Percutaneous dilation of benign biliary strictures

Percutaneous balloon dilation of benign biliary strictures was successful in 15 of 18 patients in whom the procedure was attempted. Successful dilation was achieved in nine of 11 patients who had biliary enteric strictures, with follow-up of 22-55 months (mean, 35.4 months) after catheter removal in seven patients. Five of six strictures in the biliary tree that developed after surgery were successfully dilated, with long-term follow-up available in two patients (58 and 42 months). A patient with an inflammatory common bile duct stricture that was successfully dilated was followed up for 18 months. Percutaneous dilation of biliary tract strictures is a promising technique with good long-term results and may be the initial treatment of choice in biliary stricture management.     

Percutaneous balloon dilatation of ureteral strictures

Percutaneous balloon dilatation of ureteral strictures has not gained widespread acceptance, despite proven success with the techniques for dilating stenotic blood vessels. Thirty-one ureteral strictures (in 30 patients) that were dilated during a 42-month period were reviewed to assess the results and to determine which patients are most likely to benefit from the procedure. Eighteen (58%) of 31 strictures were successfully dilated and remained patent for at least 6 months. Thirteen (42%) of 31 strictures resulted in failed patency either immediately (two patients) or within 3 months (seven patients), 6 months (three patients), or 21 months (one patient). Fourteen (64%) of 22 strictures less than 7 months of age were successfully dilated. All dilations for strictures more than 7 months of age failed. Four strictures were of unknown age. Nine (69%) of 13 strictures located in the proximal or midureter remained patent, and three (60%) of five dilations at a ureteroileal anastomosis were successful. Neither of two strictures at a ureterocolic anastomosis was treated successfully. We conclude that percutaneous balloon dilatation is an effective treatment of ureteral strictures in some patients, especially when the strictures are less than 7 months of age.     

Percutaneous antegrade dilatation of distal ureteral strictures and obstructions

Since the first ureteral dilatations in experimental dogs were performed, the technique in human has been accepted and improved over the years. Balloon dilatation has been successful, but it has been very difficult or impossible to force the guide wires through long total strictures, especially those localized distally. In order to recanalize very narrow strictures or total occlusions located in the distal ureter, a modified angiographic technique was developed and tested in 12 ureters in 10 patients.     

Percutaneous renal and ureteral stone removal

Percutaneous removal of upper urinary tract calculi has become an accepted alternative to surgical removal. Calculi may be removed through large nephrostomy tracts under fluoroscopic or endoscopic control. Close cooperation between the radiologist and urologist should increase the success rate of the procedure.     

Percutaneous renal and ureteral stone removal

Percutaneous removal of upper urinary tract calculi has become an accepted alternative to surgical removal. Calculi may be removed through large nephrostomy tracts under fluoroscopic or endoscopic control. Close cooperation between the radiologist and urologist should increase the success rate of the procedure.     

Percutaneous techniques in the management of urological complications in renal transplant patients

Obstruction of urine flow and urine leaks are potentially life-threatening complications in renal transplant patients. The diagnosis is difficult, and definite treatment may therefore be delayed. This paper reviews the clinical course of ten renal transplant patients with urologic complications, discusses the limitations of the standard tests used to investigate such problems, and describes the role of percutaneous antegrade pyelography and nephrostomy drainage catheter placement as safe and accurate diagnostic and therapeutic procedures.     

Percutaneous management of benign biliary strictures with balloon dilation and self-expanding metallic stents

Seventy patients with benign biliary strictures were treated by means of percutaneous balloon dilation and stenting. Patients with stenoses relapsing during catheter stenting (18/70) were treated with self-expanding metallic stents. Results were evaluated in 56 patients; in patients without sclerosing cholangitis (n=47) the patency rate with both modalities of treatment was 96%, while in the patients with secondary sclerosing cholangitis (n=9), it was 33%, for a total success rate of 86%. The average follow-up was 23 months (range 3–72 months). Major complications included one death for septic shock (1%), three severe hemorrhages (4%), two of which required arterial embolization, two pleural effusions (3%), and one liver abscess following arterial embolization. Moderate fever for 1–2 days was a common finding after percutaneous puncture and balloon dilation. Percutaneous management of benign biliary strictures so far has been attempted only in surgical failures or in complicated cases. In view of our midterm results it may well become the initial treatment in many patients.     

