Ureteroscopic endoureterotomy

Abstract

OBJECTIVE To highlight the current status of ureteroscopic endoureterotomy (UE) by reporting extensive experience with the endoscopic management of ureteric strictures, with special emphasis on factors determining success, and by reviewing publications on the minimally invasive management of ureteric strictures. PATIENTS AND METHODS The study comprised 50 patients (mean age 53 years, range 18–85, equal sex distribution) with ureteric strictures of varying causes; all had their stricture treated endoscopically. The follow‐up was 0.5–9 years; 10 patients with recurrent strictures had two ipsilateral stents placed to try to improve the outcome, and eight patients with completely obliterating strictures were treated by ureteroscopic re‐canalization. RESULTS The site of stricture had no bearing on the eventual outcome. Patients with uretero‐enteric and malignant strictures did not fare so well. The most important predictor of failure was the length of the stricture, with failure in all seven patients with strictures of > 2 cm. In the 10 patients treated with two ipsilateral stents, eight were successful, which was very promising considering that these patients had recalcitrant strictures and placing one stent had previously failed. The overall success rate was 74%. CONCLUSION UE has become the procedure of choice for the initial management of ureteric strictures. Simple balloon dilatation is also effective in certain situations. The characteristics of the stricture often govern the eventual outcome. In properly selected cases success rates of ≈ 75% can be expected.

Single Versus Double Ureteral Stent Placement After Laser Endoureterotomy for the Management of Benign Ureteral Strictures: A Randomized Clinical Trial

“…Razdan and associates 8 have shown that double stent placement may increase the likelihood of success when encountering a difficult stricture with previously failed intervention. Some authors advocated using two stents, which may act as a mold around which the ureter reforms with wide lumen.…”

Laparoscopic reconstruction of iatrogenic-induced lower ureteric strictures: Does timing of repair influence the outcome?

“…Endourological reconstruction of these pathologies seldom suffices. [5] In the presence of a salvagable renal unit, uretereoneocystostomy with or without Boari flap remains the most desired option for restoration of ureteral continuity. Contrastingly, in iatrogenic lower ureteric injuries conventional practice entails attempting a temporising measure (ureteral stent or nephrostomy) primarily, deferring definitive reconstruction for an interval of six weeks.…”

Endoscopic ureterotomy for the treatment of ureteric stricture following laparoscopic oophorectomy

“…1,5,6 Acucise endoureterotomy is more commonly used for treatment of short-segment ureteric strictures that develop after urologic procedures such as pyeloplasty, renal transplantation, ureterocystoneostomy, ureteroenteric anastomosis, calico-ureterostomy, and transurethral resection of the ureteral orifice. 5 There have been case reports of Acucise endoureterotomy used for the treatment of stricture formation after gynecologic procedures such as hysterectomy, 6,7 but we were unable to identify any reports of the use of this procedure after laparoscopic ureteric injury.…”

“…1 The device consists of an inflatable balloon and monopolar electrical wire. A retrograde pyelogram is performed to identify the area of stricture, and the Acucise device is placed into the ureter along a guidewire inserted by a cystoscope through the bladder.…”