Endourological treatment of ureteral strictures with the use of self-expanding stents: is it possible to completely cure the stricture endoscopically? A report on the experience with implantation of 35 stents with a two-year follow-up period; a retrospective study.

Abstract

Background: The current results of endoscopic treatment of ureteral strictures are characterized by very divergent treatment results, which is due to a wide range of criteria for including patients in the analyses and different definitions of effective treatment. In this retrospect study we wanted to introduce a possibility of curing ureteral strictures depending on their type and degree with the use of self-expanding ureteral stents (SUS).

Methods: 33 patients with ureteral strictures received endourological treatment with the use of Allium® SUS (2 patients with SUS placed on both sides). Patients were divided into 2 groups: patients with uncomplicated strictures (Grp 1) and patients with complicated strictures (Grp 2). Uncomplicated stricture was defined as a single stricture below 2 cm. A complicated stricture was defined as a stricture over 2 cm and/or multiple strictures. The follow-up time was 24 months. All patients were scheduled for renoscintigraphy during the treatment. A full therapeutic success was defined as no tight stenosis in renoscintigraphic furosemide test after SUS explantation.

Results: In Grp 1, full therapeutic success was achieved in 80% of patients, which was statistically significant (p < 0.001). Serious complications (Clavien-Dindo > 3a) occurred significantly more often in Grp 2 (p = 0.046). Renal outflow during stenting was present in 70% of the patients in Grp 2.

Conclusions: A full therapeutic success of endoscopic, SUS-assisted treatment can be considered among patients with short, single ureteral stricture. In long and/or multiple strictures, SUS can be used as drainage element, but full recovery of the stricture is unlikely.