Ureteroscopic endoureterotomy.
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.


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%.


CONCLUSIONS
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 approximately 75% can be expected.
Razdan
Sanjay
S
Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Silberstein
Irene K
IK
Bagley
Demetrius H
DH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*