]. Diagnosis is often based on changes in renal function. Anastomotic closure can lead to renal hydronephrosis and irreversible decline in renal function without timely treatment [ 15 ]. Wang et al. demonstrated that specific surgical techniques, such as the passage of the left ureter through the sigmoid colon mesentery to obtain sufficient length for anastomosis with the new bladder, may increase the incidence of left UIAS [ 15 ]. Therefore, precise surgical techniques, including attention to details such as ureteral disconnection, degree of ureteral tissue separation, interruption time of ureteral blood supply, and tension of ureteral ileal anastomosis suture, are crucial for reducing the occurrence of benign UIAS. The surgeon's experience and the use of robotic assistance play significant roles in achieving successful outcomes. However, a comparison between robotic reimplantation and laparoscopic reimplantation was not conducted due to the sample size limitations. Minimally invasive surgery [ 16 ] and laparoscopic ureteral reimplantation are currently the mainstream treatment methods for benign UIAS worldwide. Minimally invasive surgery options include cystoscope retrograde intubation, antegrade percutaneous nephroureteroscopy combined with retrograde cystoscope dilatation, and endoscopic holmium laser incision. These methods offer fewer complications and a shorter recovery period compared to open surgery [ 17 ]. However, some scholars argue that the gold standard for benign UIAS is to incise the narrow segment and reimplant the ureter [ 18 ]. Based on our experience, the anatomical structure is often disrupted due to the initial surgery, and resolving tissue and freeing abdominal adhesions constitute a significant portion of the time during secondary surgical treatment. Additionally, locating the anastomosis and narrow segment between the ileal bladder and ureter becomes challenging, resulting in high difficulty and an increased incidence of complications. Therefore, a thorough study and comparison of these two treatment methods are essential. In this study, there was no significant statistical difference between the two groups in terms of gender, average age (70 ± 11 vs 72 ± 10), BMI (22.7 ± 2.6 vs 22.6 ± 2.5), preoperative creatinine value (107 ± 27 vs 114 ± 37), preoperative urea (8.6 ± 2.8 vs 9.1 ± 4.1), preoperative GFR on the affected side (24.1 ± 2.9 vs 24.7 ± 3.3), and degree of hydronephrosis (P > 0.05). This indicates that the baseline data of the two groups are suitable for subsequent research analysis. Based on intraoperative data, there were statistical differences (P < 0.05) between group A and group B in terms of surgical time (96 ± 35 vs 184 ± 39), intraoperative bleeding (17 ± 11 vs 84 ± 41), postoperative hospital stay (5.8 ± 1.8 vs 8.4 ± 3.3), and postoperative feeding time (1.7 ± 0.9 vs 2.9 ± 1.3). Compared with laparoscopic reimplantation, endoscopic treatment has a shorter surgical time and less bleeding volume, better safety, and faster postoperative recovery, making it more easily accepted by patients. According to postoperative data, comparing biochemical test values during postoperative hospitalization may not accurately reflect efficacy. Therefore, we evaluated surgical efficacy through imaging examination, biochemistry, and GFR on the affected side after extubation. The preoperative and postoperative creatinine values, urea values, and GFR values on the affected side of each group were compared. The results showed that there was no significant statistical difference (P > 0.05) for creatinine values (107 ± 27 vs 102 ± 20) and urea values (8.6 ± 2.8 vs 7.9 ± 1.7) in the endoscopic treatment group, while there was statistical significance (P < 0.05) for GFR values on the affected side (24.1 ± 2.9 vs 17.9 ± 3.2). It indicated that patients treated under endoscopy did not show significant improvement in renal function after extubation, and some patients even experienced ureteral restenosis and hydronephrosis, resulting in a continuous decline in renal function. While the creatinine value (114 ± 37 vs 106 ± 28), urea value (9.1 ± 4.1 vs 8.1 ± 3.2), and GFR value (24.7 ± 3.3 vs 24.7 ± 3.3) of the affected side in the laparoscopic reimplantation group showed no significant statistical significance (P > 0.05). It indicated that creatinine value, urea value, and GFR on the affected side did not show any significant changes in the laparoscopic reimplantation group after extubation, and the reason may be that the renal function on the affected side of most patients didn’t significantly decrease. Besides, the contralateral kidney was still intact and played a compensatory function. In conclusion, laparoscopic reimplantation can improve or delay the deterioration of renal function to a certain extent and alleviate hydronephrosis for a long time. Furthermore, for patients with bilateral stenosis, laparoscopic reimplantation can simultaneously treat both sides of stenosis, but endoscopic treatment usually involves surgery on one side and temporary nephrostomy on the other side, requiring secondary surgery. The placement of a single-J tube is crucial for maintaining ureteral patency after surgery, and the patency and maintenance of ureteral function after extubation play an important role in judging the efficacy of different treatment modalities. In this study, the time for extubation (6.5 ± 2.2 vs 4.2 ± 3.8), whether hydronephrosis occurred after extubation, and the time to hydronephrosis after extubation (5.4 ± 2.7 vs 11.8 ± 1.9) showed statistically significant differences (P < 0.05) between the two groups. Compared with endoscopic treatment, the extubation time after laparoscopic reimplantation can be earlier, and the reoccurrence rate of restenosis and hydronephrosis after extubation was lower, even the time of occurrence was relatively late. However, endoscopic treatment only showed short-term therapeutic efficacy and cannot permanently solve the problem of ureteral stenosis. Besides, the renal function of the affected side remained decreasing, and the reoccurrence rate of restenosis was higher. While laparoscopic reimplantation can relatively better solve the problem of stenosis, earlier extubation of the single-J tube, keeping the ureter patent for a long time, preserving the residual kidney function, relieving the hydronephrosis, and reducing the reoccurrence of restenosis. Furthermore, the length of the ureteral stricture is a key factor in deciding the appropriate surgical method. A 1 cm threshold can be considered; ureteral strictures larger than 1 cm are better treated with reimplantation surgery than endoscopic intervention. When the stricture is less than 1 cm, endoscopic treatment is considered more suitable. Daniel et al. demonstrated that the success rate of minimally invasive endoscopic surgery for benign UIAS less than 1 cm can reach 50%, but it only shows a 6% success rate for UIAS greater than 1 cm, while the success rate of reimplantation surgery treatment reached 86% [ 19 ]. The length of ureteral stenosis was not deeply explored in this study due to the limitation of sample size, and the generalization of ureteral length will be a focus of our future research. With the improvement of surgical techniques and methods, the cure rate of minimally invasive endoscopic surgery for benign UIAS has increased but is