Retrograde Balloon Dilatation Research Articles

The Role of Percutaneous Endopyelotomy for Ureteropelvic Junction Obstruction

Over the last 20 years, the surgical management of ureteropelvic junction obstruction (UPJO) has been revolutionised by the development of endourological instrumentation and several minimally invasive procedures including: antegrade or retrograde endopyelotomy, retrograde balloon dilatation, and laparoscopic pyeloplasty. Currently, in our department, we offer percutaneous antegrade endopyelotomy (PAE) as primary treatment of UPJO in adults, believing it offers less morbidity, better cosmetic results, and quicker operating time compared with open pyeloplasty. We performed a retrospective audit of our results for the 14 patients who underwent percutaneous antegrade endopyelotomy between January 2000 and May 2004. Mean operative time was 53 min (range, 30-80 min), mean in-patient stay was 3.8 days (range, 2-7 days), and there were no major postoperative complications for this series with mean follow-up of 31.8 months (range, 12-52 months). Eleven out of the 14 patients (79%) showed radiological improvement on their 3-month MAG 3 (mercaptoacetyl-triglycyl) renogram, and 13 out of the 14 (93%) patients reported significant reduction or resolution of pain, compared with their preoperative state. The majority of urologists still offer open pyeloplasty as primary treatment for UPJO with laparoscopic pyeloplasty currently an evolving procedure in the UK. Our series reports comparable success rates for PAE compared to other series. Despite these results, we feel that the future role of percutaneous endopyelotomy will be as a salvage procedure following failed open or laparoscopic surgery. However, in patients with concurrent stone disease or requiring antegrade ureteric access, percutaneous endopyelotomy would be suitable as a primary treatment option.

Usefulness of Short-Term Retrievable Ureteral Stent in Pediatric Laparoscopic Pyeloplasty

Methods of stenting after laparoscopic pyeloplasty have included indwelling Double-J stents and percutaneous nephrostomy tubes. The disadvantages of these methods are that they necessitate a second surgery for stent removal or require an external drainage bag. To circumvent these issues, the tolerance, safety and outcomes of using a Double-J ureteral stent with a dangler, permitting early office removal, was investigated in a series of pediatric laparoscopic pyeloplasties. Medical records from a consecutive series of pediatric patients undergoing transperitoneal laparoscopic pyeloplasties were reviewed. Indications for surgery included ipsilateral flank pain with severe hydronephrosis (12 patients), recurrent pyelonephritis with severe hydronephrosis (2), and hematuria and flank pain (6). All patients were discharged home within 24 to 48 hours of the procedure with prophylactic oral antibiotics. The stent was removed by postoperative day 18 during a followup office visit. Patient tolerance of the indwelling stent, outpatient removal and success of pyeloplasty were assessed. A total of 20 patients underwent transperitoneal laparoscopic pyeloplasty by 1 surgeon (LAB) between 2001 and 2005. All patients underwent cystoscopy and retrograde Double-J ureteral stent placement before pyeloplasty under the same anesthesia. Mean patient age at operation was 11.3 years (median 11.3, range 4.6 to 17.2). Stents were left indwelling for a mean of 10.3 days (median 10, range 7 to 18). All patients tolerated the Double-J stent well, with 2 requiring anticholinergic therapy for mild urgency symptoms and 1 demonstrating urinary tract infection. All patients tolerated outpatient stent removal via the dangler at the office without discomfort. One patient was lost to followup. At a mean followup of 1.04 years (range 0.1 to 2.88) 17 of 19 patients (89%) had resolution of flank pain/urinary tract infections, with sonographic improvement in hydronephrosis with or without endoscopic intervention. Six patients (30%) had flank pain with or without continuous hydronephrosis and required re-stenting, and 3 also required balloon dilation. Of these 6 patients 2 (10%) had recurrent ureteropelvic junction obstruction and required open pyeloplasty. All patients are now clinically and radiologically unobstructed and asymptomatic. Pediatric transperitoneal laparoscopic pyeloplasty with indwelling Double-J ureteral stent with a dangler is successful and the stent is well tolerated. Whether the duration of ureteral stenting affects the surgical success will require further controlled long-term studies.

First Description of Retrograde Balloon Dilatation of the Cardia of Achalasia Using the Retroflexed Gastroscope – Technique and Early Clinical Experience

Although oesophagomyotomy provides the best long-term results for achalasia, pneumatic balloon dilation of the cardia is the preferred treatment modality for many patients. For optimal dilation a 3–4cm balloon is usually positioned across the cardia under radiographic control.

