Antegrade percutaneous endoluminal treatment of non-malignant ureterointestinal anastomotic strictures following urinary diversion

OBJECTIVE: We report our experience on antegrade percutaneous incision of ureterointestinal anastomosis strictures after urinary diversion. MATERIALS AND METHODS: Since 1994, we have evaluated retrospectively 18 patients with 22 ureterointestinal anastomosis strictures (UAS), who were treated with cold-knife incision. After placement of an 8-french nephrostomy tube, a 0.035-inch guide wire bypassed the stricture under guidance of a centrally opened (5-french) ureter catheter. A wire-mounted cold-knife was pulled through the strictured area retrogradely under fluoroscopic control. Routinely, following the incision, an 8-french external stent was left in place for 6-8 weeks. RESULTS: After stent removal as a primary procedure, the ureteroenteric area has remained patent in 14 of 19 (74%) UAS. In 3 cases undergoing a secondary or repeated procedure, treatment failed. The average follow-up was 23.5 (range 12-39) months. Failures were associated with radiogenic injury of the ureter in 5 UAS and unexplained in 2. No complication was observed. CONCLUSION: Percutaneous endourological management of UAS with the cold-knife incision, when used as a primary treatment, is a safe and effective alternative to open surgical repair and should be considered as an initial approach.     

腔内技术处理膀胱全切术后输尿管肠吻合口梗阻

目的报道腔内技术处理膀胱全切术后输尿管肠吻合口梗阻的经验。方法 2001年6月至2008年5月对11例膀胱全切术后14侧输尿管肠吻合口梗阻采用腔内技术处理,顺行置入导丝通过梗阻后结合气囊扩张或内切开,并留置双J管6～8周。术后定期随诊,行B超、肾图和肾功能的检查。结果所有患侧输尿管均顺行成功将导丝通过梗阻段,3侧输尿管行气囊扩张,9侧输尿管行内切开,2侧输尿管怀疑肿瘤复发而直接置管。术后平均随访36.0（3～108）月,6侧输尿管拔除内支架管后引流通畅,肾图示尿路无明显梗阻。6侧输尿管在拔除内支架管后梗阻复发,分别采用永久肾造瘘（1侧）、输尿管换管（2侧）和开放手术处理（3侧）。术中术后均未见并发症发生。结论腔内技术处理输尿管肠吻合口梗阻简单安全,创伤小,可作为膀胱全切术后输尿管肠膀胱吻合口梗阻的首选治疗手段。     

Treatment of benign ureterointestinal anastomotic strictures with permanent ureteral Wallstent after Camey and Wallace urinary diversion: long-term follow-up

BACKGROUND AND PURPOSE: Ureterointestinal anastomotic stricture follows urinary diversion in 4% to 8% of patients and may lead to a progressive deterioration of renal function. There are problems with all current management techniques: surgical revision, endourologic incision, nephrostomy drainage, external ureteral stents, and dilation with a high-pressure angioplasty balloon. The authors present their long-term results with permanent ureteral Wallstents for the treatment of benign ureterointestinal stricture. PATIENTS AND METHODS: Eight patients with 10 strictures were treated by placement of self-expanding permanent indwelling stents via percutaneous nephrostomy between September 1993 and January 1998. The mean age of the group was 59.2 years. Development of strictures occurred a mean of 20.9 months after urinary diversion. There were seven complete and three partial strictures. Of 49 patients treated by the Camey procedure, 7 patients (14%) developed 9 (18%) strictures. Of 28 patients having the Wallace procedure, 1 patient (3.5%) developed one stricture. After recanalization of the distal ureter by a Terumo guidewire and dilation with a high-pressure angioplasty balloon, a Wallstent was placed across the stricture via a percutaneous approach. RESULTS: The endourologic placement of the Wallstent was well tolerated by all patients. The hospital stay averaged 2 days. Seven patients with nine strictures after the Camey procedure are doing well with a follow-up of 7 to 68 months (mean 22.4 months). One major complication was observed in one patient necessitating an additional procedure (lithotripsy) because of stone formation at the lower part of the stent extending into the neobladder in order to maintain patency after 68 months. The other patient, who had a Wallace procedure, is doing well 1 year 8 months afterward. CONCLUSION: An endourologic ureteral Wallstent approach to ureterointestinal stricture is a successful alternative, providing satisfactory management of the problem in most patients. No complication such as stent migration, hematuria, pain, or recurrent stricture was observed.     

