Introduction & Objective : Ureteral strictures may result from various etiology, benign or malignant conditions, especially from endoscopic procedures and gynecological surgery. In the last years, advances in endourological techniques have provided a less invasive way to treat this condition, with good results and low morbidity. The aim of this study was to evaluate the results of the endourological retrograde treatment of ureteral stricture due to benign conditions.
Methods : A retrospective study was carried out on patients treated endourologically for ureteral stricture. We included patients undergoing the following approaches: balloon dilation, ureterotomy with Holmium laser, and/or dilation with ureteral catheters. We excluded malignant ureteral strictures and ureteroenteric stenosis. Follow-up was tailored on the patient according to the severity of stenosis (endourological re-evaluation and further treatment vs clinical control). Success was considered when the patient was stent-free with a functioning kidney, evaluated with renal scintigraphy or uro-TC. We also recorded patients who underwent surgery and/or had loss of renal function.
Results : Thirty-two patients were enrolled. Of whom, 47% were male. Median age was 62.6 years. Etiology of ureteral strictures was: 78% stone-related, 6.3% following pelvic surgery, 6.3% after trauma, 3.1% radiotherapy, and 6.3% idiopathic. The median length of the stricture was 12 mm (range 3-30 mm) and the prevalent site was the lumbar ureter (59.4%). Balloon dilation, ureterotomy, dilation with ureteral sheath/catheter or combined procedures were used in 46.8%, 12.5%, 6.3%, 34.4%, respectively. A post-procedural stenting was used in all cases and maintained for 2 to 6 months. Post-operative complications were: fever (9.4%), low urinary tract infection (3.1%), systemic hypertension (3.1%), acute renal failure due to stent obstruction (3.1%). Median number of endourological procedure for patient was 1 (range 1-4). At 25-months median follow-up, 25% were placed in a periodic stent substitution, 25% underwent major surgery for stricture correction, and 6% underwent nephrectomy for severe loss of renal function. However, up to 44% was stent- and symptom-free without any additional major surgery.
Conclusions : Endourological retrograde treatment of benign ureteral strictures, with its minimal invasiveness and acceptable long-term results, is an effective first-line treatment option. However, further studies - e.g. multi-institutional, prospective clinical trials - are still needed to determine the long-term impact of endourology as a first line treatment and which approach is the most effective.
Michele Colicchia– Resident in Urology, Urologic Clinic - University of Padua, Padova, Veneto, Italy
Laura Bettin– Urologic Clinic - University of Padua, Padova, Veneto, Italy
Carlo Berto– Urologic Clinic - University of Padua, Padova, Veneto, Italy
Massimo Iafrate– Urologic clinic - University of Padua, Padova, Veneto, Italy
Fabrizio Dal Moro– Urologic clinic - University of Padua, Padova, Veneto, Italy
Paolo Beltrami– Director, Endourology Unit - Urologic Clinic - University of Padua, Padova, Veneto, Italy
Filiberto Zattoni– Director, Urologic clinic - University of Padua, Padova, Veneto, Italy
Resident in Urology
Urologic Clinic - University of Padua
Padova, Veneto, Italy
Endourology Unit - Urologic Clinic - University of Padua
Padova, Veneto, Italy