Endoscopic Balloon Dilatation in the Treatment of Benign Ureteral Strictures: A Meta-Analysis and Systematic Review

Lu, Chaoyue; Zhang, Wei; Peng, Yonghan; Li, Ling; Gao, Xianhua; Liu, Min; Fang, Ziyu; Wang, Zeyu; Ming, Shaoxiong; Dong, Huijuan; Shen, Rong; Xie, Fei; Sun, Yinghao; Gao, Xin

doi:10.1089/end.2018.0797

Cited by 35 publications

(33 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In univariate analysis, no significant statistical difference had revealed among different stenosis sites or the number of stents retained. It is similar to previous studies that reported that there was no apparent association between stricture location (upper, mid, or distal ureter) with long-term success rate [18,[20][21][22][23][24]. M.J.van Son's study reported that the stricture side was an independent risk factor for stricture recurrence (P = 0.009, HR 0.35, 95%CI 0.16-0.77) [8].…”

Section: Discussionsupporting

confidence: 86%

A nomogram to predict stricture-free survival in patients with ureteral stricture after balloon dilation

Lai

Gao

et al. 2021

BMC Urol

View full text Add to dashboard Cite

Background Balloon dilation is a commonly used minimally invasive endourological treatment of ureteral stricture, but the postoperative recurrence rate is relatively high. And factors contributing to recurrence after treatment are poorly understood. Herein, we sought to develop a novel clinical nomogram to predict ureteral stricture-free survival in patients suffering from ureter stricture and performed balloon dilation. Methods The nomogram was established based on a retrospective analysis of 321 patients who received endoscopic balloon dilation alone for ureter strictures from January 2016 to January 2020 in Sun Yat-sen Memorial Hospital using the Cox regression model. Perioperative clinical data and disease outcomes were analyzed. The primary endpoint was the onset of ureteral re-stricture after ureter balloon dilation. Discrimination of the nomogram was assessed by the concordance index (C-index) and the calibration curve. The results were internally validated using bootstrap resampling. Results Overall, 321 patients with a median follow-up of 590 days were enrolled in the study, among which 97 patients (30.2%) developed recurrence of ureteral stricture during follow-up. Five variables remained significant predictors of ureteral re-stricture after multivariable analyses: stricture nature (P < 0.001), urinary nitrite (P = 0.041), CKD (P = 0.005), stent retention time (P < 0.001), and balloon size (P = 0.029). The calibration craves for the probability of 1-, 3-, and 5-years stricture-free survival (SFS) presented satisfied with the consistency of nomogram prediction and actual observation. The C-index of the model was 0.74 (95% CI 0.70–0.79). Conclusions Our study developed the first nomogram to effectively predict stricture-free survival in patients suffering from ureter stricture after balloon dilation. It is helpful to identify the optimal patients with ureter stricture for balloon dilation and improve treatment outcomes. However, further external validation of the nomogram is warranted.

show abstract

Section: Discussionsupporting

confidence: 86%

A nomogram to predict stricture-free survival in patients with ureteral stricture after balloon dilation

Lai

Gao

et al. 2021

BMC Urol

View full text Add to dashboard Cite

show abstract

“…Four years later, Banner et al reported the use of balloon dilation in ureteral strictures with a 48% success rate in 44 patients (7). A recent meta-analysis summarized a total of 19 studies from 1983 to 2016 and showed a short-term success rate of 60%±10% and a long-term success rate of 54%±14% with a random effects model (8). The outcome of balloon dilation is influenced by several parameters, such as stricture etiology, stricture length, stricture location, renal function, and stent duration (9).…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopy-free minimally invasive ureteral stricture balloon dilatation: a retrospective safety and efficacy cohort study

