Ureteric stricture formation following ureteric instrumentation in patients with a nephrostomy drain in place

Factors associated with ureteral strictures following ureteroscopy for impacted ureteral stones? A multicenter study by EAU-YAU endourology and urolithiasis working party

OBJECTIVE

To determine the relation between ureteral stone impaction and ureteral stricture formation and associated factors.

MATERIAL AND METHODS

We retrospectively analyzed the medical records of all patients who underwent endoscopic ureteral stone surgery for impacted ureteral stone at three academic institutions in Turkey, United Kingdom and Spain between June 2019 and January 2022. Examined parameters included patient demographics, stone side, size and localization, time between initiation of symptoms and surgery, type of ureteroscopy (rigid/flexible), presence of nephrostomy or double-J stent prior to URS, intraoperative complications (avulsion/perforation, stone-free status, number of procedures required for stone-free status, postoperative imaging results.

RESULTS

A total of 41 patients whom 25 were male and 16 were female, from 3 institutions were included the study. The mean age of the patients was 48.2 ± 13.5 years. The median largest diameter of the stones was 9 mm (IQR: 8 mm). Total 14 (34.1%) patients developed ureteral strictures following ureteroscopy. There was no difference between patients who developed ureteral strictures and patients who did not developed strictures in terms of stone laterality, stone location, hydronephrosis and multiplicity, p = 0.58, p = 0.14, p = 0.79 and p = 0.31. Patients who developed ureteral strictures had a higher rate of preoperative urinary diversion such as nephrostomy or DJS, p = 0.000.

CONCLUSION

Interruption of urine passage through ureter via urinary diversion such as nephrostomy or DJS stent prior to ureteral stone surgery might lead ureteral stricture formation in the postoperative period.

Predictors of Ureteral Strictures after Retrograde Ureteroscopic Treatment of Impacted Ureteral Stones: A Systematic Literature Review

BACKGROUND

The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral stricture formation is not yet fully understood. It is likely that the patient and stone characteristics, as well as intervention factors, play a role in this process. In this systematic review, we aimed to determine the potential factors responsible for ureteral stricture formation in patients having impacted ureteral stones.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, we conducted systematic online research through PubMed and Web of Science without a time restriction, applying the keywords "ureteral stone", "ureteral calculus", "impacted stone", "ureteral stenosis", "ureteroscopic lithotripsy", "impacted calculus", and "ureteral strictures" singly or in combination.

RESULTS

After eliminating non-eligible studies, we identified five articles on ureteral stricture formation following treatment of impacted ureteral stones. Ureteral perforation and/or mucosal damage appeared as key predictors of ureteral stricture following retrograde ureteroscopy (URS) for impacted ureteral stones. Besides ureteral perforation stone size, embedded stone fragments into the ureter during lithotripsy, failed URS, degree of hydronephrosis, nephrostomy tube or double-J stent (DJS)/ureter catheter insertion were also suggested factors leading to ureteral strictures.

CONCLUSION

Ureteral perforation during surgery might be considered the main risk factor for ureteral stricture formation following retrograde ureteroscopic stone removal for impacted ureteral stones.

Ureteral strictures revisited…trying to see the light at the end of the tunnel: a comprehensive review

A ureteral stricture is a rather rare urological event defined as a narrowing of the ureter causing a functional obstruction and renal failure, if left untreated. The aim of this review article is to summarize and discuss current knowledge on the incidence, pathogenesis, management, and follow up of proximal, mid, and distal ureteral strictures.

Ureteroscopic management of ureteral and ureteroenteral strictures

The ureteroscopic approach to ureteral strictures has diminished morbidity because of smaller-caliber equipment, improved optics, Ho:YAG laser, and a better understanding of the risk factors for ureteral strictures. Direct visualization by means of retrograde ureteroscopy provides a safe and effective approach to treat ureteral strictures without the need for an open incision or percutaneous nephrostomy access. All patients with a ureteral stricture require an extensive evaluation and planning before treatment. Generally, patients with ureteral strictures and a history of carcinoma should undergo biopsy of the area of stricture. With recurrent cancer, patients may present with pain, nausea, vomiting, pyelonephritis, or loss of the ipsilateral renal unit. Malignant strictures tend to not respond well to balloon dilation alone. Open or laparoscopic resection and reconstruction may be indicated if there is a chance for cure. In patients who are not good surgical candidates or in those who have advanced disease, the urologist is left with the option of an indwelling stent or nephrostomy tube.

Endoscopic ureteroneocystostomy for complete obstruction at the ureterovesical junction

PURPOSE

We evaluated the technical and long-term success of endoscopic ureteroneocystostomy in patients with complete obstruction of the distal ureter.

MATERIALS AND METHODS

We treated 7 patients with complete obstruction at the ureterovesical junction via a combined antegrade and retrograde endoscopic approach (endoscopic ureteroneocystostomy). The etiology of obstruction included ureteroscopy for ureteral calculi in 3 patients and previous resection of bladder tumors or the prostate in 4. Six patients had proximal drainage with a percutaneous nephrostomy catheter at referral. An antegrade approach was used for localization, and a retrograde approach was used for direct visual ureteral meatotomy or ureterotomy with the endoscopic scissors or a cold-knife urethrotome.

RESULTS

Continuity at the ureterovesical junction was restored in all 7 patients, and 6 are currently stricture-free with followup of 14 to 64 months. The sole failure in this series was due to recurrent invasive transitional cell carcinoma.

CONCLUSIONS

Endoscopic ureteroneocystostomy is a safe and effective treatment of complete obstruction of the ureterovesical junction.

One-session bilateral ureteroscopy: is it safe in selected patients?

The aim of this study was to investigate the possibility to perform bilateral ureteroscopy in one session and to determine the procedure's indications and complication rate. Twenty-two patients underwent bilateral ureteroscopy in one session. Eighteen patients had bilateral lithiasis of the lower ureteral third, three patients had unexplained haematuria and one had unexplained bilateral hydronephrosis. The rigid ureteroscope was used in cases with stones and the flexible one in cases with haematuria and hydronephrosis. Ureteral catheters were placed in all patients. The overall stone-free rate was 83.3%. The procedure failed to confirm a diagnosis in 2 patients with unexplained haematuria. Follow-up included IVU and retrograde cystogram 3 months after the procedure and a renal scan one year later. No major complication was observed. It is concluded that bilateral ureteroscopy in one session can be performed safely in selected patients. The method does not yield major complications and saves patients from a second procedure and a second anaesthesia.