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Long-Term Results of Endoureterotomy for Benign Ureteral and Ureteroenteric Strictures

医学 外科 输尿管 输尿管镜检查 肾功能 泌尿科 回顾性队列研究 内科学
作者
J. Stuart Wolf,Osama M. Elashry,Ralph V. Clayman
出处
期刊:The Journal of Urology [Lippincott Williams & Wilkins]
卷期号:158 (3): 759-764 被引量:135
标识
DOI:10.1016/s0022-5347(01)64308-8
摘要

No AccessJournal of UrologyClinical Urology: Original Articles1 Sep 1997Long-Term Results of Endoureterotomy for Benign Ureteral and Ureteroenteric Strictures J. Stuart Wolf, Osama M. Elashry, and Ralph V. Clayman J. Stuart WolfJ. Stuart Wolf More articles by this author , Osama M. ElashryOsama M. Elashry More articles by this author , and Ralph V. ClaymanRalph V. Clayman More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64308-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We reviewed the results of endoureterotomy for benign ureteral and ureteroenteric strictures to determine efficacy and factors associated with a successful outcome. Materials and Methods: Followup was available for 69 patients undergoing 77 endoureterotomies. Success was defined as symptomatic improvement and radiographic resolution of obstruction. Kaplan-Meier survival curves were constructed and data were analyzed with a Cox proportional hazards model. Results: None of 9 procedures in patients with the ipsilateral kidney contributing less than 25% of total renal function was successful. Among the 38 remaining benign ureteral stricture treatments with ipsilateral function 25% or greater with a median followup of 28.4 months among successful cases the 3-year success rate was 80%. No procedure failed beyond 11 months and there were 25 patients at risk beyond this point. Among the 30 remaining ureteroenteric stricture treatments with ipsilateral function 25% or greater the success rates at 1, 2 and 3 years were 73, 51 and 32%, respectively. Failures were noted during the first 36 months but none occurred later and 5 patients were at risk beyond this point. Overall, complete or tight strictures were less successfully treated. A nonischemic etiology, a stent 12F or greater and injection of triamcinolone into the bed of the incised stricture were associated with better outcome for strictures longer than 1 cm. Conclusions: Endoureterotomy of benign ureteral strictures is associated with an excellent outcome (80% success at 3 years). Endoscopic treatment of ureteroenteric strictures is less successful but still offers a reasonable first step (32% 3-year success rate). For all strictures failure is likely if ipsilateral renal function is poor. For strictures longer than 1 cm. use of a stent 12F or greater and injection of triamcinolone appear to be beneficial. References 1 : Endo-ureteroplasty with a free urothelial graft.. J. Urol.1994; 152: 910. Abstract, Google Scholar 2 : Nonparametric estimation from incomplete observations.. Amer. Stat. Ass. J.1958; 53: 457. Google Scholar 3 : Statistical Models and Methods for Lifetime Data. New York: John Wiley and Sons, Inc.1982. 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Urol.1996; 155: 882. Abstract, Google Scholar 20 : Percutaneous management of benign ureteral strictures and fistulas.. J. Urol.1987; 137: 1126. Abstract, Google Scholar 21 : Ureteral stricture: experience with 31 cases.. J. Urol.1988; 140: 737. Abstract, Google Scholar 22 : Endourologic treatment of ureteral strictures.. J. Endourol.1988; 2: 263. Google Scholar 23 : The cold-knife technique for endourological management of stenoses in the upper urinary tract.. J. Urol.1991; 146: 961. Abstract, Google Scholar 24 : Percutaneous balloon catheter dilatation of benign ureteral strictures: effect of multiple dilatation procedures on long-term patency.. AJR1995; 165: 97. Google Scholar 25 : Transurethral ureteroscopic ureterotomy assisted by a prior balloon dilation for relieving ureteral strictures.. J. Urol.1995; 153: 1418. Abstract, Google Scholar 26 : Balloon catheter dilation of ureteroenteric strictures: long-term results.. Radiology1988; 168: 385. Google Scholar 27 : Endourological treatment of ureteroenteric anastomotic strictures: long-term followup.. J. Urol.1991; 145: 723. Link, Google Scholar 28 : Percutaneous transrenal electroincision of ureterointestinal anastomotic strictures: long-term results and comparison of fluoroscopic and endoscopic guidance.. J. Urol.1996; 155: 1575. Link, Google Scholar From the Section of Urology, University of Michigan, Ann Arbor, Michigan and Department of Urology, Tanta University, Tanta, Egypt and Division of Urologic Surgery, Department of Radiology, Washington University, St. Louis, Missouri.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 158Issue 3September 1997Page: 759-764 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information J. Stuart Wolf More articles by this author Osama M. Elashry More articles by this author Ralph V. Clayman More articles by this author Expand All Advertisement PDF downloadLoading ...
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