Patel Rakesh C, Newman Robert C
Division of Urology, University of Florida,1600 Southwest Archer Road, Room N2-3, Gainesville, FL 32610, USA.
Urol Clin North Am. 2004 Feb;31(1):107-13. doi: 10.1016/S0094-0143(03)00092-2.
The ureteroscopic approach to ureteral strictures has diminished morbidity because of smaller-caliber equipment, improved optics, Ho:YAG laser, and a better understanding of the risk factors for ureteral strictures. Direct visualization by means of retrograde ureteroscopy provides a safe and effective approach to treat ureteral strictures without the need for an open incision or percutaneous nephrostomy access. All patients with a ureteral stricture require an extensive evaluation and planning before treatment. Generally, patients with ureteral strictures and a history of carcinoma should undergo biopsy of the area of stricture. With recurrent cancer, patients may present with pain, nausea, vomiting, pyelonephritis, or loss of the ipsilateral renal unit. Malignant strictures tend to not respond well to balloon dilation alone. Open or laparoscopic resection and reconstruction may be indicated if there is a chance for cure. In patients who are not good surgical candidates or in those who have advanced disease, the urologist is left with the option of an indwelling stent or nephrostomy tube.
由于设备口径更小、光学性能改善、钬激光以及对输尿管狭窄危险因素有了更好的认识，输尿管镜治疗输尿管狭窄的发病率有所降低。通过逆行输尿管镜进行直接可视化操作，为治疗输尿管狭窄提供了一种安全有效的方法，无需进行开放切口或经皮肾造瘘。所有输尿管狭窄患者在治疗前都需要进行全面评估和规划。一般来说，有输尿管狭窄且有癌症病史的患者应进行狭窄部位的活检。对于复发性癌症，患者可能会出现疼痛、恶心、呕吐、肾盂肾炎或同侧肾单位丧失。恶性狭窄往往对单纯球囊扩张反应不佳。如果有治愈的机会，可能需要进行开放或腹腔镜切除及重建手术。对于不适合手术的患者或患有晚期疾病的患者，泌尿外科医生可选择留置支架或肾造瘘管。
