Purpose: The study aimed to assess the impact of the Memokath 051 stent (MK) on glomerular filtration rate (GFR) and split renal function in the management of ureteroileal anastomotic strictures. Materials and Methods: We treated 6 patients in the ages of 66–77 years, 2 of whom had bilateral strictures, with a total of 8 ureteroileal strictures using the MK stent. Five patients had chronic kidney disease (CKD) prior to MK insertion. Mean time between conduit surgery and MK insertion was 28.4 months. Serum creatinine, GFR, and MAG-3 renography were determined before stent insertion and postoperatively at 3 months. Results: Postoperative complications at 3-month follow-up included migration in 2 patients, occlusion in 2 patients, and urinary tract infection in 4 patients. The mean stent indwelling time was 353.4 ± 169.3 days. Mean preoperative creatinine, GFR, right, and left split renal function were 158.3 ± 76.3 μmol/L, 43.6 ± 32.9 mL/min/1.73 m2, 52.8 ± 22.2%, and 47.1 ± 22.2%, respectively. Mean postoperative values were 168.1 ± 84 μmol/L (p = 0.84), 40.8 ± 28.4 mL/min/1.73 m2 (p = 0.56), 51.1 ± 18.3% (p = 1), and 48.8 ± 18.3% (p = 1), respectively. Conclusion: MK stent is a safe and efficient minimally invasive long-term treatment option to preserve GFR in patients who develop CKD through ureteroileal anastomotic stricture. In spite of MK stent insertion and alleviation of obstruction, it was presumably inserted too late to improve renal function.

Keywords:
Urinary diversion, Ileal conduit, Ureteroileal stricture, Ureteroileal anastomosis, Memokath
1.
Liatsikos EN, Kagadis GC, Karnabatidis D, Katsanos K, Papathanassiou Z, Constantinides C, et al: Application of self-expandable metal stents for ureteroileal anastomotic strictures: long-term results. J Urol 2007; 178: 169–173.
2.
Davis NF, Burke JP, McDermott T, Flynn R, Manecksha RP: Bricker versus Wallace anastomosis: a meta-analysis of ureteroenteric stricture rates after ileal conduit urinary diversion. Can Urol Assoc 2015; 9: 284–290.
3.
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: 985–990.
4.
Shimko MS, Tollefson MK, Umbreit EC, Farmer SA, Blute ML, Frank I: Long-term complications of conduit urinary diversion. J Urol 2011; 185: 562–567.
5.
Richards KA, Cohn JA, Large MC, Bales GT, Smith ND, Steinberg GD: The effect of length of ureteral resection on benign ureterointestinal stricture rate in ileal conduit or ileal neobladder urinary diversion following radical cystectomy. Urol Oncol 2015; 33: 65.e1–e8.
6.
DiMarco DS, LeRoy AJ, Thieling S, Bergstralh EJ, Segura JW: Long-term results of treatment for ureteroenteric strictures. Urology 2001; 58: 909–913.
7.
Milhoua PM, Miller NL, Cookson MS, Chang SS, Smith JA, Herrell SD: Primary endoscopic management versus open revision of ureteroenteric anastomotic strictures after urinary diversion – single institution contemporary series. J Endourol 2009; 23: 551–555.
8.
Lobo N, Dupré S, Sahai A, Thurairaja R, Khan MS: Getting out of a tight spot: An overview of ureteroenteric anastomotic strictures. Nat Rev Urol 2016; 13: 447–455.
9.
Papatsoris AG, Buchholz N: A novel thermo-expandable ureteral metal stent for the minimally invasive management of ureteral strictures. J Endourol 2010; 24: 487–491.
10.
Shapiro J, Gordon L, Banner MP, Pollack M, Wein AJ: Balloon catheter dilation of ureteroenteric strictures: long-term results. Radiology 1988; 168: 385–387.
11.
Staios D, Shergill I, Thwaini A, Junaid I, Buchholz NP: The Memokath stent. Expert Rev Med Devices 2007; 4: 99–101.
12.
NG KL, Nawawi O, Lim BK, Htun TH, Dublin N, Razack AH: Antegrade repositioning of Memokath stent in malignant ureteroileal anastomotic stricture. Asian J Surg 2017; 40: 171–174.
13.
Pan T, Al-sameraaii A: Use of the Memokath Urethral Stent in the management of ileal conduit stomal stenosis. Int J Surg Case Rep 2016; 19: 124–126.
14.
Naganuma T, Takemoto Y, Maeda S, Iwai T, Kuwabara N, Shoji T, et al: Chronic kidney disease in patients with ileal conduit urinary diversion. Exp Ther Med 2012; 4: 962–966.
15.
Jin XD, Roethlisberger S, Burkhard FC, Birkhaeuser F, Thoeny HC, Studer UE: Long-term renal function after urinary diversion by ileal conduit or orthotopic ileal bladder substitution. Eur Urol 2012; 61: 491–497.
16.
Anderson CB, Morgan TM, Kappa S, Moore D, Clark PE, Davis R, et al: Ureteroenteric anastomotic strictures after radical cystectomy-does operative approach matter? J Urol 2013; 189: 541–547.
17.
Joshi HB, Newns N, Stainthorpe A, MacDonagh RP, Keeley FX, Timoney AG: Ureteral stent symptom questionnaire: development and validation of a multidimensional quality of life measure. J Urol 2003; 169: 1060–1064.
18.
Bier S, Amend B, Wagner E, Rausch S, Neumann E, Stühler V, et al: The thermoexpandable nitinol stent: a long-term alternative in patients without nephropathy or malignancy. Scand J Urol 2017; 51: 388–391.
19.
Kulkarni RP, Bellamy EA: A new thermo-expandable shape-memory nickel-titanium alloy stent for the management of ureteric strictures. BJU Int 1999; 83: 755–759.
20.
Kulkarni R, Bellamy E: Nickel-titanium shape memory alloy Memokath 051 ureteral stent for managing long-term ureteral obstruction: 4-year experience. J Urol 2001; 166: 1750–1754.
21.
Klarskov P, Nordling J, Nielsen JB: Experience with Memokath 051 ureteral stent. Scand J Urol Nephrol 2005; 39: 169–172.
22.
Moltzahn F, Haeni K, Birkhäuser FD, Roth B, Thalmann GN, Zehnder P: Peri-interventional antibiotic prophylaxis only vs continuous low-dose antibiotic treatment in patients with JJ stents: a prospective randomised trial analysing the effect on urinary tract infections and stent-related symptoms. BJU Int 2012; 111: 289–295.
23.
Chew BH, Flannigan R, Kurtz M, Gershman B, Arsovska O, Paterson RF, Eisner BH, Lange D: A single dose of intraoperative antibiotics is sufficient to prevent urinary tract infection during ureteroscopy. J Endourol 2016; 30: 63–68.
© 2018 S. Karger AG, Basel
2018
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