Contemporary management of ureteral strictures

Vasudevan, Vinaya; Johnson, Emmanuel Uche; Wong, Kee; Iskander, Morkos; Javed, Saqib; Gupta, Nikhil; McCabe, Jennifer E.; Kavoussi, Louis R.

doi:10.1177/2051415818772218

Cited by 16 publications

(6 citation statements)

References 121 publications

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“…Depending on the location and length of the obstructed segment, uretero-ureterostomy or uretero-neocystostomy with or without a psoas hitch or boari flap can be performed. In situations where a long segment is obstructed, trans-ureteroureterostomy, ileal ureter, or renal auto-transplantation are appropriate alternatives [ 45 , 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Unveiling the Challenges in Tandem Ureteral Stent Management for Malignant Ureteral Obstruction: Failure Rate, Risk Factors, and Durability of Their Replacement

Carmona

Shvero

Zilberman

et al. 2023

JCM

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Background: Malignant ureteral obstruction (MUO) is a sequela of advanced malignant disease that requires renal drainage, with tandem ureteral stents (TUSs) being a viable option. This study aimed to evaluate the TUS failure rate, associated risk factors, and the feasibility of replacing failed TUSs with a new pair of stents. Methods: A retrospective analysis of MUO patients treated with TUS insertion from 2014 to 2022 was conducted. TUS failure was defined as urosepsis, recurrent urinary tract infections, acute kidney failure, or new hydronephrosis on imaging. Cox proportional hazard regression analysis identified the independent predictors of TUS failure. Results: A total of 240 procedures were performed on 186 patients, with TUS drainage failing in 67 patients (36%). The median time to failure was 7 months. Multivariate analysis revealed female gender (OR = 3.46, p = 0.002), pelvic mass (OR = 1.75, p = 0.001), and distal ureteral obstruction (OR = 2.27, p = 0.04) as significant risk factors for TUS failure. Of the failure group, 42 patients (22.6%) underwent TUS replacement for a new pair. Yet, 24 (57.2%) experienced a second failure, with a median time of 4.5 months. The risk factors for TUS second failure included a stricture longer than 30 mm (OR = 11.8, p = 0.04), replacement with TUSs of the same diameter (OR = 43, p = 0.003), and initial TUS failure within 6 months (OR = 19.2, p = 0.006). Conclusions: TUS insertion for the treatment of MUO is feasible and has good outcomes with a relatively low failure rate. Primary pelvic mass and distal ureteral obstruction pose higher risks for TUS failure. Replacing failed TUSs with a new pair has a success rate of 42.8%. Consideration should be given to placing larger diameter stents when replacing failed TUS.

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Section: Discussionmentioning

confidence: 99%

Unveiling the Challenges in Tandem Ureteral Stent Management for Malignant Ureteral Obstruction: Failure Rate, Risk Factors, and Durability of Their Replacement

Carmona

Shvero

Zilberman

et al. 2023

JCM

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“…Ureteral strictures constitute an important clinical problem due to increasing number of cases, which may be related to the increasing the use of high-power lasers in urological departments and, as a result, thermal narrowing of the ureters after endoscopic treatment of upper urinary tract stones [1]. The standard treatment for ureteral strictures is reconstructive surgery with complete excision of the narrowed ureter [2] [3]. Endoscopy has an established but limited role in the treatment of ureteral strictures due to the high recurrence rate [4].…”

Section: Introductionmentioning

confidence: 99%

Endourological treatment of ureteral strictures with the use of self-expanding stents: is it possible to completely cure the stricture endoscopically? A report on the experience with implantation of 35 stents with a two-year follow-up period; a retrospect study

