Razdan Sanjay, Silberstein Irene K, Bagley Demetrius H
Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
BJU Int. 2005 Mar;95 Suppl 2:94-101. doi: 10.1111/j.1464-410X.2005.05207.x.
To highlight the current status of ureteroscopic endoureterotomy (UE) by reporting extensive experience with the endoscopic management of ureteric strictures, with special emphasis on factors determining success, and by reviewing publications on the minimally invasive management of ureteric strictures.
The study comprised 50 patients (mean age 53 years, range 18-85, equal sex distribution) with ureteric strictures of varying causes; all had their stricture treated endoscopically. The follow-up was 0.5-9 years; 10 patients with recurrent strictures had two ipsilateral stents placed to try to improve the outcome, and eight patients with completely obliterating strictures were treated by ureteroscopic re-canalization.
The site of stricture had no bearing on the eventual outcome. Patients with uretero-enteric and malignant strictures did not fare so well. The most important predictor of failure was the length of the stricture, with failure in all seven patients with strictures of > 2 cm. In the 10 patients treated with two ipsilateral stents, eight were successful, which was very promising considering that these patients had recalcitrant strictures and placing one stent had previously failed. The overall success rate was 74%.
UE has become the procedure of choice for the initial management of ureteric strictures. Simple balloon dilatation is also effective in certain situations. The characteristics of the stricture often govern the eventual outcome. In properly selected cases success rates of approximately 75% can be expected.
通过报告输尿管镜下输尿管内切开术（UE）治疗输尿管狭窄的丰富经验，特别强调决定手术成功的因素，并回顾输尿管狭窄微创治疗的相关文献，以突出UE的当前现状。
本研究纳入50例输尿管狭窄病因各异的患者（平均年龄53岁，范围18 - 85岁，男女比例均等）；所有患者均接受了输尿管狭窄的内镜治疗。随访时间为0.5 - 9年；10例复发性狭窄患者置入了两根同侧支架以改善治疗效果；8例完全闭塞性狭窄患者接受了输尿管镜下再通术。
狭窄部位与最终治疗效果无关。输尿管肠吻合口狭窄和恶性狭窄患者的治疗效果欠佳。最重要的失败预测因素是狭窄长度，所有7例狭窄长度>2 cm的患者均治疗失败。在10例接受两根同侧支架治疗的患者中，8例治疗成功，鉴于这些患者之前狭窄顽固且置入一根支架失败，这一结果很有前景。总体成功率为74%。
UE已成为输尿管狭窄初始治疗的首选方法。单纯球囊扩张在某些情况下也有效。狭窄的特征往往决定最终治疗效果。在恰当选择的病例中，预计成功率约为75%。
