title: Endoscopic treatment of ureteric strictures: acucise, cold-knife endoureterotomy and wall stents as a salvage approach.
abstract: OBJECTIVE
  To evaluate the factors influencing the results of endoureterotomy using cold-knife and cutting balloon dilatation, and permanent ureteral wall stents in patients with benign ureteral strictures after different operations affecting the ureter.
  
  
  METHODS
  Over a 4-year period, in 18 patients, endoscopic cold-knife and Acucise endoureterotomies were performed in 13 and 7 renal units, respectively. Eight Memoterm permanent ureteral wall stents were inserted into 7 patients when endoureterotomy failed. Successful outcome was defined by the absence of re-stricture assessed both clinically and radiologically.
  
  
  RESULTS
  The strictures were secondary to ureterolithotomy in 6, ureteroscopy in 3, gynecological procedures in 4, abdominal surgeries in 2, transplantation in 2 and continent urinary diversion in 1. The right and left ureters were unilaterally affected in 5 and 11 patients, respectively (5 of them had a solitary kidney), while the remaining 2 patients had bilateral ureteral strictures. We achieved total ureteral patency of 3 (43%) and 7 (54%) renal units with Acucise and cold-knife incision, respectively. Obstructive uropathy was resolved in 6 renal units (75%) of 8 using ureteral wall stents.
  
  
  CONCLUSIONS
  Endoureterotomy with cold-knife or Acucise cutting balloon dilatation is effective in the treatment of iatrogenic ureteral strictures, but only in a selected group. Based on our results, the favorable prognostic criteria for endoureterotomy are the length (< or =1.5 cm), the nonischemic nature of the stricture and adequate renal function. As a salvage approach, permanent self-expanding ureteral wall stents with a 75% success rate may provide a satisfactory outcome for decompression of an obstructed system.
authors.affiliation: Department of Urology, Akdeniz University Faculty of Medicine, Antalya, Turkey. terdogru@akdeniz.edu.tr
authors.forename: Tibet
authors.initials: T
authors.lastname: Erdogru
authors.forename: Omer
authors.initials: O
authors.lastname: Kutlu
authors.forename: Turker
authors.initials: T
authors.lastname: Koksal
authors.forename: Ahmet
authors.initials: A
authors.lastname: Danisman
authors.forename: Mustafa F
authors.initials: MF
authors.lastname: Usta
authors.forename: Erdal
authors.initials: E
authors.lastname: Kukul
authors.forename: Mehmet
authors.initials: M
authors.lastname: Baykara
mesh_terms: D000328:Adult; D000368:Aged; D003452:Cryosurgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy; D015607:Stents; D014517:Ureteral Obstruction / Q000601:surgery*; D018666:Ureteroscopy