Balloon catheter dilation of ureteroenteric strictures: long-term results.

Abstract

Balloon catheter dilation of benign ureteroenteric anastomotic strictures has been proposed as an alternative to either surgical revision or chronic ureteral stenting, with moderately successful short-term results reported by several groups in a limited number of patients. However, the authors' experience with 29 patients exhibiting 37 benign ureteroenteric strictures treated over the past 7 years revealed that in the majority of cases (23 patients, 26 strictures [70%]), strictures recurred within 6 months of balloon catheter dilation/ureteral stent therapy. Furthermore, of the 11 strictures that appeared to have been successfully dilated at a follow-up interval of 6 months, five restenosed within 1 year. Therefore, only six of 37 (16%) ureteroenteric stricture dilations could be considered successful when viewed at least 1 year after interventional therapy. Furthermore, repeat dilations have often been required to maintain ureteral patency in these patients.

Antegrade Percutaneous Endoluminal Treatment of Non–Malignant Ureterointestinal Anastomotic Strictures following Urinary Diversion

“…One year later, Rosen et al [19]favored the permanent antegrade catheter placement in an obstructed ureteroileal anastomosis without any previous dilatation or incision. In 1983 and 1988, Shapiro et al [6]and Banner et al [20]reported a short–term success rate of 40% with balloon dilatation that fell to 16% after 1 year [6, 20]. In contrast to these results from the USA, a French team [22]reported a long–term success rate of 61% using a high–pressure balloon dilatation (until 20 atm for 5–15 min).…”

“…In the last decades, the percutaneous transrenal access to the ureter has been established as an alternative to re–laparotomy. In the literature, many endoscopic methods, for example angioplasty balloon dilatation [6], percutaneous transrenal electro–incision [7], cold–knife incision [8, 9]and metal stenting [10], were published with different success rates. Since the long–term success rate after the first percutaneous dilatation with the angioplasty balloon was only 16% [6], a new method for the anastomosis incision under endoscopic guidance with better results was introduced [11].…”

“…In the literature, many endoscopic methods, for example angioplasty balloon dilatation [6], percutaneous transrenal electro–incision [7], cold–knife incision [8, 9]and metal stenting [10], were published with different success rates. Since the long–term success rate after the first percutaneous dilatation with the angioplasty balloon was only 16% [6], a new method for the anastomosis incision under endoscopic guidance with better results was introduced [11]. Other studies reported successful endoscopic incision with the papillotome in 71% of their patients [7], with holmium YAG–laser in 100% [12]and with acucise balloon catheter in 100 [13]or in 30% [14].…”

Nonvascular Interventions of the Urinary Tract

“…Malignant ureteral strictures may develop in primary ureteral tumors or secondary to direct invasion or metastasis (8)(9)(10)(11)(12). The average success rate is about 50% although the outcome of the percutaneous dilatation for benign ureteral strictures has been variably reported (8)(9)(10)(11)(12)(13)(14). Factors affecting the outcome include underlying causes, location, length, duration of strictures, and associated vascular compromise.…”

“…Like other procedures, percutaneous ureteral dilatation should begin with formation of PCN (9)(10)(11)(12)(13)(14). Although the lower-polar calyx is usually favorable for external drainage, the interpolar calyx is more suitable for ureteral dilatation.…”