Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China.
J Endourol. 2019 Apr;33(4):255-262. doi: 10.1089/end.2018.0797. Epub 2019 Feb 7.
Although balloon dilatation is one of the main endoscopic procedures used to treat benign ureteral strictures, its precise efficacy remains controversial. We aimed to identify, combine, and analyze existing published data to ascertain the efficacy of endoscopic balloon dilatation for benign ureteral strictures.
In December 2018, a literature search was performed using Medline, Embase, and Web of Science databases. We included reports in which the study population consisted of patients who underwent endoscopic balloon dilatation for the treatment of benign ureteral strictures. Technical, short-term, and long-term success rates (expressed as mean ± standard error) were adopted as the outcome measures.
Using our search strategy, a total of 19 studies (all series reports) were included for analysis. Using a random-effects model, the pooled technical success rate of endoscopic balloon dilatation for benign ureteral strictures was found to be 89% ± 4%. Furthermore, the short-term success rate (i.e., 3 months after surgery) was 60% ± 10%, and the long-term success rate (i.e., 6-12 months after surgery) was 54% ± 14%. In the subgroup analysis, the success rate of endoscopic balloon dilatation for ≤2-cm benign ureteral strictures was significantly higher than that for >2-cm ones (odds ratio [OR]: 0.13; 95% confidence interval [CI]: 0.05-0.35). In addition, the success rate in cases with strictures of onset timing ≤3 months was relatively higher than that in cases with strictures of onset timing >3 months (OR: 0.46; 95% CI: 0.15-1.43).
Our study indicates that endoscopic balloon dilatation has a high success rate in the treatment of benign ureteral strictures with length ≤2 cm and onset timing ≤3 months. However, there is still no consensus on balloon type, dilatation pressure, expansion number, postoperative ureteral stent type, and stent retention time for the balloon dilatation technique.
尽管球囊扩张术是治疗良性输尿管狭窄的主要内镜治疗方法之一，但确切疗效仍存在争议。我们旨在确定、合并和分析现有已发表的数据，以确定内镜球囊扩张术治疗良性输尿管狭窄的疗效。
2018 年 12 月，我们使用 Medline、Embase 和 Web of Science 数据库进行了文献检索。我们纳入了研究人群为接受内镜球囊扩张术治疗良性输尿管狭窄的患者的报告。技术、短期和长期成功率（表示为均值±标准误差）被用作结局指标。
使用我们的搜索策略，共纳入 19 项研究（均为系列报告）进行分析。使用随机效应模型，发现内镜球囊扩张术治疗良性输尿管狭窄的总体技术成功率为 89%±4%。此外，短期成功率（即术后 3 个月）为 60%±10%，长期成功率（即术后 6-12 个月）为 54%±14%。在亚组分析中，内镜球囊扩张术治疗≤2cm 良性输尿管狭窄的成功率明显高于>2cm 者（比值比[OR]：0.13；95%置信区间[CI]：0.05-0.35）。此外，起病时间≤3 个月的病例的成功率相对较高，而起病时间>3 个月的病例的成功率较低（OR：0.46；95%CI：0.15-1.43）。
我们的研究表明，内镜球囊扩张术治疗长度≤2cm 和起病时间≤3 个月的良性输尿管狭窄成功率较高。然而，对于球囊类型、扩张压力、扩张次数、术后输尿管支架类型和支架留置时间，球囊扩张技术仍没有达成共识。
