Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
J Endourol. 2009 Nov;23(11):1909-12. doi: 10.1089/end.2008.0453.
During the past decade, endoscopic management has emerged as the first-line treatment of benign ureteral strictures. We reviewed our experience with the management of benign ureteral strictures to determine the success rate of endoscopic surgery in a contemporary series and assessed the viability of surgical reimplantation in the modern era.
We identified 75 patients with a diagnosis of ureteral stricture between 2000 and 2005 via electronic medical records search and excluded those with completely obliterated, external compressive, malignant, or ureteroenteric strictures, ureteropelvic junction obstruction, and those with follow-up less than 2 months.
Thirty-four patients who were treated endoscopically (balloon dilation and/or holmium laser endoureterotomy) were identified. Mean stricture length in each patient was 1.6 +/- 1 cm (range 0.5-4 cm), and the mean number of procedures per patient was 1.7 +/- 0.8. Endoscopic success was achieved in 29 (85%), while 5 (15%) patients experienced endoscopic management failure and ultimately needed ureteral reimplantation. When comparing the endoscopically treated and reimplant groups, there was no significant difference in mean stricture length (1.38 +/- 1.13 vs 2 +/- 1.1 cm, P = 0.14), yet mean number of procedures performed (1.41 +/- 0.85 vs 3.6 +/- 1.5; P = 0.002) reached statistical significance. There were no clinical or radiographic signs of obstruction in 100% of patients who received endoscopic therapy only and 100% of patients who needed open surgical management at a mean follow-up of 25.2 +/- 19.3 and 7.7 +/- 3.2 months, respectively.
Endoscopic surgery is clearly a successful primary treatment modality in the management of benign ureteral strictures with minimal morbidity. In the modern era of endoscopic surgery, however, ureteral reimplantation remains a viable option in treating the small subset of patients with benign ureteral strictures for whom endoscopic management fails.
在过去十年中，内镜治疗已成为治疗良性输尿管狭窄的首选方法。我们回顾了我们在良性输尿管狭窄管理方面的经验，以确定在当代系列中内镜手术的成功率，并评估在现代时代进行手术再植入的可行性。
通过电子病历搜索，我们确定了 2000 年至 2005 年间诊断为输尿管狭窄的 75 名患者，并排除了完全闭塞、外部压迫、恶性或输尿管肠吻合口狭窄、肾盂输尿管交界处梗阻以及随访时间少于 2 个月的患者。
确定了 34 例接受内镜治疗（球囊扩张和/或钬激光腔内切开术）的患者。每位患者的平均狭窄长度为 1.6+/-1 厘米（范围 0.5-4 厘米），每位患者的平均手术次数为 1.7+/-0.8 次。29 例（85%）患者内镜治疗成功，而 5 例（15%）患者内镜治疗失败，最终需要输尿管再植入。在比较内镜治疗和再植入组时，平均狭窄长度（1.38+/-1.13 与 2+/-1.1 厘米，P=0.14）无显著差异，但手术次数（1.41+/-0.85 与 3.6+/-1.5；P=0.002）达到统计学意义。仅接受内镜治疗的患者 100%和需要开放手术治疗的患者 100%在平均 25.2+/-19.3 和 7.7+/-3.2 个月的随访中均无临床或影像学梗阻迹象。
内镜手术显然是治疗良性输尿管狭窄的一种成功的初始治疗方法，其发病率较低。然而，在现代内镜手术时代，对于内镜治疗失败的一小部分良性输尿管狭窄患者，输尿管再植入仍然是一种可行的选择。