Does retrograde balloon dilation compromise outcome of secondary open pyeloplasty: 17 Years’ experience at a single center

ObjectivesTo determine whether the outcome of secondary open pyeloplasty is compromised by previous retrograde balloon dilation. MethodsPatients undergoing secondary open pyeloplasty after retrograde balloon dilation (n = 25) were compared with a similar group undergoing primary open pyeloplasty (n = 25) at the same institution. Patients were assessed by renography before and after surgery, and postoperative success was determined by the complete absence of pain. ResultsIn the primary pyeloplasty group, the success rate was 96%, with a mean follow-up of 33 months (range 17 to 53). In the secondary pyeloplasty group, the success rate was 88%, with a mean follow-up of 20 months (range 9 to 32). No statistically significant difference was found in the success rates between the two groups (P = 0.6). ConclusionsTreatment failures after retrograde balloon dilation can be salvaged by secondary pyeloplasty with no detriment to the chance of long-term success compared with primary pyeloplasty.

Modified extravesical ureteral reimplantation and routine stenting in kidney transplantation.

In the past, extravesical ureteroneocystostomy has been technically modified several times, with varying results. In this study, we evaluate our experience with modified extravesical re-implantation and routine stenting. From January 1988 to September 2001, 411 consecutive renal transplantations (220 LRD/LUD, 191 CAD) were performed at our institutions. Of 220 kidneys utilized for living related transplantation, 39 were retrieved laparoscopically and 181 were retrieved by open nephrectomy. The ureteroneocystostomy performed was a modified Lich-Gregoir re-implantation with routine stenting, using the upper transplant ureter. A double ureter was encountered in 11 patients and was managed with a conjoint ureteral ostium-to-mucosa anastomosis, using two stents. In two patients with graft ureteropelvic junction (UPJ) stenosis, a double ipsilateral drainage was performed, applying modified extravesical reimplantation with concomitant ureteroneocystostomy. There were no ureteral leaks. Five (1.22%) patients developed temporary ureterovesical junction (UVJ) obstruction/edema following stent removal, which necessitated re-stenting for 4-6 weeks. Two patients (0.49%) developed delayed stenosis and were successfully treated with retrograde balloon dilatation.(One at the UPJ of a pediatric kidney, and one at UVJ). All patients with functioning grafts in this series are currently stent-free. We conclude that the modified extravesical reimplantation with routine stenting is an effective and safe technique in renal transplantation, associated with almost no complications.

Ten years' experience of retrograde balloon dilatation of pelvi-ureteric junction obstruction.

To analyse the long-term success of retrograde balloon dilatation (RBD) of pelvi-ureteric junction obstruction (PUJO). The records of 58 adult patients (mean age 48 years, range 18-94) who had RBD between 1990 and 2001 were reviewed retrospectively. All symptomatic patients were included and assessed by dynamic renography. Success was judged as a symptomatic and/or functional improvement. Recurrence of symptoms was recorded and any evidence of deterioration of function despite improved symptoms. Complications were also recorded. In all, 44 (76%) patients were asymptomatic after RBD. There was no relationship between symptomatic change and renographic improvement; some patients who were rendered pain-free had either no improvement or even deterioration in their split renal function. Conversely, some patients who had a demonstrable improvement in their renal function continued to be symptomatic. However, a long-term follow-up (mean 6.1 years) of nine patients who were symptomatically improved showed good maintenance of split renal function. RBD is an effective treatment for PUJO and its success is maintained in the long term.