still lower than that of reimplantation surgery [ 15 ]. While the advantages of minimally invasive endoscopic surgery should not be ignored, as it offers certain benefits, it cannot maintain ureteral patency for an extended period. Robot-assisted laparoscopic/general laparoscopic reimplantation seems to be the better choice for patients with benign UIAS. This study has certain limitations that warrant careful consideration and address in future research. The small sample size underscores the need to enhance statistical power by increasing the number of surgeries and engaging in multi-center collaborative studies to ensure the data's authority and reliability. Moreover, this study only investigated two treatment groups. Future research should explore and evaluate the specific efficacy of four different treatment modalities, including endoscopic balloon dilation, endoscopic holmium laser dissection, robotic-assisted laparoscopic reimplantation, and general laparoscopic reimplantation. Additionally, investigating other treatments for benign UIAS, such as cold knife incision and open surgery, would contribute to a more comprehensive understanding of the subject. 4 Conclusion The management of benign UIAS following RC combined with UD remains a challenging and pivotal area of research in urology globally. Advances in surgical techniques and tools necessitate the exploration of more effective treatment modalities. With the decline of open surgery in favor of laparoscopic procedures and the increasing use of da Vinci robotic surgery, it becomes crucial to compare and analyze the efficacy of laparoscopic reimplantation versus minimally invasive endoscopic surgery for improved therapeutic outcomes. Although endoscopic treatment offers advantages such as shorter operative time, reduced bleeding, faster recovery, and increased safety with lower trauma and economic burden, laparoscopic reimplantation appears to be more effective in addressing benign UIAS. It excels in promptly removing ureteral stents post-surgery, maintaining long-term ureteral patency, preserving residual kidney function, alleviating hydronephrosis, and reducing the likelihood of ureteral restenosis and hydronephrosis, ultimately yielding superior treatment results. Declarations Ethics approval and consent to participate The studies involving human participants were reviewed and approved by Zhejiang Provincial People’s Hospital and the approval number: QT2022425. The patients provided the written informed consent to participate in this study. Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are included in this published article and available from the corresponding author. Competing interests The authors declare no conflict of interest. Funding This project was funded by Zhejiang Medical and Health Science and Technology Project (Grant No. 2024KY702) . Authors’ contributions Yixuan Mou, Cenchao Yao and Zhenghong Liu contributed to writing/editing and data collection or management; Xiaolong Qi, Pu Zhang and Dahong Zhang contributed to suggestions and data proofreading; Shuai Wang and Weiwen Yu gave approval of the final version of this work. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Madersbacher S, Schmidt J, Eberle JM, Thoeny HC, Burkhard F, Hochreiter W, et al. Long-term outcome of ileal conduit diversion. J Urol. 2003;169(3):985-90. Hautmann R E, de Petriconi R C, Volkmer B G. 25 years of experience with 1,000 neobladders: long-term complications. J Urol. 2011;185(6):2207-2212. Shimko MS, Tollefson MK, Umbreit EC, Farmer SA, Blute ML, Frank I. Long-term complications of conduit urinary diversion. J Urol. 2011;185(2):562-7. Katkoori D, Samavedi S, Adiyat KT, Soloway MS, Manoharan M. Is the incidence of uretero-intestinal anastomotic stricture increased in patients undergoing radical cystectomy with previous pelvic radiation? BJU Int. 2010;105(6):795-8. d Studer UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A, et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute--lessons to be learned. J Urol. 2006;176(1):161-6. 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Case characteristics Overall Group 1 N=19(%) Group 2 N=28(%) P value Sex： 0.947 # M 16(84.2) 25(89.3) F 3(15.8) 3(10.7) Mean age（X±S years） 70±11 72±10 0.486 BMI（X±S kg/m 2 ） Side affected Left Right Bilateral Narrow length（cm）： ≤1 ＞1 Urinary diversion： Bricker In situ 22.7±2.6 8(42.1) 8(42.1) 3(15.8) 15 4 12 7 22.6±2.5 14(50.0) 10(35.7) 4(14.3) 16 12 17 11 0.985 Creatinine（X±Sμmol/L） 107±27 114±37 0.475 Urea（X±S mmol/L） 8.6±2.8 9.1±4.1 0.632 Affected side GFR（X±S ml/min） 24.1±2.9 24.7±3.3 0.544 Hb (X±S g/ml) 117±20 118±18 0.855 Degree of hydronephrosis 0.888 * Mild 15(78.9) 19(67.9) Moderate 3(15.8) 5(17.9) Severe 1(5.3) 3(10.8) Table 2. Clinical efficacy comparison Group 1 N=19(%) Group 2 N=28 P v alue Operative time（X±S mins） 96±35 184±39 0.000 Bleeding volume（X±S ml） 17±11 84±41 0.000 Postoperative hospitalization（X±S days） 5.8±1.8 8.4±3.3 0.004 Postoperative feeding time（X±S days） 1.7±0.9 2.9±1.3 0.001 Perioperative blood transfusion 0.650 # No blood transfusion 19(100) 26(92.9) Blood transfusion Preoperative Creatinine（X±Sμmol/L） Urea（X±S mmol/L） Affected side GFR（X±S ml/min） Postoperative Creatinine（X±Sμmol/L） Urea（X±S mmol/L） Affected side GFR（X±S ml/min） Extraction time of ureteral stent (mouths) Ureteral stent in place Hydronephrosis after extubation Yes No Time of hydronephrosis after extubation (months) 0 107±27 8.6±2.8 24.1±2.9 102±20 7.9±1.7 17.9±3.2 6.5±2.2 4 7 12 5.4±2.7 2(7.1) 114±37 9.1±4.1 24.7±3.3 106±28 8.1±3.2 24.2±3.5 4.2±3.8 2 21 7 11.8±1.9 0.105 0.070 0.000 0.118 0.108 0.107 0.043 0.009 # 0.000 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4190650","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":292048012,"identity":"c0def811-dea5-4ff5-b96e-43cf99d2a7d5","order_by":0,"name":"yixuan mou","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"yixuan","middleName":"","lastName":"mou","suffix":""},{"id":292048014,"identity":"5d937c44-48ae-4269-ad18-645b044e2bcb","order_by":1,"name":"Cenchao Yao","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cenchao","middleName":"","lastName":"Yao","suffix":""},{"id":292048016,"identity":"432e0760-a877-4d52-b242-b0f3b75b0fbb","order_by":2,"name":"Zhenghong Liu","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhenghong","middleName":"","lastName":"Liu","suffix":""},{"id":292048020,"identity":"083eb836-f5d2-4af2-9bf8-be4a183e5110","order_by":3,"name":"Pu Zhang","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pu","middleName":"","lastName":"Zhang","suffix":""},{"id":292048023,"identity":"ecaaad5c-bfe1-43f9-9a8d-79ce2df5f688","order_by":4,"name":"Xiaolong Qi","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaolong","middleName":"","lastName":"Qi","suffix":""},{"id":292048024,"identity":"5d9ba8e9-435f-430e-aed4-d2eb6e20104f","order_by":5,"name":"Dahong Zhang","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dahong","middleName":"","lastName":"Zhang","suffix":""},{"id":292048025,"identity":"074d982f-9aef-4039-9004-fe9962dffb92","order_by":6,"name":"Yiyang Chen","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yiyang","middleName":"","lastName":"Chen","suffix":""},{"id":292048026,"identity":"563482fe-9d02-41c7-b23a-8951bb73f30d","order_by":7,"name":"Weiwen