Objective: We report our experience on antegrade percutaneous incision of ureterointestinal anastomosis strictures after urinary diversion. Materials and Methods: Since 1994, we have evaluated retrospectively 18 patients with 22 ureterointestinal anastomosis strictures (UAS), who were treated with cold–knife incision. After placement of an 8–french nephrostomy tube, a 0.035–inch guide wire bypassed the stricture under guidance of a centrally opened (5–french) ureter catheter. A wire–mounted cold–knife was pulled through the strictured area retrogradely under fluoroscopic control. Routinely, following the incision, an 8–french external stent was left in place for 6–8 weeks. Results: After stent removal as a primary procedure, the ureteroenteric area has remained patent in 14 of 19 (74%) UAS. In 3 cases undergoing a secondary or repeated procedure, treatment failed. The average follow–up was 23.5 (range 12–39) months. Failures were associated with radiogenic injury of the ureter in 5 UAS and unexplained in 2. No complication was observed. Conclusion: Percutaneous endourological management of UAS with the cold–knife incision, when used as a primary treatment, is a safe and effective alternative to open surgical repair and should be considered as an initial approach.

Keywords:
Ureterointestinal anastomosis strictures, Urinary diversion, Endourology, Antegrade percutaneous treatment, Cold knife
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