Kowalski,

Kuffel,

Późniak

et al. 2024

Preprint

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Background: The current results of endoscopic treatment of ureteral strictures are characterized by very divergent treatment results, which is due to a wide range of criterion for including patients in the analyses and different definitions of effective treatment. In this retrospect study we wanted to introduce a possibility of curing ureteral strictures depending on their type and degree with the use of self-expanding ureteral stents (SUS). Methods: 33 patients with ureteral strictures received endourological treatment with the use of Allium® SUS (2 patients with SUS placed on both sides). Patients were divided into 2 groups: patients with uncomplicated strictures (Grp 1) and patients with complicated strictures (Grp 2). Uncomplicated stricture was defined as a single stricture below 2 cm. A complicated stricture was defined as a stricture over 2cm and/or as multiple strictures. The follow-up time was 24 months. All patients were scheduled for renoscyntygraphy during the treatment. A full therapeutic success was defined as no tight stenosis in renoscyntygraphic examination after SUS explantation. Results: In Grp 1, full therapeutic success was achieved in 80% of patients, which was statistically significant (p < 0.001) compared to Grp 2. Serious complications (Clavien-Dindo > 3a) occurred significantly more often in Grp 2 (p = 0.046). Renal outflow during stenting was present in 70% of the patients in Grp 2. Conclusions: A full therapeutic success of endoscopic SUS-assisted treatment can be achieved in patients with a short, single ureteral stricture. In long and/or multiple strictures SUS can be used as drainage element.

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“…5 Management of the post-URS stricture exhibits conspicuous polemics with options ranging from open repair to include laparoscopic, robotic and interventional techniques. 6 We herein report in this article a case of an iatrogenic complete ureteral obstruction caused by ureteroscopy (URS), in which a minimally invasive, endo-urological cut-to-the-light technique efficaciously repaired the ureteral stricture.…”

Section: Introductionmentioning

confidence: 99%

The “Cut-to-the-Light” Technique Laser Endoureterotomy for Complete Ureteral Obstruction Resurfaces! A New Application of an Old Technique

Yarak¹,

Zouari²,

Karray³

et al. 2022

RRU

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To describe our new endoscopic approach in treating iatrogenic ureteral stenosis using the "cut-to-The-light" technique. Methods: Case of a 54 year-old female patient who underwent a right percutaneous nephrolithotomy to treat a staghorn calculus with two subsequent complimentary ureteroscopies complicated by a severe proximal ureteral obstruction. An antegrade flexible uretereroscope and a retrograde rigid ureteroscope were used to locate the stenosis. With the aid of a 365-µm Ho: YAG laser fiber (settings 0.4 J, 12 Hz), we managed to successfully create a small incision in the stenotic lesion, the rigid ureterscopy light was clearly seen by the antegrade flexible ureteroscope and a through-and-through guidewire was then placed, securing the ureter. Ureteral dilatation was then performed followed by a full thickness incision of the ureteral stenosis. A single 8Fr, 28 cm double J ureteral stent was finally placed after stone fragmentation. Results: The operating time was 200 mins. No blood loss. No fever or signs of UTI were seen shortly after the operation. The Foley catheter was successfully removed at day one post-op. The hospital stay was short of only 2 days. Conclusion:The "cut-to-the-light" technique is a new application in the arsenal of ureteral stricture treatment that has been scarcely described in the literature before. The use of this method seems to offer excellent outcomes thus demonstrating the importance of this minimally invasive technique as an alternative to conventional invasive methods used. We believe that studies with larger samples and longer follow up are needed in order to fully determine the benefits of this method and to assess and reveal its suitable application and its drawbacks.

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Contemporary management of ureteral strictures

Cited by 16 publications

References 121 publications

Unveiling the Challenges in Tandem Ureteral Stent Management for Malignant Ureteral Obstruction: Failure Rate, Risk Factors, and Durability of Their Replacement

Unveiling the Challenges in Tandem Ureteral Stent Management for Malignant Ureteral Obstruction: Failure Rate, Risk Factors, and Durability of Their Replacement

Endourological treatment of ureteral strictures with the use of self-expanding stents: is it possible to completely cure the stricture endoscopically? A report on the experience with implantation of 35 stents with a two-year follow-up period; a retrospect study

The “Cut-to-the-Light” Technique Laser Endoureterotomy for Complete Ureteral Obstruction Resurfaces! A New Application of an Old Technique

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