Abstract
IntroductionUreteric strictures are well-documented complications related to surgery or radiation therapy. Minimally invasive treatment using endoscopic dilatation or laser incision is the standard practice. There are no existing guidelines on which techniques to use in the treatment of different stricture types and a paucity of data regarding long-term results.PurposeOur study aimed to retrospectively assess the long-term efficacy of minimally invasive treatment in benign and malignant ureteric strictures.Materials and methodsOver a 5-year period, 2007–2012, we analyzed the data of 59 consecutive patients undergoing minimally invasive treatment for symptomatic ureteric strictures. We excluded 16 patients from final analysis due to failed access or loss to follow-up. All patients but one were treated with antegrade, retrograde balloon or catheter dilatations. Successful outcome was defined as an asymptomatic, completely catheter free patient, with stable renal function.Results43 patients were eligible for retrospective final analysis. The largest proportion of strictures occurred following surgery combined with radiotherapy 8/43 (19%). Preoperative decompression was required in 30/43 (70%). We identified 32/43 (75%) balloon dilatations, 10/43 (23%) catheter dilatations and 1/43 (2%) laser incision. Overall success rate was 31/43 (72%). All 6 recurrences occurred within 36 months, 4 within the first 12 months. 3/6 patients were successfully re-dilated.ConclusionMinimally invasive treatment is a worthwhile alternative in strictures due to previous radiation and/or surgical treatment of malignancies. Most recurrences occurred within the first year. However, late recurrences arise; therefore, patients should be subject to long-term follow-up. Moreover, re-dilatation may be required.
Highlights
Ureteric strictures are well-documented complications related to surgery or radiation therapy
Based on several studies on laser incision of ureteric strictures [6,7,8,9,10,11,12,13,14,15,16,17], the latest EAU Guidelines conclude that retrograde endoureterotomy should be considered as a first-line treatment option [18]
16 patients were excluded, 13 of which required invasive surgery due to failed access at first dilatation attempt, i.e., the guide wire could not be passed through the stricture
Summary
Ureteric strictures are well-documented complications related to surgery or radiation therapy. Invasive treatment using endoscopic dilatation or laser incision is the standard practice. Purpose Our study aimed to retrospectively assess the long-term efficacy of minimally invasive treatment in benign and malignant ureteric strictures. Materials and methods Over a 5-year period, 2007–2012, we analyzed the data of 59 consecutive patients undergoing minimally invasive treatment for symptomatic ureteric strictures. Based on several studies on laser incision of ureteric strictures [6,7,8,9,10,11,12,13,14,15,16,17], the latest EAU Guidelines conclude that retrograde endoureterotomy should be considered as a first-line treatment option [18]. Strictures > 2 cm have been shown to be associated with poorer outcome [2, 18]
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