Yu","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Weiwen","middleName":"","lastName":"Yu","suffix":""},{"id":292048027,"identity":"fbb0fef1-d9e6-40f9-9c6b-a9c9dd93bf92","order_by":8,"name":"Shuai Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtElEQVRIiWNgGAWjYHAC5gcfKmzs+EnRwmY440xasmQDKXqkOdsOMW44QKxyeffmA8aMbQeYjY8nb2D4UbGNsBbDM8cSHhecu8NnduZZAWPPmdtEaJmRY2A8o+wZs9mNHANmxjZitMx/YyDNw3aYcfMMYrXIS/AAtbQdZtwgQawWA560NHAgSwD9cpAov8i3Hz4Micr25I0PflQQY8sBODMBiY3XlgYkLUTpGAWjYBSMgpEHAN+CQPyXhoo3AAAAAElFTkSuQmCC","orcid":"","institution":"Zhejiang Provincial People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Shuai","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-03-30 05:15:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4190650/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4190650/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55003293,"identity":"79179f7a-072a-470d-92d6-9d7e9dff4e0a","added_by":"auto","created_at":"2024-04-19 18:42:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":43375,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePort placement of robot-assistedLaparoscopic ureteral replantation\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4190650/v1/b8f3379fc3db32c1fdfad214.png"},{"id":55003294,"identity":"7975aa7d-084b-490a-b927-317b5b2b537e","added_by":"auto","created_at":"2024-04-19 18:42:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1886475,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRobot-assisted Laparoscopic ureteral replantation.\u003c/strong\u003e Separated the ureter carefully to the outflow intestinal segment, the lower ureteral wall was seen to be stiff and luminal narrowed (A-B); A single-J tube was placed between the ureteral stenotic side and the new segment of the outflow tract (C); Dissociated a portion of the greater omentum (D)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4190650/v1/622bb501962fa5e4ee782b74.png"},{"id":59265941,"identity":"e7682ea9-0f96-45c7-a428-dedd16d8adf8","added_by":"auto","created_at":"2024-06-28 11:08:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3676594,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4190650/v1/93338c65-c9bc-48e5-8f82-c14c2184c6ed.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The therapeutic analysis of benign uretero-ileal anastomotic stricture after radical cystectomy and urinary diversion.","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eRadical cystectomy (RC) combined with urinary diversion (UD) is considered the gold standard and an effective method for treating high-risk non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) confined to organs. However, the complexity, high complications, and mortality rate associated with the procedure limit its advancement. Postoperative benign uretero-ileal anastomotic stricture (UIAS) is a serious complication, with an incidence ranging from 3\u0026ndash;30% [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. UIAS can lead to hydronephrosis, complicated urinary tract infections, stone formation, and renal impairment, significantly impacting prognosis and quality of life [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVarious treatment methods for benign UIAS can be categorized into surgery and endoscopic surgery. Surgical approaches include open reimplantation, robot-assisted laparoscopic or conventional laparoscopic ureteral reimplantation. Endoscopic interventions involve balloon dilation or incision, with techniques such as ureteroscopic balloon dilation and endoscopic incision using holmium laser, monopolar instruments, or cold knife being commonly used [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. As endoscopic techniques continue to improve, endoscopic management has become a frequently employed minimally invasive treatment modality. The choice between surgical and endoscopic approaches depends on factors such as the severity of the stricture, patient anatomy, and the surgeon's expertise. Each approach has its advantages and considerations, and the selection is often tailored to the specific characteristics of the individual case.\u003c/p\u003e \u003cp\u003eDifferent treatment modalities for benign UIAS after RC combined with UD have been implemented at Zhejiang People's Hospital since October 2014, including endoscopic surgery (balloon dilation or holmium laser incision) and ureteral reimplantation (robotic or conventional laparoscopic). Laparoscopic ureteral reimplantation is known for its guaranteed success rate but is limited by its complexity and potential trauma. On the other hand, endoscopic surgery is considered less invasive and safer, but its ability to maintain long-term ureteral patency and delay the deterioration of renal function requires further research. Given the variety of available treatments, the choice of the optimal treatment modality for benign UIAS has become a significant topic. To contribute more evidence for making informed decisions, the hospital conducted a retrospective analysis of data from patients with benign UIAS after RC with UD, and compared the efficacy of the two approaches after the initial diagnosis.\u003c/p\u003e"},{"header":"2 Patients and methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Patient Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter Institutional Review Board approval, the medical records of patients who developed benign UIAS after RC combined with UD (Ileal Conduit or orthotopic neobladder) admitted at Zhejiang Provincial People’s Hospital were retrospectively reviewed. All methods were performed in accordance with the relevant guidelines and regulations. From October 2014 to June 2021, a total of 47 patients were identified and divided into two groups: Group A (the endoscopic management group: endoscopic balloon dilation or endoscopic holmium laser incision), Group B (the laparoscopic reimplantation group: robot-assisted laparoscopic ureteral reimplantation or conventional laparoscopic ureteral reimplantation). All patients underwent preoperative biochemical, renal function, imaging examinations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Study methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient demographics are given in \u003cstrong\u003eTable 1\u003c/strong\u003e. Preoperative radiographic imaging (CT urography, ultrasound, renal ECT, etc.) was performed to verify the diagnosis and identify stricture length and location. Surgical approach (endoscopic management or reimplantation surgery) was dependent on stricture length, and discussion for patient informed consent. The degree of hydronephrosis were collected to analyze whether there were statistical differences between two groups. The hydronephrosis was divided into three degrades according to the imaging examinations:\u0026nbsp;①Mild hydronephrosis: normal thickness of renal parenchyma, separation of renal collecting system is between 2 to 3cm.\u0026nbsp;②Moderate hydronephrosis: the separation of renal collecting system is about 3 to 4cm, the pelvis and calyces are dilated, and the renal parenchyma is thinned.