Fluoroscopically guided percutaneous transrenal electroincision of ureterointestinal anastomotic strictures.

A new technique for electroincision of a strictured ureterointestinal anastomosis is described that uses a sphincterotome and high frequency current. After placement of a percutaneous nephrostomy tube a 7F "wire guided" sphincterotome was placed into the stenosis. The cutting wire was then deflected while cutting current was applied intermittently. Injection of contrast medium through the papillotome probe assessed the depth of the incision. A 10 mm. angioplasty balloon was inflated at low pressure to verify that the anastomosis had been incised to a depth of 1 cm. The anastomosis was then stented for 8 weeks with an 18F stent. The operative time did not exceed 45 minutes. A total of 9 stenoses was treated in 7 patients: 4 were ileal conduit diversions and 5 were enterocystoplasties. No immediate complication was observed. In 1 case a small urinoma was surgically drained at removal of the stent. Six stenoses are patent with 2, 3, 4, 4, 10 and 13 months of followup after removal of the stent. One patient died of bladder tumor metastases during the stenting period and 1 with bilateral incision still has a stent. The technique can be performed without major complication (bleeding or digestive fistula). Long-term results remain to be assessed.     

Editorial comment

BACKGROUND: We determined the long-term result of our percutaneous antegrade balloon dilation technique performed for adult patients with ureterointestinal anastomotic stricture between 1992 and 1997. METHODS: Balloon dilation was performed on 13 ureterointestinal anastomotic structures in 10 patients. After a nephrostomy was performed, a guide wire was introduced into the intestinal loop through the stenotic portion under direct observation using a ureterorenoscope. Dilation was performed using the Olbert balloon dilator (30-Fr) inserted along a guide wire into the stenotic portion. A 20-Fr or 22-Fr multihole catheter was left for approximately 6 weeks. No major complications were encountered during or after these procedures. After removal of the indwelling catheters, the progress of each patient was followed fo rat least 14 months. RESULTS: Additional dilation was necessary in three of 10 patients for the recurrent stricture. The balloon dilation was ineffective in two patients with a long stenosis of the ureter or a previous history of radiation therapy for uterine cancer. Eight of 10 patients showed satisfactory outcomes during the mean follow-up period of 47.1 months. CONCLUSIONS: Based on these results, we believe that the balloon dilation could be the first line of treatment for strictures of uro-digestive anastomosis, except for some patients with a long stenosis or a previous history of intrapelvic radiation.     

Management of ureterointestinal anastomotic strictures: comparison of open surgical and endourological repair

The established treatment for ureterointestinal anastomotic strictures is open surgical revision. In an effort to evaluate the efficacy of endourological surgery for this problem, we compared 7 patients (9 strictures) who underwent open revision to 6 patients (7 strictures) who underwent endoscopic incision and balloon dilation of the stricture. The success rate (that is patent ureter and no stent) was 89 per cent for the open revision group and 71 per cent (5 of 7) for the endoscopic group. All open revisions required use of general anesthesia, while 3 of the endoscopic procedures were performed with the patient under assisted local anesthesia. The endoscopic group had markedly shorter hospitalization, decreased blood loss, diminished patient discomfort and no postoperative complications. While the endoscopic procedure for ureteroileal anastomotic strictures is less successful than open revision, the lower morbidity, decreased cost and shorter hospital stay associated with the endourological approach favor its use over open revision. For elderly patients who fail initial endoscopic revision and for patients with metastatic transitional cell cancer, placement of an indwelling stent is a reasonable alternative. Given these guidelines, less than 30 per cent of the patients who suffer a ureteroileal anastomotic stricture will require open surgical revision.     