Esophageal strictures: balloon dilation

One hundred seventy transnasal balloon catheter dilation procedures were performed in 35 patients with esophageal strictures to assess the efficacy and safety of the procedure. On the average, five dilations were required per patient. Depending on the cause of the esophageal stricture, success rates for the technique ranged from 67% to 87%, with success defined as the resolution of dysphagia to both fluids and solids. Three complications, all perforations, were seen; one perforation required surgical repair. No procedure-related deaths were identified in this series. Balloon catheter dilation can be safely applied to esophageal strictures from a variety of causes, with a high degree of clinical success.     

Percutaneous nephrostomy in the management of ureteral and renal calculi.

A percutaneous nephrostomy tract can serve both to decompress the renal pelvis and as a route for dissolving renal stones and assisting in basket retrieval of ureteral stones. These techniques are especially valuable in patients who are poor operative risks.     

Percutaneous transluminal angioplasty of renal transplant artery stenosis

Renal transplant artery stenosis occurs in approximately 10% of renal transplants, and antihypertensive drugs, vascular reconstructive surgery, and percutaneous transluminal angioplasty may be used in its treatment. Details of 28 cases of renal transplant artery stenosis were collected from a postal survey of United Kingdom transplant centres. The success rate for angioplasty (63% clinical cure or improvement) is lower than in previous reports.     

Catheter dilatation of benign ureteral strictures

Twenty-seven symptomatic, benign postoperative strictures of the ureter or ureteropelvic junction were dilated with balloon or angiographic catheters in an attempt to definitively treat the strictures without surgery. Twenty-three dilatations were performed in antegrade fashion in conjunction with or subsequent to percutaneous nephrostomy, and four strictures were dilated in retrograde fashion per urethra. Thirteen of 27 strictures (48%) were successfully dilated. Certain strictures were more amenable to dilatation than others. In general, the potential for success in dilating ureteral strictures appears to be more dependent on the nature of the stricture than either its duration or the method of dilatation. Based on our initial experience, suggested techniques and guidelines for patient selection are offered.     

Antegrade stenting of malignant ureteral strictures

Renal failure due to malignant ureteral obstruction presents a management dilemma because there is invariably advanced disease. We review our experience with 28 patients referred for antegrade ureteral stenting of malignant ureteral obstruction. Antegrade stenting was successful in 17 and unsuccessful in 11. In the former group, mean survival was 14.3 months (range 0.5–92 months), whereas in the latter mean survival was 3.8 months (range 0.3–14 months). Our experience is that when successful, intervention does prolong life. We challenge the widespread belief that such intervention is not justified. Acknowledging that each case should be dealt with on its merits, we advocate that if nephrostomy drainage is performed for malignant ureteral obstruction, such patients deserve at least an attempt at antegrade stenting. Our modification to the technique uses a 12f Amplatz fascial dilator to create a coaxial system, allowing greater guide-wire and catheter control.     

经皮穿刺肾盂治疗移植肾输尿管狭窄

目的:探讨经皮穿刺肾盂治疗移植肾输尿管狭窄的有效性和安全性。方法:5例肾移植术后输尿管狭窄患者行球囊扩张并双"J"管置入术,球囊完全膨胀4例,1例脐凹存在。结果:5例输尿管狭窄气囊扩张术后均恢复了尿路通畅,手术成功率为100%,无并发症出现。术后肾功能改善,血肌酐下降。结论:介入治疗移植肾输尿管狭窄是安全和有效的。     

Management of ureteral strictures in renal transplants by antegrade balloon dilatation and temporary internal stenting

Purpose: To evaluate the efficacy of percutaneous balloon dilatation and temporary internal stenting in the treatment of transplant ureteral strictures. Methods: Nine patients presenting with obstructed renal transplants were treated by antegrade nephrostomy insertion, ureteroplasty, and temporary internal stenting. Following stent removal, patients were divided into two groups for analysis according to whether the obstruction occurred less than (group A) or more than (group B) 3 months following transplantation. Results: All procedures were technically successful. In group A (n= 6), all patients were successfully treated by one or two dilatations with stenting. In group B (n= 3), two patients were successfully treated by one dilatation with stenting. Overall, eight patients (89%) have had their primary or secondary stent removed successfully at a mean interval of 97.5 days after insertion, and remain well at a mean follow-up interval of 22 months. Conclusion: Balloon dilatation and temporary internal stenting is a useful method for treating transplant ureteral strictures.