Successful Multidisciplinary Repair of Severe Bilateral Uretero-Enteric Stricture with Inflammatory Reaction Extending to the Left Iliac Artery, after Robotic Radical Cystectomy and Intracorporeal Ileal Neobladder

Uretero-enteric anastomotic strictures (UES) after robot-assisted radical cystectomy (RARC) represent the main cause of post-operative renal dysfunction. The gold standard for treatment of UES is open uretero-ileal reimplantation (UIR), which is often a challenging and complex procedure associated with significant morbidity. We report a challenging case of long severe bilateral UES (5 cm on the left side, 3 cm on the right side) after RARC in a 55 years old male patient who was previously treated in another institution and who came to our attention with kidney dysfunction and bilateral ureteral stents from the previous two years. Difficult multiple ureteral stent placement and substitutions had been previously performed in another hospital, with resulting urinary leakage. An open surgical procedure via an anterior transperitoneal approach was performed at our hospital, which took 10 h to complete, given the massive intestinal and periureteral adhesions, which required very meticulous dissection. A vascular surgeon was called to repair an accidental rupture that had occurred during the dissection of the external left iliac artery, involved in the extensive periureteral inflammatory process. Excision of a segment of the external iliac artery was accomplished, and an interposition graft using a reversed saphenous vein was performed. Bilateral ureteroneocystostomy followed, which required, on the left side, the interposition of a Casati-Boari flap harvested from the neobladder, and on the right side a neobladder-psoas-hitching procedure with intramucosal direct ureteral reimplantation. The patient recovered well and is currently in good health, as determined at his recent 24-month follow-up visit. No signs of relapse of the strictures or other complications were detected. Bilateral ureteral reimplantation after robotic radical cystectomy is a complex procedure that should be restricted to high-volume centers, where multidisciplinary teams are available, including urologists, endourologists, and general and vascular surgeons.

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Delayed massive hemorrhage due to external iliac artery pseudo-aneurysm and uretero-iliac artery fistula following robotic radical cystectomy and intracorporeal Studer pouch reconstruction: endovascular management of an unusual complication

Canadian Urological Association Journal ◽

10.5489/cuaj.170 ◽

2013 ◽

Vol 7 (9-10) ◽

pp. 605 ◽

Cited By ~ 5

Author(s):

Ali Fuat Atmaca ◽

Abdullah Erdem Canda ◽

Mehmet Gumus ◽

Murat Canyigit ◽

Erem Asil ◽

...

Keyword(s):

Lymph Node ◽

Radical Cystectomy ◽

Lymph Node Dissection ◽

Iliac Artery ◽

Pelvic Lymph Node Dissection ◽

Unusual Complication ◽

Node Dissection ◽

Pseudo Aneurysm ◽

Robotic Radical Cystectomy ◽

Pouch Reconstruction

We report a very unusual complication of uretero-iliac artery fistula that developed following robotic radical cystectomy (RARC), bilateral extended pelvic lymph node dissection and intracorporeal Studer pouch reconstruction. Our patient was a 54-year-old male who was admitted 1 month after undergoing robotic surgery due to intermittently occurring massive transurethral bleeding necessitating blood transfusion that stopped by itself. Angiography showed a right external iliacartery pseudo-aneurysm and a fistula tract between the pseudo-aneurysm and Wallace type ureteral anostomosis that was successfully treated by an angiographic endovascular stent insertion at this level. Uretero-iliac artery fistula might occur following RARC, bilateral extended pelvic lymph node dissection and intracorporeal Studer pouch reconstruction leading to intermittently massive transurethral bleeding. Angiography and stenting are important for diagnosis and successful treatment of this rare entity.

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700 Uretero-intestinal anastomotic strictures in patients with ileal neobladder after radical cystectomy

European Urology Supplements ◽

10.1016/s1569-9056(04)90695-1 ◽

2004 ◽

Vol 3 (2) ◽

pp. 178

Author(s):

V. Novotny ◽

N. Berdjis ◽

S. Leike ◽

O. Hakenberg ◽

M. Wirth

Keyword(s):

Radical Cystectomy ◽

Ileal Neobladder ◽

Anastomotic Strictures

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Unusual Representation of a Common Iliac Artery Double Aneurysm

Journal for Vascular Ultrasound ◽

10.1177/154431671704100305 ◽

2017 ◽

Vol 41 (3) ◽

pp. 129-134

Author(s):

Janine Oliveri

Keyword(s):

Abdominal Aorta ◽

Iliac Artery ◽

Coil Embolization ◽

Common Iliac Artery ◽

Artery Aneurysm ◽

Ultrasound Screening ◽

Vascular Surgeon ◽

Ultrasound Study ◽

Internal Iliac ◽

The Right

This case discusses an unusual representation of a 3.1-cm double aneurysm of the right common iliac artery with an ectatic distal abdominal aorta. The patient was a 64-year-old asymptomatic male who participated in a routine ultrasound screening at his church. On the basis of the findings, a full ultrasound study was ordered and conducted at the request of his primary physician. The patient's history included smoking cessation in 1975. He currently had hypertension and hyperlipidemia. He was physically active and ran 40 miles per week until developing right Achilles tendonitis. Because of this injury, the patient biked daily. The patient's medications included atenolol and daily vitamins. The ultrasound findings revealed two aneurysms of the right common iliac artery. Both areas were fusiform and measured 3.1 and 2.9 cm, respectively. The dilation extended to the right internal iliac artery. The left common iliac was mildly dilated and kinked to the left. There was mild enlargement of the distal abdominal aorta measuring 3.4 cm by ultrasound and 3.1 cm by computed tomography angiogram. There is no evidence of internal thrombus. Usually asymptomatic, iliac artery aneurysms can be lethal if large (above 3.0 cm) and undetected. With appropriate, timely intervention the aneurysm can be safely repaired before rupture. Various aneurysm treatment options include conventional open abdominal surgery or endovascular stent graft placement with coil embolization. This patient discussed options with the vascular surgeon and was scheduled to have a cardiac catheterization with right internal iliac coil embolization. Staging of the endovascular graft was planned to follow. This case presents the uncommon finding of a large iliac artery aneurysm. This patient's disease was made more unusual by the presence of two distinct aneurysms present within the same vessel. It further reinforces the common practice of fully examining patients with aneurismal disease bilaterally and over multiple levels as a significant portion of patients have multilevel disease.

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