Effectiveness of endoscopic and open surgical management in benign ureteral strictures.

OBJECTIVE To assess the effectiveness of different treatment modalities for benign ureteric strictures. SETTING Department of Urology, Al-Emiri Hospital, Kuwait. PATIENTS AND METHODS Twenty four cases (19 unilateral and 5 bilateral) of ureteral strictures were reviewed. Retrograde endoscopic dilatation was tried, initially for all of the strictures. Technical failure was observed in 8/29 (27.5%) strictures. Three of them were negotiated through antegrade endoscopic dilatation, while in 5 of the strictures open surgical repair was required. Both the balloon and fascial dilator were used for endoscopic dilatation; ureteroneocystostomy with or without Boari's bladder flap were the procedures employed for open repair. RESULTS Of the 29 strictures the majority were secondary to Bilharzial cystitis (66.6%). Twenty-four (82.7%) strictures underwent endoscopic manipulation and 5 (17.2%) had open repair. Among the 24 strictures that had endoscopic dilatation, 21 (87.5%) were managed in retrograde fashion while in 3 (12.5%) technical failures were due to the inability to canulate the strictured ureter with a guide wire in retrograde fashion. All these patients were treated successfully by antegrade stenting. Among 24 strictures that were initially managed with dilatation and stenting, recurrence was found in 9 (37.5%) patients. The group had open repair, no recurrence was found during the follow up. There was no serious intraoperative or postoperative complications of both the procedures. Patients were followed up with intravenous urography. CONCLUSION Endoscopic dilatation is an effective treatment modality for partial benign ureteric strictures. However, open ureteroneocystostomy with or without Boari's flap or Psoas hitch should be reserved for complete or recurrent ureteric strictures. Bilharzial strictures are amenable to endoscopic dilation but recurrence rate is high and re-implantation is frequently required.