IS ENDOSCOPIC BALLOON DILATATION OF URETERAL STRICTURES AN ALTERNATIVE TO OPEN SURGERY?

Abstract

dilatation while opponents prefer surgical solutions due to better long term success rates. Therefore we evaluated the effect of balloon dilatation in the treatment of ureteral stenoses. METHODS: Between 2000 and 2007 a consecutive series of 40 patients with ureteral stenoses of benign and malignant etiology underwent endoscopic dilatation. We report on the median term outcome. RESULTS: 38 patients presented with 40 ureteric stenoses: iatrogenic strictures in 15 cases, 14 due to colorectal or uro-gynecological tumors and 11 because of ureterointestinal anastomotic strictures after urinary diversion. Two patients were not evaluable. A median of 4 dilatations was performed in monthly intervals. Success was reviewed by intravenous pyelogram, renal scan and ultrasound. Treatment was initially successful in 24 cases (60%). Of these 18 patients (75%) had no signs of ureteral obstruction after a median follow up of 16,6 months (range: 4,8-83). The remaining patients underwent additional open surgery or permanent ureteral stenting. Of these, nephrectomy was necessary in 3 cases due to preexisting renal deterioration. The worst outcome was noted in malign strictures. CONCLUSIONS: Endoscopic ureteral balloon dilatation may be an alternative to open surgery in patients with ureteral strictures, especially in older and morbid patients unable to undergo invasive surgery. Nevertheless long term success rates are disappointing particularly in malign stenoses. If possible open surgery should be preferred.