eMedicine Specialties > Urology > Strictures

Ureteral Stricture: Follow-up

Author: Benjamin N Breyer, MD, Clinical Instructor, Department of Urology, University of California - San Francisco
Coauthor(s): Christopher J Kane, MD, FACS, Professor of Surgery, Chief of Urology, University of California San Diego
Contributor Information and Disclosures

Updated: Aug 17, 2009

Outcome and Prognosis

The success rate of balloon dilation is 48%-88%, with a mean of approximately 55%. The length and location of the stricture are important factors, with short and distal strictures responding best.

The success rate of endoureterotomy used to manage benign strictures is 78%. Higher success rates are achieved in nonischemic strictures, those shorter than 1 cm, and those treated less than 24 months from the etiologic event. In addition, the use of a large stent (>12F) is associated with a better outcome, as is stenting for less than 4 weeks.

The success rate of endoureterotomy used to manage ureteroenteric strictures is 32% at 3 years. Right ureteroenteric strictures tend to have better outcomes compared with left ureteroenteric strictures. Large stents (>12F) are associated with better outcomes, as is longer stenting, ie, over weeks.3

The success rate of balloon dilation used to manage ureteral strictures after renal transplantation is 45%-79%. Antegrade or retrograde cold-knife incision has a success rate of 82% at 26 months.

The success rate of open surgical repair of ureteral strictures is over 90%.

Future and Controversies

A current controversy involves the usefulness of intralesional injection of steroids to inhibit stricture recurrence. In a retrospective review of 77 endoureterotomies, Wolf et al found that the injection of intralesional triamcinolone was associated with greater success in strictures longer than 1 cm.3 The significance of this observation in an uncontrolled review is uncertain.

The future of ureteral stricture management may involve extraurinary tissue used as grafts or vascular pedicle flaps to replace damaged portions of ureter. Naude reported the successful use of buccal mucosal grafts with omental wrap in 4 patients with segmental ureteric loss.20 An artificial ureter crafted from silicone-polyester was used in two renal transplant patients with ureteral stricture in whom endoscopic and open repair had failed.21 At 12 and 15 months of follow-up, the renal function was stable, with no evidence of obstruction.

Innovative tissue engineering technology may produce ureteral tissue that closely mimics native ureteral tissue for ureteral replacement. Some groups have used xenogenic acellular collagen membranes such as porcine small intestine submucosa for ureteral reconstruction. Atala is using similar technology to engineer bladder, cavernosal, urethral, and ureteral tissue.22

 


More on Ureteral Stricture

Overview: Ureteral Stricture
Workup: Ureteral Stricture
Treatment: Ureteral Stricture
Follow-up: Ureteral Stricture
Multimedia: Ureteral Stricture
References
Further Reading
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References

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  2. Vakili B, Chesson RR, Kyle BL, Shobeiri SA, Echols KT, Gist R, et al. The incidence of urinary tract injury during hysterectomy: a prospective analysis based on universal cystoscopy. Am J Obstet Gynecol. May 2005;192(5):1599-604. [Medline].

  3. Wolf JS Jr, Elashry OM, Clayman RV. Long-term results of endoureterotomy for benign ureteral and ureteroenteric strictures. J Urol. Sep 1997;158(3 Pt 1):759-64. [Medline].

  4. Karod JW, Danella J, Mowad JJ. Routine radiologic surveillance for obstruction is not required in asymptomatic patients after ureteroscopy. J Endourol. Jul-Aug 1999;13(6):433-6. [Medline].

  5. Chung SY, Stein RJ, Landsittel D, Davies BJ, Cuellar DC, Hrebinko RL, et al. 15-year experience with the management of extrinsic ureteral obstruction with indwelling ureteral stents. J Urol. Aug 2004;172(2):592-5. [Medline].

  6. Grasso M, Li S, Liu JB, Beaghler M, Newman R, Bagley DH. Examining the obstructed ureter with intraluminal sonography. J Urol. Oct 1999;162(4):1286-90. [Medline].

  7. Hafez KS, Wolf JS Jr. Update on minimally invasive management of ureteral strictures. J Endourol. Sep 2003;17(7):453-64. [Medline].

  8. Goldfischer ER, Gerber GS. Endoscopic management of ureteral strictures. J Urol. Mar 1997;157(3):770-5. [Medline].

  9. Kwak S, Leef JA, Rosenblum JD. Percutaneous balloon catheter dilatation of benign ureteral strictures: effect of multiple dilatation procedures on long-term patency. AJR Am J Roentgenol. Jul 1995;165(1):97-100. [Medline].

  10. Liatsikos EN, Kagadis GC, Barbalias GA, Siablis D. Ureteral metal stents: a tale or a tool?. J Endourol. Oct 2005;19(8):934-9. [Medline].

