Balloon Catheter Dilatation in the Treatment of Ureteral and Ureteroenteric Stricture

Abstract

Balloon catheter dilatation is a low-cost alternative to open surgery in patients with ureteral strictures, leading to low morbidity and short hospitalization. The goal of this study was to evaluate the results of this technique in patients with inflammatory ureteral strictures or ureteroenteric strictures after radical cystectomy. Twenty-five ureteral strictures in 20 (15 male, 5 female) patients were consecutively treated by high-pressure balloon dilatation: 14 cases of ureteroenteric stricture (9 after ileal cutaneous diversion, and 5 after orthotopic enterocystoplasty) and 11 of ureteral stricture from various inflammatory causes (tuberculosis, iatrogenic injury, radiation therapy, parasitosis). Dilatation was performed by an antegrade (ureteroenteric strictures) or retrograde (inflammatory strictures) approach using a balloon insufflated up to 10 to 20 atm for 5 to 15 minutes. The ureter was stented for a mean time of 2.1 months (range 1-5 months). Results were evaluated clinically and radiologically (intravenous urogram or CT scan). Immediate success was assessed by intraoperative radiologic monitoring. Long-term success was defined as the absence of recurrence of the stenosis after 6 months. Nineteen procedures were successful among the 23 evaluable cases. With a mean follow-up of 16 months (range 6-39 months), the long-term success rate was 52%: 40% in ureteral strictures and 61% in ureteroenteric strictures. Five strictures secondary to cutaneous diversion and six caused by radiation therapy recurred after dilatation. After cutaneous diversion, the failure occurred mostly at the anastomosis and involved the crossed-over ureter. This study shows that high-pressure balloon dilatation of ureteral strictures has a high early success rate and a long-term success rate of 52%. It can therefore be considered as an alternative to open surgery.

Ureterointestinal strictures following Bricker ileal conduit: management via a percutaneous approach

“…Of note, three of these patients were managed under local anesthetic regimens. Ravery et al [21] using high pressure balloon dilatation of the stricture through a percutaneous procedure reported an early success rate of 80%, while long-term success (patent ureter after 6 months) was 61% in 23 patients; mean follow-up 16 months. Bierkens et al included balloon dilation in their technique along with semi-rigid fascial dilators, and managed successfully 12 out of 15 patients [19].…”

Antegrade Percutaneous Endoluminal Treatment of Non–Malignant Ureterointestinal Anastomotic Strictures following Urinary Diversion

“…In order to exclude a local cancer recurrence safely, the biopsy from the affected ureterointestinal area during the open surgical revision seems to be the most reliable method [4, 5]. However, in cases of endourological treatment, imaging methods (CT scans of the abdomen and pelvis) together with endoscopy of the conduit and urinary cytology should be part of the preoperative evaluation of patients with a history of pelvic cancer [11, 22]. The initial tumor staging may help to avoid histological examination during the endoluminal therapy.…”

“…In 1983 and 1988, Shapiro et al [6]and Banner et al [20]reported a short–term success rate of 40% with balloon dilatation that fell to 16% after 1 year [6, 20]. In contrast to these results from the USA, a French team [22]reported a long–term success rate of 61% using a high–pressure balloon dilatation (until 20 atm for 5–15 min). In 1988, Kramolowski et al [4]tried to improve the effectiveness of the dilatation using an endoscopic electro–incision before the dilatation.…”

“…Bierkens et al [8]had a success rate of 53%, with ureteral stenting for a minimum of 6 weeks. Contrarily, Ravery et al [22]postulated that the increased duration of ureter stenting may have promoted healing the ureter and attributed to the high success rate of 61% to the very long duration of stenting (4–30 months). According to our results, stenting may be advocated for 6–8 weeks, which is also widely accepted in the literature (table 3).…”

“…Although some authors recommended a second endourologic treatment with balloon dilatation, the long–term results of the multiple attempts were comparable with those of the first treatment [30, 31]. Ravery et al [22]suggested a combination of different methods (for example balloon dilatation and incision) as a possible alternative, but the long–term results were also disappointing [4, 11, 24]. Bierkens et al [8]reported a 33% success rate in 3 patients with ureterointestinal stricture recurrence after a second dilatation in patients followed–up for 12 months.…”