MP22-13 DOUBLE URETERAL STENT PLACEMENT REDUCES RESTENOSIS AFTER INCISION AND DILATATION FOR URETERAL STENOSIS

Abstract

INTRODUCTION AND OBJECTIVE: Laser incision (laser endoureterotomy: LE) and balloon dilatation (BD) are the treatments for ureteral strictures measuring ≤20 mm; however, these treatments are associated with a high risk of postoperative restenosis. Endoscopic management of benign ureteral strictures has been described in the adult literature with failure rates of 12% to 38%. Therefore, this study aimed to investigate the effectiveness of a novel method to place double ureteral stents after LE and BD. METHODS: In total, 10 patients who underwent endoscopic surgery for ureteral stenosis from January 2016 to March 2019 were included. All stenoses were iatrogenic rather than congenital. In LE, the stenosis site, including 2 mm before and after the site, was incised using a laser until the fat tissue outside the ureter was visible. A flexible ureteroscope was used for upper ureteral stenosis and a semi-rigid ureteroscope was used for middle or lower ureteral stenosis. In BD, the stenosis site was dilated with a balloon up to 15 Fr. In all cases, two 4.7-Fr ureteral stents were placed and removed 4–8 weeks after surgery. The improvement of hydronephrosis, surgical parameters, and complications were evaluated. RESULTS: The stenosis site was confirmed in the upper ureter in six patients; in the middle ureter in three patients; and in the lower ureter in one patient, with an average distance of 9.7 ± 5.6 mm. Preoperative hydronephrosis was grade G1 in one patient, grade G2 in one patient, grade G3 in four patients, grade G4 in four patients, and improved in nine patients (90%) 3 months after surgery. The average duration of surgery was 111 ± 21 minutes, and no surgical complications over grade 3 were observed. The average duration of hospital stay was 4.1 ± 0.5 days. The mean follow-up period was 661 ± 405 days, and no restenosis was observed in any of the eight patients. CONCLUSIONS: Placement of double ureteral stents after surgery for ureteral stenosis was effective. Source of Funding: none