Long-term results of antegrade endoureterotomy using the holmium laser in patients with ureterointestinal strictures

Objectives. To investigate the effectiveness and morbidity of percutaneous laser endoureterotomy in the management of ureterointestinal anastomotic strictures after radical cystectomy and urinary diversion.Methods. Between May 1997 and August 2000, 19 percutaneous endoureterotomy incisions, including 3 repeated incisions, were performed on 15 patients with a mean age of 61 years (range 41 to 80) to treat ureterointestinal strictures. A total of 16 renal units were treated (9 left, 7 right), including one bilateral procedure. All procedures were performed using a 200-μm holmium laser fiber in antegrade fashion with a 7.5F flexible ureteroscope. A nephroureteral stent was left in place for 4 to 6 weeks postoperatively. Success was defined as radiologic improvement and/or the ability to return to full activity in the absence of flank pain, infection, or the need for ureteral stents or nephrostomy tubes.Results. With a median follow-up of 20.5 months (range 9 to 41), the overall success rate was 57% (8 of 14 renal units). Two patients were lost to follow-up. The mean operative time was 91 minutes, and no perioperative complications occurred. Three patients required repeated endoureterotomies, with two requiring open reimplantation. Overall, the endoureterotomy failed in 6 patients in the series, with five of the six failures involving left-sided strictures.Conclusions. Percutaneous endoureterotomy is an effective, minimally invasive treatment option for patients with ureterointestinal strictures after urinary diversion. Better visualization and a more precise incision may make the holmium laser a safer cutting modality than alternative methods in patients with ureteroenteric strictures. Patients with left-sided ureterointestinal strictures should be cautioned that endourologic management might have a lower success rate.     

Ureterointestinal strictures following Bricker ileal conduit: management via a percutaneous approach

OBJECTIVE: Urinary diversion after radical cystectomy is commonly performed via an ileal conduit using the Bricker method. However, 4-8% of these cases are complicated with stricture formation at the ureterointestinal junction. Thus, this could eventually lead to hydronephrosis and kidney loss in neglected patients. Few data exist concerning the outcomes of patients with ureterointestinal junction strictures managed via a percutaneous approach and balloon dilatation of the stricture. The potential of managing these strictures, using a stent replacement strategy, was evaluated. PATIENTS AND METHODS: A total of 14 patients (10 male, 4 female; age range 24-72 years) were enrolled in the study. Mean follow-up time was 30.9 months. Invasive bladder cancer was diagnosed in 11, neurogenic bladder in 2 and shrunk bladder after external beam radiation for prostate cancer in 1 patient. They were all managed by radical cystectomy followed by Bricker ileal conduit. In 6 cases, ureterointestinal strictures bilaterally were discovered, whereas unilateral (left-sided) strictures were noted to the remaining 8 patients. All strictures were managed via a percutaneous approach and balloon dilatation. A double J stent was placed at the end of the procedure and was regularly replaced after an interval of 3-6 months. RESULTS: A percutaneous nephrostomy was successfully placed in all patients. Double J stent insertion was possible in 18 of a total of 20 (90%) obstructed ureters. No major complications were observed in any of the cases while adequate renal function was preserved in all patients. Quality of life is not reported to be significantly compromised in any patient. Double J ureteral stent replacement is performed every 3-6 months in a retrograde fashion. One patient died in the follow-up period due to disease progression. CONCLUSION: Placement of a double J stent via a percutaneous approach seems to have offered a viable option in the management of ureterointestinal strictures in this patient population. In addition, periodical retrograde replacement of the stent probably does not constitute a factor compromising quality of life. However, further studies are required to justify these primary clinical data.     

