Retrograde balloon dilation as a therapeutic option for post-gynecologic surgery ureteral stricture followed by ureteroureterostomy: a comparative study regarding stricture length

Abstract

BackgroundTo evaluate the success rate of balloon dilation and the factors possibly influencing the outcomes of balloon dilation for the ureteric strictured portion of ureteroureterostomy (UUS) site in patients with post-gynecologic surgeries.MethodsA single institution data base was screened for the patients who received balloon dilation for a treatment of ureteral stricture diagnosed after gynecologic surgery. Overall 114 patients underwent primary intra-operative UUS due to ureteral injury during gynecologic surgery. Among them, 102 patients received balloon dilation, and their medical records were retrospectively reviewed. Success of balloon dilation was defined as the condition that requires no further clinical interventions after 6 months from balloon dilation.ResultsThe ureter injury rate of women treated with open radical abdominal hysterectomy was highest (32 cases, 31.4%). 60 patients (60.8%) showed successful outcomes regarding dilation. All patients underwent technically successful dilation with a full expansion of balloon during the procedure, but 40 patients (39.2%) were clinically unsuccessful as they showed a recurrence of ureteral stricture on the previous balloon dilation site after the first dilation procedure. Univariate logistic regression analyses showed that stricture length >2 cm was a significant predictor of successful dilation (odds ratio, 0.751; 95% confidence interval, 0.634-0.901; p-value, 0.030), but it failed to achieve independent predictor status in multivariate analysis.ConclusionBalloon dilation can an effective alternative treatment option for strictured portion of the primary UUS in post-gynecologic surgery patients when its length is <2 cm.

Analysis of the Efficacy and Risk Factors for Failure of Balloon Dilation for Benign Ureteral Stricture

“…The vast majority of patients enrolled in this study had ureteral stricture lengths of 2 cm or less, which may be the reason why ureteral stricture length was not a risk factor for balloon dilatation failure at the time of analysis [ 33 , 35 ]. The length of ureteral stricture found in previous studies as a risk factor for balloon dilatation failure was analyzed with a cut-off length of 2 cm [ 36 ]. The balloon dilation time was overwhelmingly 3 min, which may explain why balloon dilation time was not a risk factor for balloon dilation failure at the time of analysis.…”

Left-sided flap transposition of the appendix for urethroplasty in oncourology

“…показана эффективность баллонной дилатации мочеточников при протяженности дефекта <2 см (отношение шансов (ОШ) 0,751; 95 % доверительный интервал (ДИ) 0,634-0,901; p = 0,030). Среди 102 пациентов в 60 % случаев были достигнуты относительно успешные результаты, однако впоследствии в 39,2 % случаев выявлен рецидив стриктуры мочеточника [15]. В метаанализе T. Suttle и соавт.…”