Management Of Ureteral Strictures Research Articles

An international delphi survey and consensus meeting to define the risk factors for ureteral stricture after endoscopic treatment for urolithiasis.

Iatrogenic ureteral strictures (US) after endoscopic treatment for urolithiasis represent a significant healthcare concern. However, high-quality evidence on the risk factors associated with US is currently lacking. We aimed to develop a consensus statement addressing the definition, risk factors, and follow-up management of iatrogenic US after endoscopic treatment for urolithiasis. Utilizing a modified Delphi method, a steering committee developed survey statements based on a systematic literature review. Then, a two-round online survey was submitted to 25 experts, offering voting options to assess agreement levels. A consensus panel meeting was held for unresolved statements. The predetermined consensus threshold was set at 70%. The steering committee formulated 73 statements. In the initial survey, consensus was reached on 56 (77%) statements. Following in-depth discussions and refinement of 17 (23%) statements in a consensus meeting, the second survey achieved consensus on 63 (86%) statements. This process underscored agreement on pivotal factors influencing US in endoscopic urolithiasis treatments. This study provides a comprehensive list of categorized risk factors for US following endoscopic urolithiasis treatments. The objectives include enhancing uniformity in research, minimizing redundancy in outcome assessments, and effectively addressing risk factors associated with US. These findings are crucial for designing future clinical trials and guiding endoscopic surgeons in mitigating the risk of US.

658 The Use of AlliumTM Stents in the Management of Ureteric Strictures

Abstract Aim Stents are widely used in the management of ureteric strictures but require changes every 6–12 months and stent related symptoms are commonly reported. AlliumTM ureteric stents are large calibre, metallic stents that aim to reduce the incidence of stent-related complications, with an indwelling time up to three years. These were introduced within our local hospital trust for patients requiring frequent stent changes and this study aims to review the early use of AlliumTM stents and associated complications. Method An electronic database of patients was searched for records including the words “Allium stent” between 01/01/17–01/01/21. The resulting patient electronic records were then interrogated to extract data. Results 13 patients were included in data analysis. Mean age was 62.7 years and male:female ratio was 6:7. 5 underwent antegrade insertion and 8 retrograde. 3 were inserted under local anaesthetic and 10 under general. Median follow-up time was 459 days. No cases of renal deterioration were noted, and no patients sought medical attention with pain or irritative symptoms. The majority remained in situ, however one patient reported spontaneous passage of the stent; and one patient later required a nephrectomy, necessitating stent removal. Three patients developed post-operative urinary tract infections (two requiring hospital admission); two patients required further intervention for urolithiasis causing stent blockage; and two patients died from other disease processes prior to analysis. Conclusions There are clear advantages in reducing repeated admission and anaesthesia for patients. Initial results demonstrate good patency and tolerability of AlliumTM stents though further investigation is required to analyse the long-term benefits.

MP046 - Memokath 051 stent in the management of ureteric strictures: Twelve year experience and follow up

MP046 - Memokath 051 stent in the management of ureteric strictures: Twelve year experience and follow up

V05-06 A BETTER BOARI FLAP – TECHNICAL MODIFICATIONS IN THE ROBOTIC APPROACH

INTRODUCTION AND OBJECTIVE:The Boari flap remains an excellent surgical technique in the management of ureteral strictures that are not amenable to ureteroneocystostomy or ureteroureterostomy. With...

Management of Ureteral Strictures and Ureteropelvic Junction Obstruction

The goals for management of ureteropelvic junction obstruction (UPJO) and ureteral stricture are to resolve obstruction, restore continuity, and preserve renal function while minimizing morbidity. The management of UPJO can be challenging and represents a spectrum of options that vary in the invasiveness and effective. These options include observation, long-term internal or external urinary drainage, and endoscopic or minimally invasive management. Mismanagement can potentially results in deterioration of loss of kidney function. This chapter discusses the foundations for successful management of UPJO and ureteral strictures. It also highlights the special clinical situations related to this disease entity and discusses the key advances in the field. This review contains 8 figures, 4 tables, and 73 references. Key Words: Boari flap, dismembered pyeloplasty, endopyelotomy, psoas hitch, pyeloplasty, ureteropelvic junction obstruction, ureteral obstruction, ureteral reconstruction, ureteral stricture, uretero-ureterostomy