Percutaneous antegrade endopyelotomy: long-term results from one institution

Objectives To assess the long-term efficacy of percutaneous antegrade endopyelotomy for the treatment of ureteropelvic junction (UPJ) obstruction performed at a single institution during a 10-year period. We provide alterations in investigation and management strategies on the basis of the results. Methods From July 1990 to June 2001, 80 patients with clinical and radiographic evidence of UPJ obstruction underwent percutaneous endopyelotomy for the treatment of primary (n = 61) or secondary (n = 19) UPJ obstruction. The mean patient age was 35 years (range 4 to 76). Percutaneous endopyelotomy was performed in a standard fashion using either a hooked-knife (n = 77) or holmium laser (n = 3). Results With a mean patient follow-up of 55 months (range 16 to 138), the overall success rate was 67% (53 of 79). The success rate for primary and secondary UPJ obstruction was 65% (39 of 60) and 74% (14 of 19), respectively. The mean time to failure was 15 months (range 1 to 79). Operative intervention for 24 of 26 patients with failure included open pyeloplasty (n = 18, 75%), indwelling ureteral stenting (n = 2, 8%), retrograde balloon dilation (n = 1, 4%), and nephrectomy (n = 3, 13%). Two asymptomatic patients with recurrent radiographic evidence of obstruction elected conservative follow-up. Significant crossing vessels were encountered at open pyeloplasty in 15 (83%) of 18 patients. Conclusions Our long-term results of percutaneous endopyelotomy demonstrated somewhat lower success rates than that reported in published studies. Long-term follow-up is critical in identifying late failures. The high prevalence of crossing vessels encountered at open pyeloplasty provided further evidence to support its role in endopyelotomy failure. Routine preoperative helical computed tomography to detect significant crossing vessels is recommended. Patients with crossing vessels are likely better served with operative techniques that specifically address this issue, namely open or laparoscopic pyeloplasty.

Laparoscopic Pyeloplasty for Secondary Ureteropelvic Junction Obstruction

Laparoscopic pyeloplasty has become a viable option for the treatment of select patients with primary ureteropelvic junction obstruction with success rates similar to those of open surgery. However, little has been written on the application of this technique for secondary ureteropelvic junction obstruction. We report the largest series of secondary ureteropelvic junction obstruction managed by laparoscopic pyeloplasty. Between March 1994 and March 2001, 36 patients underwent laparoscopic transperitoneal pyeloplasty for secondary ureteropelvic junction obstruction. The patients had undergone an average of 1.3 ureteropelvic junction procedures (range 1 to 4) prior to presentation, including cutting balloon retrograde endopyelotomy in 28, antegrade endoscopic endopyelotomy in 7, retrograde endoscopic endopyelotomy in 4, retrograde balloon dilation in 4 and open pyeloplasty in 3. A preoperative diagnosis of recurrent obstruction was confirmed by renal scan in 31 cases, retrograde pyelography in 2 and computerized tomography in 3. Of the 31 patients who underwent spiral computerized tomography angiogram 87% had crossing vessels. Laparoscopic repair comprised dismembered pyeloplasty in 31 cases, Fengerplasty in 3 and flap repair in 2. Postoperative renal scan or excretory urography objective followup was available for all patients at a mean of 10 months (range 3 to 40). Postoperative subjective patient well-being was assessed using an analog pain scale at a mean followup of 21.8 months (range 3 to 85). Average operative time was 6.2 hours (range 2.7 to 10). Average hospital stay was 2.9 days (range 1 to 7). One intraoperative complication occurred, that is bleeding necessitating conversion to an open procedure. Postoperative complications occurred in 8 cases, including anastomotic leakage in 4, and urinary tract infection, pneumonia, atelectasis, fever, bilateral upper extremity weakness and stone formation 2 months postoperatively in 1 each. On excretory urography, furosemide renal scan or the Whitaker test 32 of 36 patients (89%) had a widely patent ureteropelvic junction. Two patients (5.5%) had equivocal radiographic studies but were asymptomatic. In 2 patients the ureteropelvic junction was obstructed by renal scan. One patient had an indwelling stent for renal function deterioration and 1 was asymptomatic. Hence, 34 of the 36 patients (94%) had a reasonable objective response. Overall a 50% or greater decrease in pain was seen in 32 of 36 patients (89%). In the 4 patients with a less than 50% decrease in pain objective renal scans showed an open ureteropelvic junction. As such, the overall success rate of a greater than 50% decrease in pain, a patent ureteropelvic junction and stable or improved function of the affected renal unit was 83% (30 of 36 patients). For secondary ureteropelvic junction obstruction, laparoscopic pyeloplasty can be performed safely with a success rate comparable to that of standard open pyeloplasty. The patient benefits of laparoscopic ureteropelvic junction repair of secondary ureteropelvic junction obstruction are similar to the benefits of laparoscopic repair of primary ureteropelvic junction obstruction.

Simple retrograde balloon dilation for treatment of ureteral strictures: etiology-based analysis.

