Percutaneous Treatment of Uretero-Intestinal Stenosis with Acucise®: Preliminary Experience

The incidence of stenosis of uretero-intestinal anastomoses is about 5–10%. The most relevant effect of this post-surgical complication is the progressive renal function deterioration. Infections, ureteric ischemia, perianastomotic urinary extravasation and apposition of two different types of mucosa are the main causes of this complication. Several options are available for the treatment of these strictures: surgery, ureteral stenting, balloon dilation, endoscopic electrocautery or laser incision. The Acucise® catheter system combines diatermic incision with balloon dilation.Material and methods 9 stenosis of uretero-intestinal anastomoses have been treated with Acusise® endoureterotomy in 7 patients. All the patients underwent to radical cistectomy with urinary diversion for oncological disease. The diagnosis has been obtained with US and/or CT examination. Residual renal function has been assessed with sequential renal scintigraphy. The procedure includes two parts: percutaneous pleacement of nephrostomic catheter with distal part inside the neo-bladder and, after 15 days, treatment with Acucise®. The incision was performed with 75W activation of the cutting wire during inflation of the balloon at the level of stenosis.Results Mean follow-up is about 5 months so we can't consider the long term effects of the treatment but our preliminary results are interesting, with an adequate patency of the anastomoses in 8/9 cases at CT scan. The procedure, performed under fluoroscopic control and local anaesthesia, resulted ease and safe with low procedural complications.Conclusions If long term results will be confirm, Acucise® could be suggested as first-line treatment in these situations; surgery should be indicated in case of minimally invasive procedure approach.