V02-03 APPLICATION OF ROBOTIC ASSISTANCE TO TRANSPLANT URETERONEOCYSTOSTOMY

INTRODUCTION AND OBJECTIVES:Urologists are called upon to assist in management of ureteral strictures following renal transplantation. Refractory strictures can be managed with surgical reconstruction by performing ureteroneocystostomy or pyelovesicostomy. Transplant ureteroneocystostomy is often performed using an open approach. Challenges inherent to this surgery including periureteral fibrosis can be tackled with a robotic approach using advances in robotic surgical tools. Here we demonstrate our technique and rationale for performing robotic-assisted transplant ureteroneocystostomy in select patients.METHODS:We present a single surgeon's initial case series of three patients who underwent transplant ureteroneocystostomy using the daVinci® robotic surgical system, as well as discuss what influences determination of a patient's candidacy for this approach.RESULTS:Three patients with transplant ureteral strictures were identified. The median age was 61 years (26-62 years). All 3 patients failed attempts ...

Minimally invasive management of ureteral strictures: a 5-year retrospective study

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.

Использование буккального графта при стриктурах мочеточника

This review analyses of the results of using buccal mucosa graft for the management of ureteral strictures. The authors identified sixteen original studies presenting the results of ureteral reconstruction using buccal grafts. Of them, twelve, three and one studies used the open, robotic and laparoscopic technique, respectively. Open surgery was performed 44 times in 42 patients (2 patients underwent bilateral ureteroplasty) with an average ureteral stricture length of 6.0 (2.5-11) cm. Ureteral patency was restored in 93.2% (41/44) of patients with an average follow-up of 26 (3-85) months. The robotic technique was used in 18 patients with an average ureteral stricture length of 3.25 (1.5-6) cm. Positive results after similar operations were achieved in 88.9% (16/18) of patients with an average follow-up of 15 (4-30) months. The laparoscopic technique was used only once for a ureteral stricture measuring 3 cm in length and was characterized as successful at a follow-up of 9 months. All surgical modalities were associated with minimal risk of early and late postoperative complications. The review results suggest that buccal substitution ureteroplasty can be regarded as an advantageous alternative to more complicated surgical procedures associated with greater complication rates (ileal ureteral substitution and kidney autotransplantation) used for long ureteral strictures.

A Review of Buccal Mucosa Graft Ureteroplasty.

We review the buccal mucosa graft (BMG) ureteroplasty literature to evaluate its utility in the management of ureteral strictures, identify indications for which it is particularly useful, and highlight refinements in surgical technique. Recent reports have described the efficacy of robotic BMG ureteroplasty and the utilization of near-infrared fluorescence to assist with precise identification of the ureteral stricture margins. BMG ureteroplasty is well-suited for ureteral reconstruction as it allows for minimal disruption of the delicate ureteral blood supply and facilitates a tension-free anastomosis. This technique is particularly useful in patients with long ureteral strictures not amenable to ureteroureterostomy and in patients with a recurrent ureteral stricture after a previously failed ureteral reconstruction.

Management of Ureteral Strictures: NYU Case of the Month, October 2018.

Management of Ureteral Strictures: NYU Case of the Month, October 2018.

Endoscopic Management of Ureteral Stricture: NYU Case of the Month, August 2018.

Endoscopic Management of Ureteral Stricture: NYU Case of the Month, August 2018.

