Endoscopic treatment of ureteric strictures: Acucise, cold-knife endoureterotomy and wall stents as a salvage approach


ERDOGRU T., Kutlu O., KOKSAL T., DANISMAN A., USTA M. F., KUKUL E., ...Daha Fazla

UROLOGIA INTERNATIONALIS, cilt.74, sa.2, ss.140-146, 2005 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 74 Sayı: 2
  • Basım Tarihi: 2005
  • Doi Numarası: 10.1159/000083285
  • Dergi Adı: UROLOGIA INTERNATIONALIS
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Sayfa Sayıları: ss.140-146
  • Anahtar Kelimeler: ureter, stricture, endoureterotomy, stent, METALLIC STENTS, OBSTRUCTION, EXPERIENCE, MANAGEMENT
  • Akdeniz Üniversitesi Adresli: Evet

Özet

Objective: To evaluate the factors influencing the results of endoureterotomy using cold-knife and cutting balloon dilatation, and permanent ureteral wall stents in patients with benign ureteral strictures after different operations affecting the ureter. Materials and Methods: Over a 4-year period, in 18 patients, endoscopic cold-knife and Acucise endoureterotomies were performed in 13 and 7 renal units, respectively. Eight Memoterm permanent ureteral wall stents were inserted into 7 patients when endoureterotomy failed. Successful outcome was defined by the absence of re-stricture assessed both clinically and radiologically. Results: The strictures were secondary to ureterolithotomy in 6, ureteroscopy in 3, gynecological procedures in 4, abdominal surgeries in 2, transplantation in 2 and continent urinary diversion in 1. The right and left ureters were unilaterally affected in 5 and 11 patients, respectively ( 5 of them had a solitary kidney), while the remaining 2 patients had bilateral ureteral strictures. We achieved total ureteral patency of 3 (43%) and 7 (54%) renal units with Acucise and cold-knife incision, respectively. Obstructive uropathy was resolved in 6 renal units (75%) of 8 using ureteral wall stents. Conclusion: Endoureterotomy with cold-knife or Acucise cutting balloon dilatation is effective in the treatment of iatrogenic ureteral strictures, but only in a selected group. Based on our results, the favorable prognostic criteria for endoureterotomy are the length ( less than or equal to 1.5 cm), the nonischemic nature of the stricture and adequate renal function. As a salvage approach, permanent self-expanding ureteral wall stents with a 75% success rate may provide a satisfactory outcome for decompression of an obstructed system. Copyright (C) 2005 S. Karger AG, Basel.