Post ureteroscopic stone surgery ureteral strictures management: a retrospective study
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To share experience in managing ureteral strictures following ureteroscopic lithotripsy.
Ninety five patients diagnosed as ureteral strictures after ureteroscopic lithotripsy between January 2013 and January 2018 were included. 53 received endourological treatment, 34 underwent reconstruction, 6 underwent nephrectomy for severe renal impairment, and 2 chose routine ureteral stent replacement. Therapeutic success was defined as absence of clinical symptoms and radiologic relief of obstruction.
The follow-up time ranged from 13 to 57 months, with a median time of 24. It lasted more than 13 months in all patients, exception for 2 nephrectomies. Two patient groups including 69 endourological procedures and 37 reconstructions were used to compare therapeutic effects and complications. The overall success rate was 60.9% (42/69) in endourological intervention vs. 97.3% (36/37) in reconstruction (p < 0.001), while 74.4% (29/39) patients with stricture less than 1 cm and 68.8% (33/48) patients with mild-to-moderate hydronephrosis achieved success in endourological group. All except 1 failure appeared within the first year postoperatively. Subgroup analyses for endourological procedures revealed significant differences in the success rate of different stricture lengths and hydronephrosis (p = 0.004 and p = 0.043). Multivariate Cox regression analysis indicated that reconstruction was significantly related to a more successful outcome, compared with endourological procedures (HR 0.052, 95% CI 0.007–0.394, p = 0.004).
Reconstruction performs better than endourological procedures in surgical outcome. Endourological procedure provides an acceptable success rate in patients with stricture shorter than 1 cm and slight hydronephrosis. Most stricture recurrence appeared within the first year postoperatively.
KeywordsUreteral stricture Ureteroscopic lithotripsy Complication Urolithiasis Endourological surgery Stricture characteristics
Yuanzhong Deng and Xin Gou designed the research; Mao Xiong, Xin Zhu and Daihui Chen collected data and information; Mao Xiong, Mohammad Arman Hossain and Yongpeng Xie collect literatures and perform the analysis; Mao Xiong, Xin Zhu and Mohammad Arman Hossain wrote the paper.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 6.El-Abd AS, Suliman MG, Farha MOA, Ramadan AR, El-Tatawy HH, El-Gamal OM, El-Gamal SA, Figenshau R, Abd SAE (2014) The development of ureteric strictures after ureteroscopic treatment for ureteric calculi: a long-term study at two academic centres. Arab J Urol 12(2):168–172PubMedCrossRefGoogle Scholar
- 25.Jsjr W, Elashry OM, Clayman RV (1997) Long-term results of endoureterotomy for benign ureteral and ureteroenteric strictures. J Urol 158(1):759–764Google Scholar