\u0026nbsp;③Severe hydronephrosis: the renal cortex is thinned, and the separation of the renal collecting system is more than 4cm. There were no significant statistical differences in gender, age, BMI, and preoperative creatinine, BUN, GFR, Hb levels between two groups (P\u0026gt;0.05). Preoperative imaging also showed that there was no significant statistical difference in the degree of hydronephrosis between two groups (P\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eOverall, 47 patients underwent endoscopic management (n=19) or reimplantation surgery (n=28). Endoscopic management group including endoscopic balloon dilation [7-8] and endoscopic holmium laser incision [9]. Following balloon dilation or initial incision, lumen patency of the stricture segment was assessed by antegrade pyelography and under direct vision. When the ureteroscope passed through the stenotic segment smoothly, single J-tube was inserted along the guidewire, then withdrew the guidewire and ureteroscope, sutured the skin. Postoperatively, the patient was meticulously monitored for bleeding, infection, and other symptoms, and the nephrostomy tube was removed after a CT review. Laparoscopic reimplantation group can be divided into robot-assisted laparoscopic ureteral reimplantation [10] or conventional laparoscopic ureteral reimplantation [11].\u0026nbsp;Under direct laparoscopy, 12mm, 8mm, 8mm, and 8mm Trocar were placed respectively at the left anterior axillary line flat umbilicus, right anterior axillary line flat umbilicus, left midclavicular line flat umbilicus, and right midclavicular line flat umbilicus under surveillance, as illustrated in \u003cstrong\u003eFigure 1\u003c/strong\u003e. The ureter on the stenotic side was anastomosed to the new segment of the outflow tract with interrupted 4-0 absorbable sutures under tension-free and torsion, and a single-J tube of F6 was employed to drain the ureter. Additionally, a section of the greater omentum was dissected to cover and secure the lower part of the ureter on the stenotic side, ensuring adequate blood supply, as depicted in\u003cstrong\u003e\u0026nbsp;Figure 2\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eSubsequently, the perioperative data including preoperative creatinine value, preoperative urea value, preoperative GFR value of the affected side, intraoperative bleeding, postoperative hospitalization time, postoperative feeding time, and the presence of intraoperative and postoperative blood transfusion were meticulously compiled.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Data analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using SPSS 26.0 software. Continuous variables were analyzed with the Student t test, and the Fisher exact test was used to analyze categorical data with P \u0026lt; 0.05 considered statistically significant.\u003c/p\u003e"},{"header":"3 Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Perioperative data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe perioperative data revealed significant disparities between the two groups in terms of surgical time (P\u0026lt;0.05), intraoperative bleeding volume (P\u0026lt;0.05), postoperative hospital stay (P\u0026lt;0.05) and postoperative feeding time (P\u0026lt;0.05). However, regarding the intraoperative and postoperative blood transfusion, there were 19 cases without transfusion and 0 cases with transfusion in group A, 26 cases without transfusion and 2 cases with transfusion in group B, with no significant statistical difference between the two groups (P\u0026gt;0.05). Detailed data are presented in \u003cstrong\u003eTable 2\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Clinical efficacy analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.1 Intra-group comparison\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCreatinine value, urea value, and GFR are pivotal indicators for evaluating renal function, and the efficacy of the two treatment modalities can be assessed based on preoperative and postoperative indicators.\u003c/p\u003e\n\u003cp\u003eIn Group A, there was no statistically significant difference in creatinine and urea values before and after endoscopic treatment (P\u0026gt;0.05), while a statistically significant difference was observed in GFR on the affected side before and after surgery (P\u0026lt;0.05). This indicates that creatinine and urea values did not exhibit a significant decrease after endoscopic treatment, and the GFR on the affected side decreased, suggesting that endoscopic treatment did not substantially enhance renal function after extubation, and the renal function on the affected side continued to decline.\u003c/p\u003e\n\u003cp\u003eIn Group B, the postoperative creatinine value, urea value, and GFR of the affected side did not exhibit significant changes after laparoscopic reimplantation treatment (P\u0026gt;0.05), which suggests that laparoscopic reimplantation can enhance renal function and alleviate hydronephrosis to some extent. The lack of a significant decrease in total creatinine and urea biochemical values may be attributed to the fact that the renal function on the affected side did not experience significant damage, and the contralateral side played a compensatory role.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3.2 Inter-group comparison\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEvaluating the clinical efficacy of the two groups before and after extubation, including comparing the extubation time and the recurrence of hydronephrosis after extubation, to select out the most effective treatment method. Postoperative imaging examinations are commonly utilized to determine stenosis or hydronephrosis recurrence after surgery. The comparison of D-values in creatinine and urea did not reveal a statistically significant difference between the two groups (P\u0026gt;0.05). However, the D-value in GFR on the affected side exhibited a statistically significant difference (P\u0026lt;0.05). While there was no significant difference in creatinine and urea values between the two groups, the endoscopic treatment group showed a greater decrease in GFR values compared to the laparoscopic reimplantation group, indicating a continued decline in renal function. Moreover, there was a statistically significant difference in the extraction time of the single-J tube between the two groups (P\u0026lt;0.05). Telephone follow-up and electronic medical records revealed that 4 patients in group A and 2 patients in group B still had the single-J tube in place. The observation of hydronephrosis after extubation and the time of its occurrence showed a statistical difference between the two groups (P\u0026lt;0.05). In summary, while there was no significant difference in creatinine and urea values, the endoscopic treatment group exhibited a greater decline in GFR values, a longer duration of single-J tube retention, and a higher incidence of recurrent hydronephrosis after extubation compared to the laparoscopic reimplantation group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn conclusion, endoscopic treatment provides only temporary relief for hydronephrosis without addressing ureteral stenosis for an extended period. The renal function on the affected side continues to decline, and there is a high incidence of restenosis. On the other hand, laparoscopic reimplantation offers a more effective solution for maintaining ureteral patency, preserving residual renal function, alleviating hydronephrosis, and exhibiting a lower incidence of restenosis.