An endourologic approach to complete ureteropelvic junction and ureteral strictures

BACKGROUND AND PURPOSE: Complete stricture of the ureteropelvic junction (UPJ), ureter, or both represents a secondary upper tract obstruction and is a challenge for surgical management. The endourologic repair of these complete strictures remains controversial because of the many unsatisfactory results in the literature. The aim of this study was to achieve recanalization of the ureter or the UPJ using endourologic techniques to prove durable success of this technique. PATIENTS AND METHODS: We present data on the 21 patients with complete UPJ or ureteral strictures treated over 5-year period. The length of the obliterated portion of the ureter or UPJ ranged from 0.3 to 1.7 cm. The stricture was at the UPJ level in 12 patients (57%), in the upper ureter in 3, and in the lower ureter in 4. The technique was a combined approach, with antegrade introduction of the guidewire and retrograde cold-knife incision in the majority of the cases. In five cases, the incision was carried out in the reverse direction with a guidewire introduced retrograde up to the stricture level. An originally designed 6F to 7F polyethylene double-J stent with a movable 12F to 16F silicon sheath or percutaneous tube was placed at the completion of the procedure. RESULTS: The follow-up period ranged from 6 to 48 months. Recanalization was achieved in 17 patients (81%), of whom 14 became symptom free. Other surgical outcomes necessitated open surgical intervention (pyeloplasty, nephrectomy) in two patients. One patient developed a clinically significant recurrent urinary tract infection and deterioration of kidney function. Thus, the overall success rate of the endourologic management of the complete UPJ and ureteral strictures was 67% in our series. CONCLUSION: Endourologic management with retrograde or antegrade pyeloureterotomy can be successful in patients with short (up to 1.0-cm) obliterative strictures who are without extensive hydronephrosis and with preserved renal function.     

输尿管镜技术治疗输尿管良性狭窄

目的探讨输尿管镜技术治疗输尿管良性狭窄的临床疗效。方法2006年5月～2009年4月,对48例输尿管良性狭窄患者采用输尿管硬镜扩张或联合钬激光行内切开术治疗,术后留置1根6F～8F双J支架管,1～3个月后拔管。拔管后3～6个月进行超声、静脉肾盂造影检查。结果48例患者中,2例发生输尿管穿孔,2例狭窄段输尿管黏膜撕脱,均中转开放手术。44例手术成功患者中,硬性扩张成功10例,钬激光治疗成功34例;术后均有不同程度血尿,1例术后发生感染,经抗炎治疗治愈,术后1～3个月拔除双J管。40例获得随访,平均随访12个月,有效34例（85．0％）,好转4例（10．0％）,无效2例（5．0％）。结论输尿管镜直视下扩张术及钬激光内切开术治疗输尿管良性狭窄是一种安全、有效的微创手术方法。     

Retrograde ureteroscopic endopyelotomy using the holmium:YAG laser

BACKGROUND: We report our experience of retrograde ureteroscopic endopyelotomy using the holmium laser for ureteropelvic junction (UPJ) obstruction not associated with upper tract stones. METHODS: We carried out this procedure on five patients through an 8-Fr semirigid ureteroscope. The ureter was not stented before the procedure and balloon dilation was not necessary before retrograde insertion of the ureteroscope. The obstruction was incised with the holmium laser using a 200 microm fiber in a linear fashion. After completion of the incision, a 12-Fr double-J ureteral stent was left for 6 weeks. Thereafter, patients were monitored with renal scan and/or ultrasound and excretory urography at 3-6 month intervals. RESULTS: Hydronephrosis was obviously improved in four cases (80%) at an average follow up of 12.8 months (4-23 months). Although the number of treated patients was small, retrograde ureteroscopic endopyelotomy for UPJ obstruction using the holmium laser achieved good results. CONCLUSIONS: We recommend that this procedure be used initially because it is less invasive and has a favorable outcome.     

