Ureteroscopic management of ureteral and ureteroenteral strictures

Patel, Rakesh; Newman, Robert C.

doi:10.1016/s0094-0143(03)00092-2

Cited by 29 publications

(19 citation statements)

References 28 publications

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“…Reported success rates vary from 55-85%, depending on the stricture site and etiology. 8,[14][15][16][17] All eight patients undergoing endoureterotomy in our case series were treated with Ho:YAG laser. Of these, five patients One patient with recurrent ureteral stone disease was treated with uncomplicated URS and subsequently developed a distal ureteral stricture.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution

Tran¹,

Arsovska

Paterson

et al. 2015

CUAJ

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Introduction: Ureteral strictures are a significant cause of morbidity and mortality, resulting in potential kidney damage requiring several surgical procedures. Non-malignant causes include radiation, trauma from calculi impaction, pelvic surgery, or ureteroscopy (URS). We identified risk factors in our patients with ureteral strictures and the success of their treatment outcomes. Methods: A retrospective chart review of 25 patients with 29 ureteral strictures was performed to determine the success of their treatment. Results: Twenty-five (25) patients with 29 benign ureteral strictures were identified. Most cases (60%) were caused by impacted stones where the median stone size was 1.15 cm (0.37-1.8 cm). Intervention for stones prior to stricture development included shockwave lithotripsy, URS, and percutaneous nephrolithotomy. Five patients with strictures from impacted stones had ureteric complications during stone treatment including perforation +/-urinoma (n=3), fractured guidewire left in situ (n=1), and ureteric orifice resection (n=1). Other stricture etiologies included radiation (28%) and endometriosis (4%). Treatment modalities used included ureteroureterostomy (n=2), ureteral re-implant (n=3), urinary diversion (n=3), autotrasplant (n=1), laser endoureterotomy +/-balloon dilation (n=8), nephrectomy (n=2), balloon dilation +/-stent (n=3), ureterovesical junction (UVJ) resection + stent (n=1), chronic stent changes (n=4), or surveillance (n=3). Conclusions: Our evaluation highlights important principles. Patients with complicated ureteroscopies or severely impacted calculi warrant close followup with imaging after stone treatment due to possibility of rapid renal deterioration from stricture formation. Radiation-induced strictures are difficult to manage, possibly requiring subsequent urinary diversion. Finally, endoscopic management of benign ureteral strictures via balloon dilation and laser endoureterotomy is an excellent choice in properly selected patients, with opportunity for subsequent salvage treatments if needed.

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Section: Discussionmentioning

confidence: 99%

Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution

Tran¹,

Arsovska

Paterson

et al. 2015

CUAJ

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“…More recent studies have used the Nd:YAG [32,33] and Ho:YAG lasers [34][35][36][37][38][39][40][41] for either urethral incision or core-through urethrotomy. Overall, outcomes of laser therapy have been suboptimal due to stricture recurrence, presumably caused by excessive thermal damage to adjacent tissue and subsequent scar formation.…”

Section: Stricturesmentioning

confidence: 99%

Therapeutic applications of lasers in urology: an update

Fried¹

2006

Expert Review of Medical Devices

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There has been renewed interest in the use of lasers for minimally invasive treatment of urologic diseases in recent years. The introduction of more compact, higher power, less expensive and more user-friendly solid-state lasers, such as the holmium:yttrium-aluminum-garnet (YAG), frequency-doubled neodymium:YAG and diode lasers has made the technology more attractive for clinical use. The availability of small, flexible, biocompatible, inexpensive and disposable silica optical fiber delivery systems for use in flexible endoscopes has also promoted the development of new laser procedures. The holmium:YAG laser is currently the workhorse laser in urology since it can be used for multiple soft- and hard-tissue applications, including laser lithotripsy, benign prostate hyperplasia, bladder tumors and strictures. More recently, higher power potassium-titanyl-phosphate lasers have been introduced and show promise for the treatment of benign prostatic hyperplasia. On the horizon, newer and more effective photosensitizing drugs are being tested for potential use in photodynamic therapy of bladder and prostate cancer. Additionally, new experimental lasers such as the erbium:YAG, Thulium and Thulium fiber lasers, may provide more precise incision of soft tissues, more efficient laser lithotripsy and more rapid prostate ablation. This review provides an update on the most important new clinical and experimental therapeutic applications of lasers in urology over the past 5 years.

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“…The obstructions of the urinary system may result from various intraluminal and extraluminal causes including retroperitoneal fibrosis, trauma, blood clothes, tumors and foreign materials [3]. Urinary obstruction at any part of urinary system due to membranous band is a very rare cause indeed.…”

Section: Discussionmentioning

confidence: 99%

Ureteral membranous band causing ureteral obstruction after the ureterolithotomy

et al. 2006

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A 45-year-old male admitted to our clinic of symptoms with moderate left flank pain and intermittant macroscopic hematuria. During the last 6 months these complaints had worsened. He had history of open retroperitoneal ureterolithotomy 2 years previously for ureteral stone. He was investigated for calculi, infection and other urinary abnormalities. Although direct urinary system graphy was normal, excretory urography revealed left ureteric obstruction. On ureteroscopy membranous band like an ureteral valve causing ureteral obstruction was observed and removed with biopsy pens without resection.

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Ureteroscopic management of ureteral and ureteroenteral strictures

Cited by 29 publications

References 28 publications

Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution

Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution

Therapeutic applications of lasers in urology: an update

Ureteral membranous band causing ureteral obstruction after the ureterolithotomy

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