\u003c/p\u003e"},{"header":"3 Discussion","content":"\u003cp\u003eComplications following RC combined with UD surgery are reported to have an incidence ranging from 25\u0026ndash;35% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Benign UIAS is a common complication with a reported incidence of 2.7\u0026ndash;10%, with a median diagnosis time of 7\u0026ndash;18 months after surgery [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Patients with benign UIAS may be asymptomatic or exhibit mild symptoms such as obstruction, infection, or stones [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Diagnosis is often based on changes in renal function. Anastomotic closure can lead to renal hydronephrosis and irreversible decline in renal function without timely treatment [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Wang et al. demonstrated that specific surgical techniques, such as the passage of the left ureter through the sigmoid colon mesentery to obtain sufficient length for anastomosis with the new bladder, may increase the incidence of left UIAS [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Therefore, precise surgical techniques, including attention to details such as ureteral disconnection, degree of ureteral tissue separation, interruption time of ureteral blood supply, and tension of ureteral ileal anastomosis suture, are crucial for reducing the occurrence of benign UIAS. The surgeon's experience and the use of robotic assistance play significant roles in achieving successful outcomes. However, a comparison between robotic reimplantation and laparoscopic reimplantation was not conducted due to the sample size limitations.\u003c/p\u003e \u003cp\u003eMinimally invasive surgery [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and laparoscopic ureteral reimplantation are currently the mainstream treatment methods for benign UIAS worldwide. Minimally invasive surgery options include cystoscope retrograde intubation, antegrade percutaneous nephroureteroscopy combined with retrograde cystoscope dilatation, and endoscopic holmium laser incision. These methods offer fewer complications and a shorter recovery period compared to open surgery [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, some scholars argue that the gold standard for benign UIAS is to incise the narrow segment and reimplant the ureter [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Based on our experience, the anatomical structure is often disrupted due to the initial surgery, and resolving tissue and freeing abdominal adhesions constitute a significant portion of the time during secondary surgical treatment. Additionally, locating the anastomosis and narrow segment between the ileal bladder and ureter becomes challenging, resulting in high difficulty and an increased incidence of complications. Therefore, a thorough study and comparison of these two treatment methods are essential.\u003c/p\u003e \u003cp\u003eIn this study, there was no significant statistical difference between the two groups in terms of gender, average age (70\u0026thinsp;\u0026plusmn;\u0026thinsp;11 vs 72\u0026thinsp;\u0026plusmn;\u0026thinsp;10), BMI (22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6 vs 22.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5), preoperative creatinine value (107\u0026thinsp;\u0026plusmn;\u0026thinsp;27 vs 114\u0026thinsp;\u0026plusmn;\u0026thinsp;37), preoperative urea (8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8 vs 9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1), preoperative GFR on the affected side (24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 vs 24.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3), and degree of hydronephrosis (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This indicates that the baseline data of the two groups are suitable for subsequent research analysis.\u003c/p\u003e \u003cp\u003eBased on intraoperative data, there were statistical differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between group A and group B in terms of surgical time (96\u0026thinsp;\u0026plusmn;\u0026thinsp;35 vs 184\u0026thinsp;\u0026plusmn;\u0026thinsp;39), intraoperative bleeding (17\u0026thinsp;\u0026plusmn;\u0026thinsp;11 vs 84\u0026thinsp;\u0026plusmn;\u0026thinsp;41), postoperative hospital stay (5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 vs 8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3), and postoperative feeding time (1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 vs 2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3). Compared with laparoscopic reimplantation, endoscopic treatment has a shorter surgical time and less bleeding volume, better safety, and faster postoperative recovery, making it more easily accepted by patients.\u003c/p\u003e \u003cp\u003eAccording to postoperative data, comparing biochemical test values during postoperative hospitalization may not accurately reflect efficacy. Therefore, we evaluated surgical efficacy through imaging examination, biochemistry, and GFR on the affected side after extubation. The preoperative and postoperative creatinine values, urea values, and GFR values on the affected side of each group were compared. The results showed that there was no significant statistical difference (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) for creatinine values (107\u0026thinsp;\u0026plusmn;\u0026thinsp;27 vs 102\u0026thinsp;\u0026plusmn;\u0026thinsp;20) and urea values (8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8 vs 7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7) in the endoscopic treatment group, while there was statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) for GFR values on the affected side (24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 vs 17.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2). It indicated that patients treated under endoscopy did not show significant improvement in renal function after extubation, and some patients even experienced ureteral restenosis and hydronephrosis, resulting in a continuous decline in renal function.\u003c/p\u003e \u003cp\u003eWhile the creatinine value (114\u0026thinsp;\u0026plusmn;\u0026thinsp;37 vs 106\u0026thinsp;\u0026plusmn;\u0026thinsp;28), urea value (9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1 vs 8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2), and GFR value (24.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 vs 24.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3) of the affected side in the laparoscopic reimplantation group showed no significant statistical significance (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). It indicated that creatinine value, urea value, and GFR on the affected side did not show any significant changes in the laparoscopic reimplantation group after extubation, and the reason may be that the renal function on the affected side of most patients didn\u0026rsquo;t significantly decrease. Besides, the contralateral kidney was still intact and played a compensatory function. In conclusion, laparoscopic reimplantation can improve or delay the deterioration of renal function to a certain extent and alleviate hydronephrosis for a long time. Furthermore, for patients with bilateral stenosis, laparoscopic reimplantation can simultaneously treat both sides of stenosis, but endoscopic treatment usually involves surgery on one side and temporary nephrostomy on the other side, requiring secondary surgery.