Endoscopic treatment of ureteric strictures: acucise, cold-knife endoureterotomy and wall stents as a salvage approach

OBJECTIVE: To evaluate the factors influencing the results of endoureterotomy using cold-knife and cutting balloon dilatation, and permanent ureteral wall stents in patients with benign ureteral strictures after different operations affecting the ureter. MATERIALS AND METHODS: Over a 4-year period, in 18 patients, endoscopic cold-knife and Acucise endoureterotomies were performed in 13 and 7 renal units, respectively. Eight Memoterm permanent ureteral wall stents were inserted into 7 patients when endoureterotomy failed. Successful outcome was defined by the absence of re-stricture assessed both clinically and radiologically. RESULTS: The strictures were secondary to ureterolithotomy in 6, ureteroscopy in 3, gynecological procedures in 4, abdominal surgeries in 2, transplantation in 2 and continent urinary diversion in 1. The right and left ureters were unilaterally affected in 5 and 11 patients, respectively (5 of them had a solitary kidney), while the remaining 2 patients had bilateral ureteral strictures. We achieved total ureteral patency of 3 (43%) and 7 (54%) renal units with Acucise and cold-knife incision, respectively. Obstructive uropathy was resolved in 6 renal units (75%) of 8 using ureteral wall stents. CONCLUSION: Endoureterotomy with cold-knife or Acucise cutting balloon dilatation is effective in the treatment of iatrogenic ureteral strictures, but only in a selected group. Based on our results, the favorable prognostic criteria for endoureterotomy are the length (< or =1.5 cm), the nonischemic nature of the stricture and adequate renal function. As a salvage approach, permanent self-expanding ureteral wall stents with a 75% success rate may provide a satisfactory outcome for decompression of an obstructed system.     

Endoureterotomy by intraluminal invagination for nonmalignant ureterointestinal anastomotic strictures: description of a new surgical technique and long-term followup

PURPOSE: We describe a new surgical endoscopic technique for nonmalignant ureterointestinal anastomotic strictures. This procedure involving endoureterotomy by intraluminal invagination (the Lovaco technique) is performed by adopting a combined percutaneous antegrade and endoscopic retrograde approach. The results obtained by this technique are reviewed with long-term followup. MATERIALS AND METHODS: A total of 25 ureterointestinal anastomotic strictures were subjected to endoureterotomy by intraluminal invagination, including 12 left, 7 right and 3 bilateral cases. Surgical success was defined by radiological improvement and/or the ability to recover normal activity in the absence of flank pain, infection, or the need for ureteral stents or nephrostomy tubes. RESULTS: At a median followup of 51 months (range 2 to 145) the success rate for endoureterotomy by intraluminal invagination was 80% (20 of 25 ureterointestinal anastomotic strictures). No complications were recorded in the patients following endoureterotomy. CONCLUSIONS: This new endoureterotomy technique for ureterointestinal strictures following urinary diversion can be applied to any type of urinary diversion. It allows direct visualization of the stricture and stricture tissue biopsy. Intraluminal invagination makes it possible to increase the distance between the stricture, and the retroperitoneal vessels and bowels. The technique provides the control required to ensure full-thickness and full-length stricture incision. The success rate is high and it persists after long-term followup.     

Glomerular filtration rate up to 10 years after urinary diversion of different types. A comparative study of ileal and colonic conduit, refluxing and antirefluxing ureteral anastomosis and continent caecal reservoir

To evaluate the influence of conduit type (ileal or colonic) and method of ureterointestinal anastomosis (refluxing or antirefluxing) on renal function in patients with urinary diversion, a prospective randomized trial was conducted in 1977-1984. During these years urinary diversion via a continent caecal reservoir emerged as an alternative to conduit diversion at our hospital, and these patients with continent reservoir were also included in the study. Total and separate glomerular filtration rate (GFR) were measured, the latter with scintillation camera renography, preoperatively and at follow-up in 70 patients. Measurements 2-10 years postoperatively showed slight to moderate decrease of GFR in all groups, with no significant difference between values according to conduit type or caecal reservoir or between refluxing and antirefluxing ureterointestinal anastomosis. Almost all of the anastomotic strictures involved the ureter that had been brought beneath the sigmoid mesentery, indicating that ischemia secondary to extensive ureteral mobilization is a likely cause of stricture in these cases.     