This study consists of an analysis of the results of simple retrograde balloon dilation in the treatment of ureteral strictures for the evaluation of the long-term efficacy of this procedure, and the factors affecting its success rate. A prospective study was performed on 43 ureteral strictures (22 malignant, 21 benign) from 37 patients treated with retrograde balloon dilation from October 1997 to May 1999. After the stricture segments were dilated, ureteral stents were indwelled uniformly for 3 weeks. Strictures were postoperatively followed up radiographically at 1, 3, 6 and 12 months, and annually thereafter. Success was defined by symptomatic and radiographic improvement. The follow-up periods ranged from 8 to 57 months (mean 41 months). The success rates of the benign strictures at 12 and 36 months were much higher than those of the malignant strictures (67 and 57% vs., 18 and 14%, p=0.0009). While 56% and 47% of the patients with strictures shorter than 2 cm were successful at 12 and 36 months, respectively, none with strictures longer than 2 cm were successful at the same follow-up periods (p=0.0002). Of the successful benign cases with a shorter segment at 12 months, 12 out of 14 (86%) showed persistent long-term successes at the 36 months follow-up. Other prognostic factors, such as sex, age, location, disappearance of a waist, dilation time and grade of hydronephrosis, were not found to influence the success rate. A multivariate analysis revealed the etiology and stricture length were the only significant prognostic factors affecting the final outcome (p=0.030 and p=0.0262, respectively, by Cox's proportional hazards model). In consideration of its minimal invasiveness and acceptable long-term outcome, simple retrograde balloon dilation is an effective treatment modality for benign ureteral stricture with a short segment (< or = 2 cm), and a shorter duration of stenting (3-weeks) is viable.

LAPAROSCOPIC DISMEMBERED TUBULARIZED FLAP PYELOPLASTY: A NOVEL TECHNIQUE

Laparoscopic dismembered pyeloplasty is now an effective option for ureteropelvic junction obstruction. We describe a novel laparoscopic technique of dismembered tubularized flap pyeloplasty for a difficult recurrent long ureteropelvic junction stricture. A 73-year-old woman with ureteropelvic junction obstruction of a solitary left kidney had undergone failed multiple procedures, including open pyeloplasty, balloon incision endopyelotomy, retrograde balloon dilation and percutaneous endopyelotomy. Using a 4-port transperitoneal laparoscopic technique, the upper ureter was dissected, the scarred ureteropelvic junction stricture was excised and the dismembered ureteropelvic junction was closed with a stitch. A wide base renal pelvic flap was created and tubularized to bridge the 3 cm. upper ureteral defect. Laparoscopic intracorporeal freehand suturing was done to reconstruct the renal pelvis and upper ureter over a Double-J stent (Medical Engineering Corp., New York, New York). Total operative time was 4.5 hours and hospital stay was 4 days. The stent was removed 3 weeks later. At the 2-month followup the patient was asymptomatic. Excretory urography and diuretic renal scan confirmed a widely patent upper ureter with unobstructed drainage. Dismembered renal pelvis tubularized flap pyeloplasty can be successfully performed laparoscopically to bridge a long upper ureteral defect. This approach is feasible even in a ureteropelvic junction in which previous surgery has failed.

Balloon Dilation of Severe Aortic Stenosis in the Neonate: Comparison of Anterograde and Retrograde Catheter Approaches

Objectives. We sought to compare anterograde and retrograde balloon dilation of severe aortic valve stenosis in neonates.Background. There is a high incidence of iliofemoral artery complications after retrograde balloon dilation of the aortic valve in the neonate. Therefore, a nonarterial technique of catheter access to the aortic valve would be worth exploring.Methods. Group 1 included 11 consecutive patients (median age 6 days, range 1 to 42; median weight 3.5 kg, range 2.16 to 4.25) undergoing attempted anterograde dilation through a femoral venous approach. Group 2 included 15 patients (median age 3 days, range 1 to 35; median weight 3.4 kg, range 2.5 to 4.4 kg) who underwent attempted retrograde dilation, including 2 in whom attempted anterograde approach had failed.Results. The valve was successfully crossed in 9 of 11 anterograde and 13 of 15 retrograde dilations. In both groups, the peak gradient across the valve decreased significantly (both p = 0.001). On echocardiography, the jet width of the aortic incompetence/annulus diameter ratio was 0.16 ± 0.08 (mean ± SD) after anterograde and 0.51 ± 0.24 after retrograde dilation (p = 0.03), possibly because of unrecognized valve leaflet perforation. Two patients in group 1 developed persistent, mild mitral insufficiency. Femoral artery thrombosis developed in one patient after anterograde dilation and in eight after retrograde dilation (p = 0.03).Conclusions. This series demonstrates that an anterograde approach for balloon angioplasty of severe neonatal aortic valve stenosis is feasible, achieves good hemodynamic relief and lessens morbidity compared with retrograde arterial techniques.

