Factors influencing long-term results of transluminal dilatation or electrocautery incision with stenting of ureteral or ureteropelvic junction strictures

Summary This retrospective study analyses the results of 129 transluminal balloon dilatations, and 38 endopyelotomies and endoureterotomies, of strictures of the ureter and ureteropelvic junction, performed from 1977 to 1989 (a total of 192 patients, 25 lost to follow-up). The results were assessed over a follow-up period of at least 4 and up to 14 years, and stratified according to demographic criteria (location and length of stricture), aetiology (benign versus malignant) and viability, i.e. vascular supply to stricture and adjacent ureter. The success rate for endopyelotomy and endoureterotomy in non-neoplastic lesion was 90%. The success rate of transluminal balloon dilatation was 83% in short strictures with intact vascular supply but only 30% in strictures with compromised vascular supply. For lesions with compromised vascular supply with underlying malignant aetiology, the rate of failure of transluminal balloon dilatation was 92%. Based on this experience: endopyelotomy and endoureterotomy are recommended for strictures of the ureter or ureteropelvic junction with underlying non-neoplastic aetiology; transluminal balloon dilatation is recommended for short ureteric strictures with intact vascular supply and non-neoplastic aetiology; permanent stents are recommended for strictures with uncontrolled neoplastic disease and compromised vascular supply; and surgical interventions are recommended for all other strictures with compromized vascular supply.