Presentation Authors: Wai Loon Yam, Foo Cheong Ng, Benjamin Tze Ying Lim*, Kok Kit Ng, Singapore, Singapore
Introduction: Benign ureteric strictures are commonly encountered in daily practice. Severe strictures are managed by reconstructive surgery. Mild to moderate strictures can be managed endoscopically. However, balloon dilatation of benign ureteric strictures has not been widely practiced due to lack of long-term data. We would like to present the outcome of our series and examine the risk factors of stricture recurrence.
Methods: There were 111 strictures (in 101 patients) in our prospectively maintained database since August 2012 to July 2018. The strictures were dilated retrogradely or antegradely using Reef HP or Olympus EZDilate balloon catheters. They were serially dilated until a mean maximal pressure of 16.8 atm (SDÂ±3.6). A DJ stent was inserted at the end of procedure. A follow up IVU, CT or nephrostogram was performed to check for recurrence.
Results: Mean age of patients was 57.7 years old (SDÂ±12.6). There were 109 ureteric and 2 ureteroileal anastomotic benign strictures. Mean length of strictures was 11.0mm (SDÂ±8.6). Mean duration of DJ stent placement was 5.5 weeks (SDÂ±3.7). Mean follow up was 20.2 months (SDÂ±17.4). _x000D_
The overall stricture patency rate is shown in the table 1. _x000D_
There was no intraoperative ureteric injury/avulsion that required immediate or delayed reconstruction. Only 12 patients (10.8%) had to undergo reconstructive surgery or to be on long term nephrostomy tube. _x000D_
Strictures caused by radiotherapy was at 100%(5/5) risk of recurrence, iatrogenic injury 66.7%(8/12) and stone/inflammation 28.0%(21/75), p = 0.000. Strictures detected on preoperative imaging also had significantly higher risk of recurrence at 58.3% (28/48) vs incidental strictures at 13.6% (6/44), p = 0.000. Strictures associated with atrophic kidney had recurrence rate of 72.2%(13/18) vs normal kidney 28.4% (21/74), p = 0.001. The mean length of strictures was 12.5 mm (SEÂ±1.7) in the recurrence group vs 9.6 mm (SEÂ±0.7) in those without recurrence, p = 0.001. There were no significant differences in the location of stricture and severity of hydronephrosis.
Conclusions: Endoscopic balloon dilatation of benign ureteric stricture is a feasible option. Its effect can be long lasting in carefully selected patients i.e. non radiated, incidental, short strictures with normal kidneys; or those not fit for reconstructive surgery.