Retrograde Blind Endoureterotomy for Subtotal Ureteral Strictures: A New Technique

Abstract

Many causes lead to ureteral strictures. Open procedures require major surgery, for example using the "Boari"-technique. Technical developments in endoscopy provide less invasive treatment modalities for ureteral strictures. These procedures require good visualization and the ability to pass an instrument through the stricture zone. In some cases of subtotal stricture, this cannot be achieved. We introduce a new, minimally invasive surgical technique to overcome this problem. Eighteen patients with subtotal ureteral strictures included in the studied group were treated according to the technique described below. After radiographic visualization of the impassable area, a glide-wire was inserted through the stenotic portion. Alongside the wire, a 4 French ureteral catheter was advanced up to the renal pelvis and contrast medium was filled into the renal pelvis and ureter. Now a laser fiber was extended through the ureteral catheter. Under direct fluoroscopic control, the laser was slowly pulled through the stenotic zone, until the contrast medium flew freely all along the ureter. To confirm treatment success standard retrograde URS was carried out following blind incision. Eighteen patients with subtotal ureteral strictures in different locations were treated using this technique. Mean operating time was 37 min. The procedure was performed successfully in all patients. Seven out of 18 patients developed re-stenosis (38,8%) and 5 of these 7 patients required open surgery in the following. The described technique provides a minimally invasive treatment option for extreme cases of ureteral strictures. In a significant number of patients open surgery can thus be avoided.