Purpose Nephrolithiasis is an increasingly common ailment in the United States. Ureteroscopic management has supplanted shockwave lithotripsy as the most common treatment of upper tract stone disease. Ureteral stricture is a rare but serious complication of stone disease and its management. The impact of new technologies and more widespread ureteroscopic management on stricture rates is unknown. We describe our experience in managing strictures incurred following ureteroscopy for upper tract stone disease. Materials and methods Records for patients managed at 4 tertiary care centers between December 2006 and October 2015 with the diagnosis of ureteral stricture following ureteroscopy for upper tract stone disease were retrospectively reviewed. Study outcomes included number and type (endoscopic, reconstructive, or nephrectomy) of procedures required to manage stricture. Results Thirty-eight patients with 40 ureteral strictures following URS for upper tract stone disease were identified. Thirty-five percent of patients had hydronephrosis or known stone impaction at the time of initial URS, and 20% of cases had known ureteral perforation at the time of initial URS. After stricture diagnosis, the mean number of procedures requiring sedation or general anesthesia performed for stricture management was 3.3 ± 1.8 (range 1-10). Eleven strictures (27.5%) were successfully managed with endoscopic techniques alone, 37.5% underwent reconstruction, 10% had a chronic stent/nephrostomy, and 10 (25%) required nephrectomy. Conclusions The surgical morbidity of ureteral strictures incurred following ureteroscopy for stone disease can be severe, with a low success rate of endoscopic management and a high procedural burden that may lead to nephrectomy. Further studies that assess specific technical risk factors for ureteral stricture following URS are needed.
Journal of endourology. 2018 Jan 12 [Epub ahead of print]
Philip Clark May, Ryan S Hsi, Henry H Tran, Marshall Stoller, Ben H Chew, Thomas Chi, Manint Usawachintachit, Brian D Duty, John L Gore, Jonathan D Harper
University of Washington School of Medicine, Urology , 1959 NE Pacific Street , Box 356510 , Seattle, Washington, United States , 98195 ; ., Vanderbilt University Medical Center, 12328, Urologic Surgery , A-1302 Medical Center North , Nashville, Tennessee, United States , 37232 ; ., University of British Columbia, Urologic Sciences, Vancouver, British Columbia, Canada ; ., University of California San Francisco, Urology, San Francisco, California, United States ; ., University of British Columbia, Urologic Sciences , Level 6 , 2775 Laurel st. , Level 6 - 2775 Laurel St , Vancouver, British Columbia, Canada , V5Z 1M9., University of California San Francisco, Urology , 400 Parnassus Ave , 6th floor Urology Clinics A638 , San Francisco, California, United States , 94143 ; ., University of California San Francisco, Urology , 400 Parnassus Avenue , San Francisco, California, United States , 94143 ; ., Oregon Health and Science University, 6684, Urology , 3303 SW Bond Ave, CH10U , Portland, Oregon, United States , 97239 ; ., University of Washington School of Medicine, Urology, Seattle, Washington, United States ; ., University of Washington, Department of Urology , 1959 NE Pacific Street , Box 356510 , Seattle, Washington, United States , 98195 ; .