\u003c/p\u003e \u003cp\u003eThe placement of a single-J tube is crucial for maintaining ureteral patency after surgery, and the patency and maintenance of ureteral function after extubation play an important role in judging the efficacy of different treatment modalities. In this study, the time for extubation (6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 vs 4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8), whether hydronephrosis occurred after extubation, and the time to hydronephrosis after extubation (5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7 vs 11.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9) showed statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between the two groups. Compared with endoscopic treatment, the extubation time after laparoscopic reimplantation can be earlier, and the reoccurrence rate of restenosis and hydronephrosis after extubation was lower, even the time of occurrence was relatively late. However, endoscopic treatment only showed short-term therapeutic efficacy and cannot permanently solve the problem of ureteral stenosis. Besides, the renal function of the affected side remained decreasing, and the reoccurrence rate of restenosis was higher. While laparoscopic reimplantation can relatively better solve the problem of stenosis, earlier extubation of the single-J tube, keeping the ureter patent for a long time, preserving the residual kidney function, relieving the hydronephrosis, and reducing the reoccurrence of restenosis.\u003c/p\u003e \u003cp\u003eFurthermore, the length of the ureteral stricture is a key factor in deciding the appropriate surgical method. A 1 cm threshold can be considered; ureteral strictures larger than 1 cm are better treated with reimplantation surgery than endoscopic intervention. When the stricture is less than 1 cm, endoscopic treatment is considered more suitable. Daniel et al. demonstrated that the success rate of minimally invasive endoscopic surgery for benign UIAS less than 1 cm can reach 50%, but it only shows a 6% success rate for UIAS greater than 1 cm, while the success rate of reimplantation surgery treatment reached 86% [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The length of ureteral stenosis was not deeply explored in this study due to the limitation of sample size, and the generalization of ureteral length will be a focus of our future research.\u003c/p\u003e \u003cp\u003eWith the improvement of surgical techniques and methods, the cure rate of minimally invasive endoscopic surgery for benign UIAS has increased but is still lower than that of reimplantation surgery [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. While the advantages of minimally invasive endoscopic surgery should not be ignored, as it offers certain benefits, it cannot maintain ureteral patency for an extended period. Robot-assisted laparoscopic/general laparoscopic reimplantation seems to be the better choice for patients with benign UIAS.\u003c/p\u003e \u003cp\u003eThis study has certain limitations that warrant careful consideration and address in future research. The small sample size underscores the need to enhance statistical power by increasing the number of surgeries and engaging in multi-center collaborative studies to ensure the data's authority and reliability. Moreover, this study only investigated two treatment groups. Future research should explore and evaluate the specific efficacy of four different treatment modalities, including endoscopic balloon dilation, endoscopic holmium laser dissection, robotic-assisted laparoscopic reimplantation, and general laparoscopic reimplantation. Additionally, investigating other treatments for benign UIAS, such as cold knife incision and open surgery, would contribute to a more comprehensive understanding of the subject.\u003c/p\u003e"},{"header":"4 Conclusion","content":"\u003cp\u003eThe management of benign UIAS following RC combined with UD remains a challenging and pivotal area of research in urology globally. Advances in surgical techniques and tools necessitate the exploration of more effective treatment modalities. With the decline of open surgery in favor of laparoscopic procedures and the increasing use of da Vinci robotic surgery, it becomes crucial to compare and analyze the efficacy of laparoscopic reimplantation versus minimally invasive endoscopic surgery for improved therapeutic outcomes. Although endoscopic treatment offers advantages such as shorter operative time, reduced bleeding, faster recovery, and increased safety with lower trauma and economic burden, laparoscopic reimplantation appears to be more effective in addressing benign UIAS. It excels in promptly removing ureteral stents post-surgery, maintaining long-term ureteral patency, preserving residual kidney function, alleviating hydronephrosis, and reducing the likelihood of ureteral restenosis and hydronephrosis, ultimately yielding superior treatment results.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003eThe studies involving human participants were reviewed and approved by Zhejiang Provincial People\u0026rsquo;s Hospital and the approval number: QT2022425. The patients provided the written informed consent to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003eAll data generated or analyzed during this study are included in this published article and available from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e This project was funded by Zhejiang Medical and Health Science and Technology Project (Grant No. 2024KY702) .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e Yixuan Mou, Cenchao Yao and Zhenghong Liu contributed to writing/editing and data collection or management; Xiaolong Qi, Pu Zhang and Dahong Zhang contributed to suggestions and data proofreading; Shuai Wang and Weiwen Yu gave approval of the final version of this work. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMadersbacher S, Schmidt J, Eberle JM, Thoeny HC, Burkhard F, Hochreiter W, et al. Long-term outcome of ileal conduit diversion. J Urol. 2003;169(3):985-90.\u003c/li\u003e\n \u003cli\u003eHautmann R E, de Petriconi R C, Volkmer B G. 25 years of experience with 1,000 neobladders: long-term complications. J Urol. 2011;185(6):2207-2212.\u003c/li\u003e\n \u003cli\u003eShimko MS, Tollefson MK, Umbreit EC, Farmer SA, Blute ML, Frank I. Long-term complications of conduit urinary diversion. J Urol. 2011;185(2):562-7.\u003c/li\u003e\n \u003cli\u003eKatkoori D, Samavedi S, Adiyat KT, Soloway MS, Manoharan M. Is the incidence of uretero-intestinal anastomotic stricture increased in patients undergoing radical cystectomy with previous pelvic radiation? BJU Int. 2010;105(6):795-8. d\u003c/li\u003e\n \u003cli\u003eStuder UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A, et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute--lessons to be learned. J Urol. 2006;176(1):161-6.\u003c/li\u003e\n \u003cli\u003eLovaco Castellano F, Fern\u0026aacute;ndez Gonz\u0026aacute;lez I, Rodr\u0026iacute;guez Rodr\u0026iacute;guez R, Fern\u0026aacute;ndez Fern\u0026aacute;ndez E, Escudero Barrilero A, Rodr\u0026iacute;guez Luna JM, et al. [Intraluminal invagination technic for the incision of ureterointestinal stenosis]. Arch Esp Urol. 1995;48(5):541-8. Spanish.