Peng¹,

Li²,

Li³

et al. 2021

Transl Androl Urol

View full text Add to dashboard Cite

Background: Traditional ureteral stricture balloon dilation was performed with fluoroscopic assistance.The use of a C-arm X-ray machine delivered hazardous radiation to both surgeons and patients. In attempt to eliminate the radiation hazard, we developed a F4.5/6.5 ureteroscope assisted intraoperative X-ray free balloon dilation surgical approach to treat ureteral stricture and to verify its safety and efficacy. Specifically, this method had not been previously reported in the literature. Methods:We demonstrated an intraoperative X-ray free balloon dilation with detailed step-by-step procedures description and video illustration. Clinical data of patients undergoing minimally invasive endourological treatment for ureteral stricture between February 2015 and November 2019 were retrospectively analyzed. All steps of X-ray free balloon dilation were carried out under direct vision of a ureteroscope, and two indwelling F7 ureteral stents were used for 3 months postoperatively. Preoperative, intraoperative, and postoperative clinical data were evaluated, and follow-up results were reported. Successful outcome was defined as disappearance of preoperative symptoms, relief of hydronephrosis and stable of renal function. Univariate and multivariate prognostic analyses were performed.Results: We identified 109 patients who received endourological treatment for ureteral stricture in our hospital's medical database. After excluding patients undergone simple catheter dilation, endoureterotomy and other treatment method, 76 patients received balloon dilation without intraoperative fluoroscopic guidance were included in our study. 4/76 patients report a grade II complication (urinary tract infections, UTIs) according to Clavien Dindo classification. In the 22.5 months median follow-up time, the one-year cumulative success rate and two-year cumulative success rate were 85.9% and 80.2% (61/76), respectively, and the majority (13/15, 86.7%) recurrence of ureteral stricture or hydronephrosis deterioration were found within two years after surgery. The longer stenotic lesion length (>5 mm) or multiple ureter stenosis and compromised blood supply of ureter were significantly associated with postoperative stenosis recurrence.Conclusions: X-ray free endoscopic balloon dilation is a safe and effective procedure that could be performed on patients with ureteral stenosis.

show abstract

“…Congenital factors and secondary causes, such as surgical injuries, stones, infections, and trauma, can cause benign ureteral stricture [16]. Balloon dilatation is considered to be the most suitable method for the endoscopic treatment of ureteral stricture due to its fewer complications and low cost [17] with a high technical success rate up to 89% [18]. But sometimes, we will encounter the situation where the stricture segment is so narrow that it can only allow the guide wire to pass and the balloon cannot be inserted.…”

Section: Discussionmentioning

confidence: 99%

The Innovative Use of Ureter Catheter in the Surgery of Obstructive Uropathy

Zhan

Ding

Wang

et al. 2021

Computational and Mathematical Methods in Medicine

View full text Add to dashboard Cite

Purpose. Relieving obstruction and protecting renal function are the main therapeutic purposes of obstructive uropathy which often involve surgical treatment, and the ureter catheter is one of the surgical instruments commonly used in surgery. We aimed to explore the innovative use of a ureter catheter in the surgery of obstructive uropathy. Methods. We used a ureteral catheter to innovate the surgical procedure of the most common causes of obstructive uropathy: ureteral calculi and stricture, establishing an internal circulation system (ICS), proposing a three-step dilatation method, and reviewing their effects on patients. Furthermore, we introduced a simple real-time intrapelvic pressure measurement device to monitor intrarenal pressure during operation. Results. Postoperative laboratory examination showed that blood CRP, leukocyte neutrophil level, changes in the hemoglobin, urine occult blood, and positive rate of urine culture in the ICS group are significantly lower than those in the control group, corresponding to a lower incidence of bleeding and infection-related complications clinically. A three-month follow-up revealed 1/3 rate of ureteral stricture in the ICS group comparing to the control. We applied the three-step dilatation in patients with severe stenosis in which the balloon could not pass; the overall effective rate was 90.9%. The pressure of the renal pelvis was displayed on the monitor in real time. The surgeon could estimate the degree of filling of the renal pelvis and adjust the intake volume through the data. Conclusion. The innovative application of ureteral catheters in the operation of obstructive uropathy can realize the real-time monitor of intraoperative renal pelvis pressure, reduce the incidence of lithotripsy postoperative complications, and expand the indications of balloon dilatation in ureteral stricture, which has certain clinical significance.

show abstract

Endoscopic Balloon Dilatation in the Treatment of Benign Ureteral Strictures: A Meta-Analysis and Systematic Review

Cited by 35 publications

References 40 publications

A nomogram to predict stricture-free survival in patients with ureteral stricture after balloon dilation

A nomogram to predict stricture-free survival in patients with ureteral stricture after balloon dilation

Fluoroscopy-free minimally invasive ureteral stricture balloon dilatation: a retrospective safety and efficacy cohort study

The Innovative Use of Ureter Catheter in the Surgery of Obstructive Uropathy

Contact Info

Product

Resources

About