Retrograde balloon dilatation for primary pelvi-ureteric junction stenosis in children: Y. Sugita, T.D. Clarnette, and J.M. Hutson. Br J Urol 77:587–589, (April), 1996

Retrograde balloon dilatation for primary pelvi-ureteric junction stenosis in children: Y. Sugita, T.D. Clarnette, and J.M. Hutson. Br J Urol 77:587–589, (April), 1996

Retrograde balloon dilatation for primary pelvi-ureteric junction stenosis in children.

To evaluate the efficacy of retrograde balloon dilatation for primary pelvi-ureteric junction (PUJ) stenosis (RBDP) in children. Sixteen children (12 boys, four girls; mean age 29 months) with primary PUJ stenosis initially underwent RBDP. A double-pigtail catheter was left in the ureter for 6 weeks to provide drainage. The initial diagnosis of PUJ stenosis and the subsequent post-operative assessment were both made by diuretic renography in almost all patients. All children were followed up for between 9 and 38 months (mean 25) after the procedure. RBDP was unsuccessful in nine of 17 renal units. In three of these, failure was caused by inability to pass the catheter through the PUJ or vesico-ureteric junction (VUJ). In six cases, failure was caused by recurrent or persistent stenosis. In eight of 17 renal units, RBDP was successful in relieving the stenosis. The morbidity from the procedure was minimal. Long-term follow-up revealed a significant failure rate for RBDP, caused by the inability to pass the catheter through the VUJ or PUJ, or persistent and/or recurrent stenosis. Recurrent stenosis may result from excessive dilatation which traumatizes the PUJ and causes subsequent scarring. Failure to overcome the stenosis is thought to be caused by a large redundant renal pelvis, producing 'kinking' of the upper ureter. In these cases, only reduction pyeloplasty may be successful in relieving the obstruction.

Retrograde balloon dilation of ureteropelvic obstructions in infants and children: Early results

Although balloon dilation is a successful and widely accepted minimally invasive method of treating vascular, esophageal, and colonic strictures, it has not been reported in the management of ureteropelvic junction (UPJ) obstruction in infants. We investigated the role of retrograde balloon dilation as the primary treatment of UPJ obstruction in infants, and we report the technique and early results. Prospective study of infants and young children undergoing retrograde balloon dilation of primary UPJ obstruction using a 3.8 F, 8 atmosphere radial balloon dilator. Ten infants and children with a median age of 16 months (range, 3 months to 9 years 6 months) underwent retrograde balloon dilation for proven UPJ obstruction with successful outcome in 7 patients following one dilation. The minimally invasive nature of this technique and our encouraging early results lead us to conclude that this technique warrants further clinical evaluation.

Retrograde Dilation of Postsaccal Lacrimal Stenosis

The causes of nasolacrimal duct stenosis in adults can vary greatly. In general, the symptoms can also vary, but most cases share a tendency toward recurring inflammations in the prestenotic area. The treatment of these disorders is limited to either conservative therapy to control inflammation or surgically invasive measures. By using balloon catheters, usually applied in percutaneous transluminal coronary angioplasty (PTCA), dilation of the relative postsaccal stenosis can be performed under radiographic control. An exact diagnosis using various testing methods, including digital dacryocystography for detailed localization and documentation of any pathologic changes, is decisive to success. Only in cases of incomplete postsaccal stenosis is retrograde balloon dilation of the distal nasolacrimal duct indicated. A guide wire, designed for the PTCA balloon catheter set, is introduced via the canaliculus to the nasal cavity antegradely and caught with a thin hook and pulled from the naris, under visual control with an image converter. The balloon catheter is retrogradely threaded over the guide wire. The baloon is then placed at the site of the pathologic stenosis under radiographic control and dilated with high pressure. To ensure the permeability of the system, monocanalicular silicone intubation has to be performed immediately afterwards. This procedure has been performed successfully on 6 patients with a follow-up of 6 to 27 months. These initial results give rise to the hope that this minimally invasive, interdisciplinary technique represents a new alternative in the treatment of incomplete postsaccal lacrimal stenosis.