\u003c/li\u003e\n \u003cli\u003eGao X, Chen J, Wang W, Peng L, Di X, Xiao K, et al. Step-by-step technique for the endoscopic treatment of ureteric stricture. BJU Int. 2021;128(6):692-696.\u003c/li\u003e\n \u003cli\u003eHu W, Su B, Xiao B, Zhang X, Chen S, Tang Y, et al. Simultaneous antegrade and retrograde endoscopic treatment of non-malignant ureterointestinal anastomotic strictures following urinary diversion. BMC Urol. 2017;17(1):61.\u003c/li\u003e\n \u003cli\u003eHan PK, Rohan M, Mohd Adam B. The short-term outcome of laser endoureterotomy for ureteric stricture. Med J Malaysia. 2013;68(3):222-6.\u003c/li\u003e\n \u003cli\u003eDeng T, Liu B, Luo L, Duan X, Cai C, Zhao Z, et al. Robot-assisted laparoscopic versus open ureteral reimplantation for pediatric vesicoureteral reflux: a systematic review and meta-analysis. World J Urol. 2018;36(5):819-828.\u003c/li\u003e\n \u003cli\u003eSoares RS, de Abreu RA Jr, Tavora JE. Laparoscopic ureteral reimplant for ureteral stricture. Int Braz J Urol. 2010;36(1):38-43.\u003c/li\u003e\n \u003cli\u003eDe Sutter T, Akand M, Albersen M, Everaerts W, Van Cleynenbreugel B, De Ridder D, et al. The N-shaped orthotopic ileal neobladder: functional outcomes and complication rates in 119 patients. Springerplus. 2016;5:646.\u003c/li\u003e\n \u003cli\u003eShah SH, Movassaghi K, Skinner D, Dalag L, Miranda G, Cai J, et al. Ureteroenteric Strictures After Open Radical Cystectomy and Urinary Diversion: The University of Southern California Experience. Urology. 2015;86(1):87-91.\u003c/li\u003e\n \u003cli\u003eKouba E, Sands M, Lentz A, Wallen E, Pruthi RS. A comparison of the Bricker versus Wallace ureteroileal anastomosis in patients undergoing urinary diversion for bladder cancer. J Urol. 2007;178(3 Pt 1):945-8; discussion 948-9.\u003c/li\u003e\n \u003cli\u003eWang Q L, Yang S X, Wu T P, Qian HJ, Zhang XB, Cheng F. Micro-invasive treatment of ureteral obstruction after the ileal conduit urinary diversion. Journal of Clinical Urology, 2013;28(01):32-34. Chinese\u003c/li\u003e\n \u003cli\u003eAhmed YE, Hussein AA, May PR, Ahmad B, Ali T, Durrani A, et al. Natural History, Predictors and Management of Ureteroenteric Strictures after Robot Assisted Radical Cystectomy. J Urol. 2017;198(3):567-574.\u003c/li\u003e\n \u003cli\u003eHu W, Su B, Xiao B, Zhang X, Chen S, Tang Y, et al. Simultaneous antegrade and retrograde endoscopic treatment of non-malignant ureterointestinal anastomotic strictures following urinary diversion. BMC Urol. 2017;17(1):61.\u003c/li\u003e\n \u003cli\u003eLobo N, Dupr\u0026eacute; S, Sahai A, Thurairaja R, Khan MS. Getting out of a tight spot: an overview of ureteroenteric anastomotic strictures. Nat Rev Urol. 2016;13(8):447-55.\u003c/li\u003e\n \u003cli\u003eSch\u0026ouml;ndorf D, Meierhans-Ruf S, Kiss B, Giannarini G, Thalmann GN, Studer UE, et al. Ureteroileal strictures after urinary diversion with an ileal segment-is there a place for endourological treatment at all? J Urol. 2013;190(2):585-90.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Case characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"bottom\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003eGroup 1\u003c/p\u003e\n \u003cp\u003eN=19(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003eGroup 2\u003c/p\u003e\n \u003cp\u003eN=28(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eSex：\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.947\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e16(84.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e25(89.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e3(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e3(10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eMean age（X\u0026plusmn;S years）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e70\u0026plusmn;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e72\u0026plusmn;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.486\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eBMI（X\u0026plusmn;S kg/m\u003csup\u003e2\u003c/sup\u003e）\u003c/p\u003e\n \u003cp\u003eSide affected\u003c/p\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003cp\u003eNarrow length（cm）：\u003c/p\u003e\n \u003cp\u003e\u0026le;1\u003c/p\u003e\n \u003cp\u003e＞1\u003c/p\u003e\n \u003cp\u003eUrinary diversion：\u003c/p\u003e\n \u003cp\u003eBricker\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; In situ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e22.7\u0026plusmn;2.6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8(42.1)\u003c/p\u003e\n \u003cp\u003e8(42.1)\u003c/p\u003e\n \u003cp\u003e3(15.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e22.6\u0026plusmn;2.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14(50.0)\u003c/p\u003e\n \u003cp\u003e10(35.7)\u003c/p\u003e\n \u003cp\u003e4(14.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.985\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eCreatinine（X\u0026plusmn;S\u0026mu;mol/L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e107\u0026plusmn;27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e114\u0026plusmn;37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eUrea（X\u0026plusmn;S mmol/L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e8.6\u0026plusmn;2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e9.1\u0026plusmn;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eAffected side GFR（X\u0026plusmn;S ml/min）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e24.1\u0026plusmn;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e24.7\u0026plusmn;3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eHb (X\u0026plusmn;S g/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e117\u0026plusmn;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e118\u0026plusmn;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.855\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eDegree of hydronephrosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.888\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e15(78.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e19(67.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e3(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e5(17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e1(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e3(10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Clinical efficacy comparison\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.83802816901409%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" valign=\"top\"\u003e\n \u003cp\u003eGroup 1\u003c/p\u003e\n \u003cp\u003eN=19(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003eGroup 2\u003c/p\u003e\n \u003cp\u003eN=28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.908450704225352%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003eP v\u003c/em\u003ealue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.83802816901409%\" valign=\"top\"\u003e\n \u003cp\u003eOperative time（X\u0026plusmn;S mins）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" valign=\"top\"\u003e\n \u003cp\u003e96\u0026plusmn;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e184\u0026plusmn;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.908450704225352%\" valign=\"top\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.83802816901409%\" valign=\"top\"\u003e\n \u003cp\u003eBleeding volume（X\u0026plusmn;S ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" valign=\"top\"\u003e\n \u003cp\u003e17\u0026plusmn;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e84\u0026plusmn;41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.908450704225352%\" valign=\"top\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.83802816901409%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative hospitalization（X\u0026plusmn;S days）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" valign=\"top\"\u003e\n \u003cp\u003e5.8\u0026plusmn;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e8.4\u0026plusmn;3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.908450704225352%\" valign=\"top\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.83802816901409%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative feeding time（X\u0026plusmn;S days）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" valign=\"top\"\u003e\n \u003cp\u003e1.7\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e2.9\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.908450704225352%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.83802816901409%\" valign=\"top\"\u003e\n \u003cp\u003ePerioperative blood transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.908450704225352%\" valign=\"top\"\u003e\n \u003cp\u003e0.650\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.83802816901409%\" valign=\"top\"\u003e\n \u003cp\u003eNo blood transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" valign=\"top\"\u003e\n \u003cp\u003e19(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e26(92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.908450704225352%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.83802816901409%\" valign=\"top\"\u003e\n \u003cp\u003eBlood transfusion\u003c/p\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003cp\u003eCreatinine（X\u0026plusmn;S\u0026mu;mol/L）\u003c/p\u003e\n \u003cp\u003eUrea（X\u0026plusmn;S mmol/L）\u003c/p\u003e\n \u003cp\u003eAffected side GFR（X\u0026plusmn;S ml/min）\u003c/p\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003cp\u003eCreatinine（X\u0026plusmn;S\u0026mu;mol/L）\u003c/p\u003e\n \u003cp\u003eUrea（X\u0026plusmn;S mmol/L）\u003c/p\u003e\n \u003cp\u003eAffected side GFR（X\u0026plusmn;S ml/min）\u003c/p\u003e\n \u003cp\u003eExtraction time of ureteral stent (mouths)\u003c/p\u003e\n \u003cp\u003eUreteral stent in place\u003c/p\u003e\n \u003cp\u003eHydronephrosis after extubation\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eTime of hydronephrosis after extubation (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e107\u0026plusmn;27\u003c/p\u003e\n \u003cp\u003e8.6\u0026plusmn;2.8\u003c/p\u003e\n \u003cp\u003e24.1\u0026plusmn;2.9\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e102\u0026plusmn;20\u003c/p\u003e\n \u003cp\u003e7.9\u0026plusmn;1.7\u003c/p\u003e\n \u003cp\u003e17.9\u0026plusmn;3.2\u003c/p\u003e\n \u003cp\u003e6.5\u0026plusmn;2.2\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e5.4\u0026plusmn;2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\" valign=\"top\"\u003e\n \u003cp\u003e2(7.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e114\u0026plusmn;37\u003c/p\u003e\n \u003cp\u003e9.1\u0026plusmn;4.1\u003c/p\u003e\n \u003cp\u003e24.7\u0026plusmn;3.3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e106\u0026plusmn;28\u003c/p\u003e\n \u003cp\u003e8.1\u0026plusmn;3.2\u003c/p\u003e\n \u003cp\u003e24.2\u0026plusmn;3.5\u003c/p\u003e\n \u003cp\u003e4.2\u0026plusmn;3.8\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e11.8\u0026plusmn;1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.908450704225352%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.009\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"bladder cancer, radical cystectomy, benign uretero-ileal anastomotic stricture, endoscopic treatment, robotic and laparoscopic ureteral reimplantation","lastPublishedDoi":"10.21203/rs.3.rs-4190650/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4190650/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eBenign uretero-ileal anastomotic stricture (UIAS) is a potentially serious complication following radical cystectomy (RC) and urinary diversion after RC. In order to preserve residual renal function and enhance prognosis, it is imperative to draw insights from experience and tailor individualized treatment strategies for different patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients and methods: \u003c/strong\u003eBetween October 2014 to June 2021, 47 patients with benign UIAS underwent endoscopic management (n=19) or reimplantation surgery (n=28). The basic data, perioperative conditions and postoperative conditions of the two groups were compared and analyzed to evaluating the efficacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e In the comparison of preoperative and postoperative clinical efficacy of the same group, the endoscopic group exhibited no significant differences in creatinine and blood urea nitrogen (BUN) levels before surgery or after extubation (P\u0026gt;0.05), but BUN and glomerular filtration rate (GFR) levels on the affected side showed significant differences before surgery and after extubation (P\u0026lt;0.05). While the laparoscopic reimplantation group didn't show significant differences in creatinine, BUN and GFR levels before surgery and after extubation (P\u0026gt;0.05). According to the data of postoperative clinical efficacy between the two groups, there was no significant difference in creatinine and BUN levels (P\u0026gt;0.05), but GFR values in the endoscopic treatment group decreased more than those in the laparoscopic reimplantation group (P\u0026lt;0.05). Additionally, the laparoscopic reimplantation group could remove the single J tube earlier than the endoscopic treatment group (P\u0026lt;0.05) with a lower recurrence rate of hydronephrosis after extubation (P\u0026lt;0.05), and hydronephrosis occurred earlier in the endoscopic treatment group (P\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e In our experience for the treatment of UIAS after RC combined with urinary diversion, laparoscopic reimplantation can fundamentally solve the problem of UIAS, remove the ureteral stent in a relatively short time after surgery, maintain the patency of the ureter for a long time, truly preserve the residual renal function, reduce the occurrence of ureteral restenosis and hydronephrosis, and demonstrate relatively better therapeutic outcomes in this research.\u003c/p\u003e","manuscriptTitle":"The therapeutic analysis of benign uretero-ileal anastomotic stricture after radical cystectomy and urinary diversion.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-19 18:41:57","doi":"10.21203/rs.3.rs-4190650/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ef8bfe3-58ba-4a24-b124-64d2686f66bf","owner":[],"postedDate":"April 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30768766,"name":"Biological sciences/Cancer/Urological cancer"},{"id":30768767,"name":"Health sciences/Urology"}],"tags":[],"updatedAt":"2024-06-28T11:08:45+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-19 18:41:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4190650","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4190650","identity":"rs-4190650","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}