Magnetic resonance urography for diagnosis of pediatric ureteral stricture

PurposeUreteral stricture is a rare cause of hydronephrosis in children and is often misdiagnosed on ultrasound (US) and diuretic renal scintigraphy (DRS), requiring intraoperative diagnosis. We evaluated ureteral strictures diagnosed by magnetic resonance urography (MRU) at our institution. Materials and methodsChildren with ureteral stricture who underwent MRU were identified. Patient demographics, prior imaging, MRU findings, and management were assessed. The efficacy of MRU in diagnosis of stricture was compared with US and DRS. Patients with ureteropelvic or ureterovesical junction obstruction were excluded. ResultsTwenty-eight ureteral strictures diagnosed by MRU between 2003 and 2013 were identified; 22% of strictures were diagnosed by DRS ± US. The mean age at MRU diagnosis was 2.4 years (range 4 weeks–15 years). Hydronephrosis was the most common presentation, accounting for 20 (71%) cases. Other etiologies included pain (3), incontinence (2), and urinary tract infection, cystic kidney, and absent kidney, present in one case each. A mean of 2.7 imaging studies was obtained prior to MRU diagnosis. Twenty-one (75%) ureteral strictures required surgical intervention, with the approach dependent upon location. ConclusionsMRU provides excellent anatomic and functional detail of the collecting system, leading to accurate diagnosis and management of ureteral stricture in children.

Metallic stents in the management of ureteric strictures

Management of ureteric strictures is a challenging task. Subtle presentation, silent progression and complex aetiology may delay diagnosis. A wide range of available treatment options combined with the lack of adequate randomised trials has led to the introduction of personal bias in the management of this difficult group of patients. Metallic ureteric stents offer an alternative to the conventional treatment modalities. A review of the currently available metallic stents and their role in the long-term management of ureteric strictures is presented. Materials used in the manufacture of indwelling urological devices are evolving all the time. Improved endo-urological techniques combined with new devices made from better compounds will continue to improve patient experience.

Antegrade repositioning of Memokath stent in malignant ureteroileal anastomotic stricture

Ureteric strictures are common and can be due to benign or malignant causes. Various surgical treatments can be used from minimally invasive endoscopic retrograde JJ stent insertion, balloon dilatation, ureterolithotomy, to open surgical exploration and repair. Memokath 051 stent is a metallic stent designed for long-term ureteral stenting in the management of ureteral strictures. The insertion of this device is usually a straightforward procedure performed endoscopically in a retrograde fashion via cystoscopy. However, this procedure can be difficult in complicated scenarios when the bladder has been removed with neoureteral reimplantations or high-grade strictures. Here, we report a case of Memokath stent insertion complicated by placement difficulties in a lady with ileal conduit due to previous ovarian cancer complicated by vesicovaginal fistula, who presented with malignant stricture of the ureteroileal anastomosis. We describe a simple yet effective antegrade technique to precisely reposition the malpositioned Memokath stent, along with illustrations.

C183 Laparoscopic management of ureteric strictures resulting from pelvic endometriosis

C183 Laparoscopic management of ureteric strictures resulting from pelvic endometriosis

620 The incidence and management of ureteric strictures following 950 renal transplants in a single centre in the UK

620 The incidence and management of ureteric strictures following 950 renal transplants in a single centre in the UK

Management of ureteric strictures with nickel-titanium ureteric stents with thermal-shape memory: A comparison of the outcome between benign and malignant strictures

Management of ureteric strictures with nickel-titanium ureteric stents with thermal-shape memory: A comparison of the outcome between benign and malignant strictures

Segmental nickel-titanium ureteric stents with thermal-shape memory in the management of ureteric strictures

Segmental nickel-titanium ureteric stents with thermal-shape memory in the management of ureteric strictures

1086 THERMO EXPANDABLE SEGMENTAL METAL URETERIC STENTS IN THE MANAGEMENT OF URETERIC STRICTURES: A SINGLE CENTRE EXPERIENCE FROM THE UK

