Urology and Andrology

Radioendoscopic surgery of primary and secondary strictures of the upper urinary tract

The objective. Assessment of the effectiveness of radioendoscopic methods of treatment of strictures of the upper urinary tract.

Patients and methods. The work was based on the results of examination and treatment of 134 patients (aged 24 to 78 years, 51 men, 83 women) with supravesical obstruction, conditioned by stricture or obliteration of UUT, who were hospitalised and treated in the urology clinic of the University Clinical Hospital No 2 of the Sechenov First Medical University. The patients underwent endoscopic treatment (balloon dilation, endopyelotomy, endoureterotomy, ureteral recanalization, Memokath stent placement).

Results. Good and satisfactory results were obtained in 116 (86.6%) patients. The best results were obtained in patients with a stricture less than 1 cm, who underwent combined balloon dilation with laser endotomy (95.8% efficacy). Unsatisfactory results of endotomy were noted in 18 (13.4%) cases. 15 patients underwent further various reconstructive surgery. Nephrectomy was performed in 3 (2.2%) patients due to loss of renal function when stricture recurred. Conclusion. In case of UUT strictures, endotomy is indicated in patients with primary or post-operative UUT strictures no more than 2 cm long. The best outcomes can be obtained in treatment of patients with strictures shorter than 1 cm and in combination of balloon dilation and laser incision. The obtained evidence are demonstrative of the effectiveness and expediency of the selected low-invasive treatment tactics, which permits to reduce the likelihood of open operative interventions in a part of patients.

Key words: iatrogenic ureteral injury, ureteral strictures, ureteropelvic segment stenosis, endoscopic treatment of upper urinary tract strictures, laser endomomy of strictures, baloon dilation of ureter, endopyelotomy, endoureterotomy, ureteral recanalization, Memokath stent placement.

For citation: Alyaev Yu.G., Glybochko P.V., Rapoport L.M., Gazimiev M.A., Akopyan G.N. Radioendoscopic surgery of primary and secondary strictures of the upper urinary tract. Vopr. urol. androl. (Urology and Andrology). 2017; 5(4): 5–12. (In Russian).
DOI: 10.20953/2307-6631-2017-4-5-12