Failure of endoscopic management of ureteral strictures is due to ureteroscopic lithotripsy as a cause and longer length of stricture

Abstract

Background Ureteroscopic lithotripsy is a common treatment for middle and lower ureteral stones. Although effective and minimally invasive, this technique might cause significant complications, including postoperative ureteral strictures, which occur in 1–4% of patients after ordinary ureteroscopic lithotripsy and in 7.8–24% when lithotripsy is performed for impacted stones. The main purpose of the management of ureteral strictures is to improve hydronephrosis and protect renal function. However, factors that influence the success rate of the endoscopic management of US (e.g., the cause and length of stricture, the duration of hydronephrosis, surgical management technique, and the number of placed ureteral stents) are controversial. The aim of this study was to investigate factors determining the outcomes of endoscopic management for stone-related ureteral stricture. Methods This multi-center case series study was performed at one of the highest-volume centers and the affiliated institutions in Japan. Data of patients who underwent endoscopic surgery for ureteral stricture from January 2016 to March 2019 were retrospectively analyzed. Laser incision and/or balloon dilation were performed for management; single or double stents were placed at the end of the surgery. Treatment success was defined as improvement in hydronephrosis status. Results Nineteen patients were treated for stone-related ureteral stricture. Hydronephrosis successfully improved in 12 patients (63.2%). All seven patients with failed endoscopic management had ureteroscopic lithotripsy-related stricture, whereas 3/12 (25.0%) and 7/12 (58.3%) patients with ureteroscopic lithotripsy-related stricture and impacted stone-related stricture, respectively, underwent successful endoscopic treatment (P = 0.004). Stricture length > 15 mm was observed in five patients (71.4%) with failed management, two patients (16.6%) with successful management (P = 0.046), 7/10 patients (70.0%) with ureteroscopic lithotripsy-related stricture, and 1/7 patients (14.3%) with impacted stone-related stricture (P = 0.049). Among patients with ureteroscopic lithotripsy-related stricture and impacted stone-related stricture, both laser incision and balloon dilation were performed in 5/10 (50.0%) and 2/7 (28.6%) patients (P = 0.874) while double stents were placed in 5/10 (50.0%) and 5/7 (57.1%) patients (P = 0.874), respectively. Conclusions Ureteroscopic lithotripsy as a cause and stricture length > 15 mm could strongly affect the success rate of endoscopic management of ureteral stricture. In such cases, reconstructive management should be considered in the early stages.