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy III1 Apr 20101086 THERMO EXPANDABLE SEGMENTAL METAL URETERIC STENTS IN THE MANAGEMENT OF URETERIC STRICTURES: A SINGLE CENTRE EXPERIENCE FROM THE UK Konstantinos Moraitis, Tamer El-Husseiny, Hassan Wazait, Junaid Islam, Junaid Masood, and Niels Buchholz Konstantinos MoraitisKonstantinos Moraitis More articles by this author , Tamer El-HusseinyTamer El-Husseiny More articles by this author , Hassan WazaitHassan Wazait More articles by this author , Junaid IslamJunaid Islam More articles by this author , Junaid MasoodJunaid Masood More articles by this author , and Niels BuchholzNiels Buchholz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2283AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES JJ stents revolutionised the minimally invasive management of benign and malignant ureteric strictures but have significant side effects such as encrustation, pain, infection, reflux, decreased ureteric peristalsis and migration as well as LUTS. More recently metallic stents have been introduced to try and improve these symptoms and avoid frequent stent exchanges. We present our experience of the Memokath 051 TM (PNN Medical, Denmark); a new generation thermo-expandable segmental nickel-titanium alloy metallic stent in the management of benign and malignant ureteric strictures. METHODS Increasingly over the last 5 years, we place ureteric Memokath 051 TM stents in patients wishing minimally invasive therapy and referred with ureteric strictures. The stent has a shaft diameter of 10.5 Fr and its fluted proximal end expands to 20 Fr. Available lengths are 30, 60, 100, 150, and 200 mm. Follow-up data looking at performance and complications is prospectively collected and analysed. RESULTS 89 patients (48 females, 41 males) (mean age: 58 years) have had 124 stents placed for a total of 104 strictures. 64% of strictures are benign and 36% are malignant. Peri-ureteric fibrosis (15%), idiopathic (18.6%) and iatrogenic (9 %) strictures represent the most common benign causes. 6 (5.4%) ureteric memokaths were inserted in anastomotic strictures in transplanted kidneys. Malignant strictures were mainly caused by gynaecological (35.1%), bowel (24.3%) and prostate (18.9%) malignancy. Over a mean follow-up of 19 months (range: 1-61), 71% of patients have their original stent in situ, which is functioning well with no signs of upper tract obstruction. Over this period, 17 patients have had spontaneous resolution of their benign stricture. The most common complication in our series is stent migration, occurring in 18.5% of patients requiring either adjustment of the stent position or removal and insertion of a new stent, followed by infection (11.3%) and stent encrustation/blockage (5.6%). CONCLUSIONS Our results show that ureteric memokath stents are effective in the minimally invasive management of benign and malignant ureteric strictures. As they do not require routine exchange, are relatively resistant to encrustation compared to JJ stents, are well tolerated by patients in our experience and easy to remove, there are potential significant benefits for patients, and financial savings for hospital trusts. Larger scale studies are necessary to further evaluate the role of these stents. London, United Kingdom© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e422-e423 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Konstantinos Moraitis More articles by this author Tamer El-Husseiny More articles by this author Hassan Wazait More articles by this author Junaid Islam More articles by this author Junaid Masood More articles by this author Niels Buchholz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Holmium:Yttrium-Aluminum-Garnet Laser Endoureterotomy for the Treatment of Transplant Kidney Ureteral Strictures

The management of ureteral strictures in transplanted kidney is challenging. Open surgical treatment is effective but entails significant convalescence. Holmium:yttrium-aluminum-garnet (Ho:YAG) laser endoureterotomy is useful for other types of ureteral obstruction, and we aimed to assess its long-term success for strictures of transplant kidney ureters. We reviewed the course of 12 kidney transplant patients managed with Ho:YAG laser endoureterotomy and/or percutaneous ureteroscopic balloon dilatation for ureterovesical anastomotic strictures or ureteropelvic junction obstruction. Success was defined as stable serum creatinine and no hydronephrosis on follow-up. Of the patients, nine had ureterovesical anastomotic strictures. Of the six treated with balloon dilatation and Ho:YAG laser endoureterotomy, the success rate was 67% (58 months mean follow-up). Both strictures with failure were longer than 10 mm. Of the three patients treated with balloon dilatation only, there was success in only one (14 months follow-up) and both strictures with failure were shorter than 10 mm. There were three patients treated for ureteropelvic junction obstruction, one with balloon dilatation and two with balloon dilatation plus Ho:YAG laser endoureterotomy, all successfully (57 months mean follow-up). Overall, of the eight strictures 10 mm or shorter, there was success rate in six (75%), with 52 months mean follow-up, including five of five (100%) treated with laser endoureterotomy and one of three (33%) treated with only balloon dilation. Our results suggest that Ho:YAG laser endoureterotomy should be a first line treatment for ureteral strictures of length 10 mm or shorter in kidney transplant patients.