Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution

Abstract

Introduction: Ureteral strictures are a significant cause of morbidity and mortality, resulting in potential kidney damage requiring several surgical procedures. Non-malignant causes include radiation, trauma from calculi impaction, pelvic surgery, or ureteroscopy (URS). We identified risk factors in our patients with ureteral strictures and the success of their treatment outcomes. Methods: A retrospective chart review of 25 patients with 29 ureteral strictures was performed to determine the success of their treatment. Results: Twenty-five (25) patients with 29 benign ureteral strictures were identified. Most cases (60%) were caused by impacted stones where the median stone size was 1.15 cm (0.37-1.8 cm). Intervention for stones prior to stricture development included shockwave lithotripsy, URS, and percutaneous nephrolithotomy. Five patients with strictures from impacted stones had ureteric complications during stone treatment including perforation +/-urinoma (n=3), fractured guidewire left in situ (n=1), and ureteric orifice resection (n=1). Other stricture etiologies included radiation (28%) and endometriosis (4%). Treatment modalities used included ureteroureterostomy (n=2), ureteral re-implant (n=3), urinary diversion (n=3), autotrasplant (n=1), laser endoureterotomy +/-balloon dilation (n=8), nephrectomy (n=2), balloon dilation +/-stent (n=3), ureterovesical junction (UVJ) resection + stent (n=1), chronic stent changes (n=4), or surveillance (n=3). Conclusions: Our evaluation highlights important principles. Patients with complicated ureteroscopies or severely impacted calculi warrant close followup with imaging after stone treatment due to possibility of rapid renal deterioration from stricture formation. Radiation-induced strictures are difficult to manage, possibly requiring subsequent urinary diversion. Finally, endoscopic management of benign ureteral strictures via balloon dilation and laser endoureterotomy is an excellent choice in properly selected patients, with opportunity for subsequent salvage treatments if needed.

miR‐140‐5p‐mediated regulation of the proliferation and differentiation of human dental pulp stem cells occurs through the lipopolysaccharide/toll‐like receptor 4 signaling pathway

“…Specific concentrations of LPS can stimulate proliferation, adhesion, and migration of DPSCs, which are likely to affect pulp healing. Furthermore, LPS promotes odontoblastic differentiation of DPSCs through the TLR‐4, ERK, and p38 MAPK signaling pathways . Importantly, TLR‐4 activation is essential for LPS‐mediated proliferation and differentiation of DPSCs.…”

“…Dental pulp stem cells were seeded at a density of 1 × 10 4 cells per well in 24‐well plates and, on the following day, the DPSCs were transfected with 10 nM miRNA mimic/inhibitor for 24 h. For odontogenic differentiation, DPSCs were cultured in odontogenic‐inducing medium, as previously described . Osteogenic in vitro differentiation was evaluated using an alkaline phosphatase (ALP) staining kit (Biyuntian Biotech, Shanghai, China).…”

Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy

“…Ureteral obstruction or stricture formation following URS would have a negative impact on renal function [ 21 ]. Hydronephrosis resulting from obstruction has been acknowledged to harm the parenchyma of the kidney, resulting in renal failure [ 22 ].…”

Death of the Safety Guidewire

“…37 Delvecchio and colleagues found only one ureteral stricture in a series of 71 patients in which a ureteral access sheath was used and placed over a guidewire 38 , which is comparable to reported 0-4% rates of post-ureteroscopy strictures among patients in whom no ureteral access sheath was employed. 39 Ureteral access sheath placement also facilitates endoscopically guided access during PCNL, a technique that allows for direct visualization of nephrostomy needle placement into the collecting system. Employment of a ureteral access sheath aids in securing a "through-and-through" guidewire, subsequent tract dilation, and placement of This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction.…”