Lacrimal balloon dilatation

Retrograde balloon dilatation under X-ray visualization presents a new way of treatment of incomplete postsaccal stenosis. These stenoses in the area of the nasolacrimal duct in adults exhibit a common factor of favorable circumstances in the prestenotic area for recurring inflammations. The treatment of these disorders was-up to now-limited to either a conservative therapy to control inflammation or surgically invasive measures. The new method of treatment enables us to dilate incomplete stenoses without any alteration of skin and without bleeding.After different functional tests a digital dacryocystography is performed using a computer controlled X-ray unit with a C-arc coupled to an image intensifying TV-system. This gives the indication for balloon dilatation. A balloon catheter set originaly designed for the PTCA (percutaneous, transluminal coronary angioplasty) is used. After placing the guiding wire via canaliculi and lacrimal sac into the nose antegradely the balloon catheter is retrogradely posit...

Modified Ileocolonic Bladder: 5Years of Experience

A total of 25 patients 17 to 78 years old (mean age 61 years) underwent bladder replacement with a modified ileocolonic bladder: 20 underwent construction of the neobladder following cystoprostatectomy for invasive bladder tumor, 4 after cystectomy for severe interstitial cystitis and 1 for undiversion. There were 21 men and 4 women. Followup ranged from 3 to 66 months. There were no perioperative deaths. The early complication (perioperative 3 months) and late complication rates were 18% and 16%, respectively. Complications included ureterocolonic anastomotic strictures in 4 ureters (3 were treated via endoscopic retrograde balloon dilation and 1 with endourological antegrade dilation), urethral strictures in 2 patients, treated by urethral dilation, pancreatitis 2 weeks postoperatively in 1 and mild hyperchloremia without concomitant acidosis in 2. One patient presented 3 years postoperatively with a left mid ureteral stone that was managed by ureteroscopic extraction. Three patients died of recurrent carcinoma (none with urethral recurrence). The daytime continence rate was 100% and the nighttime continence rate was 92%. The ureters in this modified ileocolonic bladder were placed in an anatomically correct position to resemble a trigone near the mouth of the neobladder with the left ureter uncrossed. This placement provided easy visualization and instrumentation of the upper urinary tract. No patient had vesicoureteral reflux.

Retrograde Mitral Valvuloplasty—A Further Approach to Balloon Commissurotomy

Mitral valve balloon dilatation usually requires transseptal puncture. We performed a mitral valve dilatation without transseptal puncture, introducing guidewires and balloons exclusively from the arterial side in a 37‐year‐old woman with post‐rheumatic mitral stenosis. Three months later, pulmonary artery pressure had decreased from 60/35 to 40/20 mmHg and the enddiastolic pressure gradient from 20 to 8 mmHg. The mitral valve area increased from 1.3 to 2. 3 cm2. The severely disabled patient was asymptomatic following the procedure. This case demonstrates the possibility of performing retrograde balloon dilatation of the mitral valve without transseptal puncture.

New Technique: Ureterorenoscopic Urothelial Endoureteroplasty: Case Report

Traditionally, management of ureteral stricture has been with open surgical repair. The development of antegrade and retrograde balloon dilation along with ureteral stinting has introduced new options for the treatment of this disease. Results, however, have been inconsistent, with not-infrequent recurrence of stricture formation necessitating open repair or nephrectomy. Herein, we report a distal ureteral stricture following ureterolithotomy managed with retrograde ureterorenoscopic electroincision and placement of a stent bearing two free urothelial grafts into the bed of the incised stricture. Follow-up at 3 months (6 weeks after removal of the ureteral stent) reveals the ureter to be patent. The patient remains asymptomatic 8 months after the procedure.

Ureteral Stricture: Experience with 31 Cases

We reviewed the records of 31 patients treated during the last 5 years for ureteral stricture disease. The causes of stricture formation included ureteroenteral anastomoses (23 per cent), open ureterolithotomy (19 per cent), ureteroscopy (19 per cent), other urological procedures (16 per cent), general surgical and gynecological procedures (13 per cent) and miscellaneous causes (7 per cent).Of the patients 24 were managed initially with antegrade or retrograde balloon dilation or stenting and favorable outcomes were achieved in 12 (50 per cent), with a mean followup of 13 months. Of the 12 patients who failed endourological management 6 subsequently underwent open repair with a 100 per cent success rate. The remaining 7 patients underwent an open operation as the initial management and successful results were achieved in 6. The over-all rate of successful management of ureteral stricture disease using endoscopic and open surgical techniques was 77 per cent. A total of 7 patients (23 per cent) failed attempts at intervention: 5 showed evidence of decreasing renal function and 2 required nephrectomy. (J. Urol, 140: 737-740, 1988)