Open dismembered tubularized flap pyeloplasty: an effective and simple operation for treatment of ureteropelvic junction obstruction

OBJECTIVE: To evaluate the success rate of dismembered tubularized flap pyeloplasty (DTFP) in the treatment of ureteropelvic junction obstruction (UPJO). PATIENTS AND METHODS: In a prospective study from August 2002 to September 2004, 15 patients with a mean age of 21 years (range 2-47) in whom UPJO had been diagnosed by sonography, excretory urography or diuretic renography and who had a large extrarenal pelvis, underwent operation via flank intercostal incision. The proximal ureter and renal pelvis were dissected and mobilized retroperitoneally, the site of UPJO was excised and the site of insertion of the ureter on the renal pelvis was closed with a stitch. A wide based renal pelvic flap was created and tubularized to bridge the upper ureteral defect. After insertion of a nephrostomy tube, a double-J tube was inserted as an internal ureteral stent and anastomosis of the tubularized flap to the spatulated upper ureter was done and the renal pelvis window was closed. Patients were followed 3, 6 and 12 months postoperatively. RESULTS: Mean operation time was 1 h and mean hospital stay was 3 days. The ureteral stent was removed 4 weeks after operation and at the same time a nephrostogram was done that showed a widely patent ureteropelvic junction with good renal pelvis drainage in 12 ( approximately 80%) of the cases, but in 3 cases (approximately 20%) passage of contrast materials was not seen. In these patients, methylene blue was injected via a nephrostomy tube and in 2 patients (14%) urine color turned blue 20 min later, but in 1 patient (7%) this test was also negative. The latter patient underwent percutaneous endopyelotomy later. Mean patient follow-up was 14 months. Follow-up excretory urography confirmed patent and unobstructed ureteropelvic junction in all patients. The overall success rate of DTFP was 93%. CONCLUSION: DTFP is a simple and effective procedure for patients with UPJO who have long or multiple upper ureteral strictures and a large extrarenal pelvis.     

New modality for treatment of resistant anastomotic strictures after radical prostatectomy: UroLume urethral stent.

A new approach for the treatment of vesicourethral anastomotic stricture after radical retropubic prostatectomy is presented. The patient had failed treatment with bougies, balloon dilation, and cold-knife incision of the anastomotic area. Transurethral resection of the bladder neck resulted in a rapid recurrence of the stricture. He was successfully treated with insertion of a UroLume urethral stent. After 18 months of follow-up, the patient is symptom free.     

腔内切开治疗移植肾输尿管膀胱吻合口梗阻

目的 探讨腔内切开处理移植肾输尿管膀胱吻合口梗阻的安全性与有效性. 方法 18例肾移植患者术后2～18个月出现尿量减少.实验室检查SCr 230～570/μmol/L.超声检查提示中重度肾积水.膀胱镜检查18例均无法逆行输尿管置管.经皮肾造瘘后行顺行造影显示输尿管膀胱吻合口梗阻,不完全梗阻14例、完全梗阻(闭锁)4例,梗阻长度0.5～1.3 cm.术中先经皮肾通道入镜,将斑马导丝顺行插过梗阻段达膀胱,再逆行经尿道将膀胱内导丝拉出尿道外,直视下用电刀或钬激光全层切开梗阻段;若斑马导丝无法通过梗阻段,则采用造影剂混合美蓝充盈膀胱,顺行入镜到达梗阻处,X线监视下用长针向膀胱内穿刺打通.术后留置2条双J管6～8周,定期行超声、肾图和肾功能检查. 结果 18例术中见吻合口黏膜苍白水肿,管壁僵硬、管腔狭窄、瘢痕组织增生明显,均成功将梗阻段切开,无手术并发症发生.术后夹闭肾造瘘管后排尿通畅,尿量正常.实验室复查SCr降至87～233μmol/L.超声检查提示肾血流正常,肾积水消失或仅轻度积水.随访4～90个月,平均51个月.8例1次治疗成功;5例因瘢痕组织切除不彻底经再次腔内切开(3例2次,2例3次)治疗后成功;5例拔管后梗阻复发无法逆行入镜,梗阻难以处理改开放手术治疗,其中4例治疗成功,1例仍需长期输尿管置管. 结论 肾移植术后输尿管膀胱吻合口梗阻采用腔内切开治疗安全、有效,梗阻复发者可考虑再次内切开或开放手术治疗.     

