Institute of Urology, Rabin Medical Center, Petah Tikva, Israel.
Urology. 2012 Aug;80(2):255-9. doi: 10.1016/j.urology.2012.02.030. Epub 2012 Apr 11.
To evaluate the long-term outcomes and complications of retrograde endoureterotomy for persistent ureterovesical anastomotic strictures in renal transplant patients after percutaneous balloon dilation failure.
From January 2000 to May 2010, 26 (2.6%) of 1004 renal transplant patients developed ureterovesical anastomotic stricture after surgery. Seven of these patients and five additional referred patients with similar characteristics were treated with retrograde endoureterotomy after ≥1 previous unsuccessful attempt at percutaneous balloon dilation. All strictures treated were <1 cm in length. The clinical characteristics and outcomes were analyzed. Success was defined as the absence of symptoms and the resolution of obstruction on imaging after the procedure.
The median interval from initial treatment to endoureterotomy was 2.9 months (range 1.3-62.1). Before endoscopic treatment, 8 patients (67%) were treated with a single trial of balloon dilation and 4 (33%) with multiple trials. Endoureterotomy was performed using cold knife, holmium:yttrium-aluminum-garnet laser, and Bugbee electrode in 9, 2, and 1 patients, respectively. The median follow-up period was 44.4 months (range 2.4-68.6). Recurrent stricture developed in 2 patients during a mean follow-up of 4.7 months. Thus, the overall success rate was 83%. Postoperative complications appeared in 3 patients (25%) with culture-positive urinary tract infection. One graft failure occurred but was not related to a recurrent stricture.
After failure of antegrade percutaneous balloon dilation, retrograde endoureterotomy is an effective salvage procedure for well-selected cases of renal transplant patients with a short ureterovesical anastomotic stricture.
评估经皮球囊扩张失败后逆行腔内输尿管切开术治疗肾移植患者持续性输尿管-膀胱吻合口狭窄的长期疗效和并发症。
2000 年 1 月至 2010 年 5 月，1004 例肾移植患者术后发生输尿管-膀胱吻合口狭窄 26 例（2.6%）。其中 7 例患者和另外 5 例具有相似特征的转诊患者在至少 1 次经皮球囊扩张失败后接受逆行腔内输尿管切开术治疗。所有治疗的狭窄长度均<1cm。分析临床特征和结果。成功定义为术后无症状且影像学显示梗阻解除。
从初始治疗到腔内切开术的中位时间间隔为 2.9 个月（范围 1.3-62.1）。内镜治疗前，8 例（67%）患者行单次球囊扩张治疗，4 例（33%）患者行多次球囊扩张治疗。9 例患者采用冷刀、钬：钇-铝-石榴石激光和 Bugbee 电极进行腔内切开术，分别为 2 例和 1 例患者。中位随访时间为 44.4 个月（范围 2.4-68.6）。2 例患者在平均随访 4.7 个月后出现复发性狭窄，总成功率为 83%。3 例（25%）患者术后出现培养阳性的尿路感染并发症。1 例移植物失功，但与复发性狭窄无关。
经皮顺行球囊扩张失败后，逆行腔内输尿管切开术是治疗选择合适的短段输尿管-膀胱吻合口狭窄的肾移植患者的有效挽救性手术。
