Endourologic treatments of distal ureteral obstruction in patients with history of pelvic malignancies: efficacy and safety evaluation.
OBJECTIVE
Postoperative tissue adherence, scarring and radiotherapy often lead to extrinsic compression and stricture in the distal ureter of the patients who had history of pelvic malignancies. Our aim was to evaluate the efficacy and safety of endourologic techniques in treating this kind of ureteral obstruction.


METHODS
From Jan. 1998 to Mar. 2007, 46 patients with obstruction in the distal ureter and had history of pelvic malignancies underwent endoscopic treatments at the Third Affiliated Hospital of Sun Yat-sen University for relief of the obstruction. Perioperative and follow-up data were analyzed.


RESULTS
Of the 46 patients, 25 underwent laparoscopic ureterolysis and uretero-neocystostomy, 18 underwent placement of ureter stent under ureteroscope, 3 underwent percutaneous nephrostomy. No severe complication was recorded. The mean operating time was 82.5 min (range, 30-140 min). The mean blood loss was 45.5 ml (range, 5-180 ml). No blood transfusion was needed. The median follow-up time was 18.2 months (range, 3 months to 6.5 years). Three months after operation, B-ultrasonography and intravenous urography (IVU) showed that 39 (84.8%) patients had recovered normal renal function, the other 7 (15.2%) had hydronephrosis relief and renal function improvement. Nuclear renal scanning showed that the mean postoperative glomerular filtration rate (GFR) in the obstructive kidney was higher than the preoperative level (37.6 ml/min vs. 21.3 ml/min, P<0.05). No stricture in the uretero-bladder anastomotic stoma was recorded.


CONCLUSIONS
Endoscopic operation is an effective and feasible option for managing some selected kinds of distal ureteral obstruction caused by postoperative tissue adherence and radiotherapy in the patients with history of pelvic malignancies.
Wen
Xing-Qiao
XQ
Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510630, PR China.
Gao
Xin
X
Zhang
Yong
Y
Cai
Yu-Bin
YB
Qiu
Jian-Guang
JG
Situ
Jie
J
Zhan
Hai-Lun
HL
Wang
De-Juan
DJ
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D010386:Pelvic Neoplasms / Q000532:radiotherapy / Q000601:surgery; D011183:Postoperative Complications; D011878:Radiotherapy / Q000009:adverse effects; D015607:Stents; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods; D014519:Ureterostomy / Q000379:methods*; D055815:Young Adult