Endourological management of ureteral strictures

Endourological management was employed in five cases with ureteral strictures. The cause of stricture included ureteroileal anastomoses in two cases, open pyeloplasty in one, radical hysterectomy in one and retroperitoneal fibrosis in one. In four cases, strictures were dilated using a balloon dilation catheter (diameter 4 to 8 mm), followed by placement of ureteral stent (6 to 8.3 Fr), for from 8 days to 43 days. In one case, graduated flexible dilator was passed until a 10 Fr opening was obtained. A 6 Fr ureteral stent was placed for 42 days. Of the 5 strictures 3 were dilated successfully as judged by excretory urogram. Followup ranged from 7 months to 19 months. Unsuccessful dilation occurred in 2 cases. In one case, subsequent exploratory operation revealed retroperitoneal fibrosis. In another case, subsequent CT scan disclosed the metastasis of rectal cancer obstructing the site of ureteroileal anastomosis. Endourological procedure is valuable in the treatment of benign post-operative ureteral stricture.     

Holmium: Yttrium-Aluminum-Garnet Laser Endoureterotomy for Benign Ureteral Strictures: a Single-Centre Experience

Purpose: This study aimed to report the results of endoureterotomy for benign ureteral strictures using the holmium: yttrium-aluminum-garnet laser.

Material and methods: Nineteen patients (8 men and 11 women, mean age 51.47 years) underwent holmium: yttrium-aluminum-garnet laser endoureterotomy for benign ureteral strictures (8 proximal, 3 middle, and 8 distal) using semirigid ureteroscopy and 360-μm fibre at 1.2 J/pulse and 10 Hz. After completion of the incision, a 7-Fr double-J ureteral stent was left for 6 weeks. Thereafter, the patients were followed-up by ultrasound and/or intravenous urography at 36 monthly intervals.

Results: Success was defined as the absence of symptoms plus radiographic resolution of obstructions as assessed by diuretic renography and/or intravenous urography. With a mean follow-up of 40.2 months, success was achieved in 10 (52.6%) of the 19 patients. Nine patients developed recurrent strictures and were considered treatment failures. The stricture length and severity of hydronephrosis correlated with successful outcome, but gender, aetiology, side and location of strictures did not predict outcome.

Conclusions: Although endoureterotomy using a holmium: yttrium-aluminum-garnet laser has an equivocal outcome, the procedure is recommended as a safe, less invasive therapeutic option for the initial management of benign ureteral strictures.     

腹膜后腹腔镜手术治疗下腔静脉后输尿管（附14例报告）

目的 探讨腹膜后腹腔镜手术治疗下腔静脉后输尿管的手术方法和治疗效果。方法 回顾性分析2005年10月～2010年10月14例下腔静脉后输尿管患者的临床资料,术前均经B超、尿路X线平片(KUB)、静脉尿路造影(IVU)和多层螺旋CT三维尿路成像(MSCTU)检查而明确诊断,其中3例合并右输尿管结石。采用腹腔镜技术经腹膜后...