  11. Liatsikos EN, Kagadis GC, Karnabatidis D, Katsanos K, Papathanassiou Z, Constantinides C, et al. Application of self-expandable metal stents for ureteroileal anastomotic strictures: long-term results. J Urol. Jul 2007;178(1):169-73. [Medline].

  12. Simmons MN, Gill IS, Fergany AF, Kaouk JH, Desai MM. Laparoscopic ureteral reconstruction for benign stricture disease. Urology. Feb 2007;69(2):280-4. [Medline].

  13. Fugita OE, Dinlenc C, Kavoussi L. The laparoscopic Boari flap. J Urol. Jul 2001;166(1):51-3. [Medline].

  14. Modi P, Goel R, Dodiya S. Laparoscopic ureteroneocystostomy for distal ureteral injuries. Urology. Oct 2005;66(4):751-3. [Medline].

  15. Nezhat CH, Nezhat F, Seidman D, Nezhat C. Laparoscopic ureteroureterostomy: a prospective follow-up of 9 patients. Prim Care Update Ob Gyns. Jul 1 1998;5(4):200. [Medline].

  16. Patil NN, Mottrie A, Sundaram B, Patel VR. Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: a multi-institutional, multinational evaluation. Urology. Jul 2008;72(1):47-50; discussion 50. [Medline].

  17. Glinianski M, Guru KA, Zimmerman G, Mohler J, Kim HL. Robot-assisted ureterectomy and ureteral reconstruction for urothelial carcinoma. J Endourol. Jan 2009;23(1):97-100. [Medline].

  18. Pantuck AJ, Han KR, Perrotti M, Weiss RE, Cummings KB. Ureteroenteric anastomosis in continent urinary diversion: long-term results and complications of direct versus nonrefluxing techniques. J Urol. Feb 2000;163(2):450-5. [Medline].

  19. Yamada S, Ono Y, Ohshima S, Miyake K. Transurethral ureteroscopic ureterotomy assisted by a prior balloon dilation for relieving ureteral strictures. J Urol. May 1995;153(5):1418-21. [Medline].

  20. Naude JH. Buccal mucosal grafts in the treatment of ureteric lesions. BJU Int. May 1999;83(7):751-4. [Medline].

  21. Andonian S, Zorn KC, Paraskevas S, Anidjar M. Artificial ureters in renal transplantation. Urology. Nov 2005;66(5):1109. [Medline].

  22. Atala A. Tissue engineering in urologic surgery. Urol Clin North Am. Feb 1998;25(1):39-50. [Medline].

  23. Dowling RA, Corriere JN Jr, Sandler CM. Iatrogenic ureteral injury. J Urol. May 1986;135(5):912-5. [Medline].

  24. Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW. Ureteroscopy: current practice and long-term complications. J Urol. Jan 1997;157(1):28-32. [Medline].

  25. HSU TMS, Streem SB, Nakada SY. Management of upper urinary tract obstruction. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. Vol 2. 9th ed. Philadelphia, Pa: WB Saunders; 2007:1227-73.

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  27. Meng MV, Freise CE, Stoller ML. Expanded experience with laparoscopic nephrectomy and autotransplantation for severe ureteral injury. J Urol. Apr 2003;169(4):1363-7. [Medline].

  28. Miller OF, Kane CJ. Unenhanced helical computed tomography in the evaluation of acute flank pain. Curr Opin Urol. Mar 2000;10(2):123-9. [Medline].

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  30. Weinberg JJ, Ansong K, Smith AD. Complications of ureteroscopy in relation to experience: report of survey and author experience. J Urol. Mar 1987;137(3):384-5. [Medline].

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Keywords

ureteral stricture, ureteral obstruction, hydronephrosis, ureteral scar, ureteropelvic junction obstruction, UPJ obstruction, urethral narrowing, narrow urethra, congenital obstructing megaureter, ureteroscopy, laparoscopic injury, gynecologic injury, urologic injury, vascular injury, genitourinary trauma, gynecologic trauma, urologic trauma, radiation therapy, radiotherapy, urinary diversion, renal transplant, kidney transplant, ureteral ischemia, ureteral fibrosis, benign intrinsic stricture, benign intrinsic ureteral stricture, malignant ureteral stricture, retroperitoneal fibrosis, iatrogenic ureteral stricture, stricture disease

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Contributor Information and Disclosures

Author

Benjamin N Breyer, MD, Clinical Instructor, Department of Urology, University of California - San Francisco
Benjamin N Breyer, MD is a member of the following medical societies: American College of Surgeons and American Urological Association
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher J Kane, MD, FACS, Professor of Surgery, Chief of Urology, University of California San Diego
Christopher J Kane, MD, FACS is a member of the following medical societies: American College of Surgeons and American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Daniel B Rukstalis, MD, Director of Urological Services, Geisinger Medical Center, Geisinger Medical Group
Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science and American Urological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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