Our 20-year experience in treating ureteric strictures endoscopically

Abstract

Introduction and objectives: To review our centre experience in endoscopic intervention of ureteric stricture and identify factors affecting the operative outcome. Materials and methods: We retrospectively reviewed data of patients underwent endoscopic intervention of ureteric stricture in the period between January 1997 and June 2016 in Queen Mary and Tung Wah Hospitals. Ureteric stricture due to malignant obstruction and ureteric stricture of transplant kidney were excluded. Primary endpoint was stricture recurrence, defined as evidence of radiological evidence of persistent obstruction, and/or the need of drainage of the obstructed system. Kaplan-Meier model was used to analyse the recurrence-free survival (RFS), and Cox-regression model was used to compare factors affecting RFS. Results: During the studied period, endoscopic intervention for ureteric stricture was performed on 138 renal units in 113 patients. Majority (60%) of strictures were urolithiasis-related. Most common site of strictures was proximal ureter (41%), followed by distal ureter (23%) and ureteropelvic junction (UPJ) (17%); 9 strictures (7%) were of multiple levels. Balloon dilatation was the most commonly used technique (61%), followed by laser endoureterotomy (23%). 71/138 of strictures had recurrence after treated endoscopically, with the cumulative recurrence rate of 51%. The overall 1-year and 3-year RFS was 54% and 49% respectively. 59/71 (83%) of the recurrence occurred within 1 year after endoscopic intervention. Dilatation technique (balloon or serial dilatation) had higher success rate than endoureterotomy or combination of technique (3-year RFS 67% vs 42% vs 13%. P = 0.01). Second or more attempts had poorer outcome than first attempt (3-year RFS 30% vs 54%, P = 0.02). Endoscopic intervention worked better in urolithiasis-related strictures than in strictures of other aetiology (3-year RFS 59% vs 33%, P = 0.00). Stricture length, stricture level, surgeons’ experience or pre-operative renal unit differential function had no statistically significant association with recurrence. On multivariate analysis, dilatation (P = 0.02) and urolithiasis-related strictures (P = 0.00) remain as significant predictor of better RFS after endoscopic treatment. Conclusion: It is reasonable to attempt endoscopic intervention for urolithiasis-related ureteric strictures. The recommended technique is dilatation, either serial dilatation or dilation with balloon dilator. Endoscopic intervention, however, should not be considered curative treatment of ureteric strictures with non-urolithiasis aetiology or those with previous failed endoscopic treatment.