Studer新膀胱重建術後罕見晚期併發症—輸入蠕動管狀臂狹窄之Amplatz擴張治療：病例報告

許育豪¹、王華斌^1,2、吳俊賢^1,2

¹義大醫療財團法人義大醫院泌尿科；²義守大學醫學系

Afferent Isoperistaltic Tubular Limb Stricture as a Rare Late Complication of Studer Neobladder Reconstruction: Successful Management with Serial Amplatz Dilatation — A Case Report

Yu-Hao Hsu ¹, Hua-Ping Wang^1,2, Chun-Hsien Wu ^1,2

¹Department of Urology, E-Da Hospital, Kaohsiung, Taiwan

²School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan

Introduction:

Radical cystectomy with ileal neobladder reconstruction using the Studer technique is a well-established treatment for muscle-invasive bladder cancer. Although generally effective, long-term complications may occur more than a decade postoperatively, including ureteroileal anastomotic stricture, urinary tract infection, urolithiasis, and metabolic disturbances. We present a case of stricture involving the afferent isoperistaltic tubular segment, representing an exceedingly rare late complication following Studer neobladder reconstruction.

Case Presentation:

A 60-year-old female presented with voiding difficulty and bilateral flank pain 16 years after radical cystectomy with Studer ileal neobladder reconstruction. Imaging revealed severe bilateral upper urinary tract dilatation and neobladder distention, accompanied by rapid deterioration of renal function. Initial management with left percutaneous nephrostomy revealed pyonephrosis. Further imaging localized the obstruction to the distal end of the afferent isoperistaltic tubular limb of the neobladder. Endoscopic management of the stricture was challenging due to the anatomical redundancy of the afferent limb. Retrograde UroMax balloon dilatation of the stricture failed to reach the stricture site; therefore, serial dilatation using an Amplatz renal sheath was successfully performed under fluoroscopic guidance. Following the procedure and double-J stent placement across the stricture site, the patient's renal function improved, with unobstructed voiding and resolution of hydronephrosis.

Conclusion:

Late-onset afferent isoperistaltic tubular limb stricture of the ileal neobladder is a rare but serious complication after Studer neobladder reconstruction that requires lifelong surveillance. This case highlights the anatomical challenges in endoscopic management of such strictures. We demonstrate that an alternative technique, such as serial dilatation using an Amplatz renal sheath, represents a feasible minimally invasive alternative to open surgical revision.