Long-term results of percutaneous endourologic management of renal infundibular stricture

Purpose: The long-term result of percutaneous endourologic management in th e relief of infundibular stricture is not clear. We reviewed the long-term efficacy in our series of patients. Patients and Methods: Twenty-seven patients underwent percutaneous endourol ogic management between August 1990 and February 1996, This study included the 21 who could be followed for more than 2 years (mean 4.8 years). The ca uses of stricture were tuberculosis (N = 18; 86%) and stone (N = 3; 14%). W e made a cold-knife incision in eight patients; the others underwent only d ilation with fascial dilators from 20F to 30F, Success was defined as sympt omatic improvement and radiographic resolution of obstruction. Results: The overall success rate was 76% (16 of 21), Seven of the eleven p atients (64%) with concomitant ureteral stricture had a successful result. In the nine patients with multiple infundibular strictures, five procedure (56%) were successful, The success rates of the cold-knife or fascial dilat or were 88% (7 of 8) and 69% (8 of 13), respectively. In the five patients in whom the procedure failed, ureteral stricture was associated in four and multiple infundibular strictures in four. All of them had tuberculous infu ndibular strictures. No significant difference in the success rate was obse rved according to the duration of indwelling catheter, There was no signifi cant complication except pyelonephritis in four patients, which was control led with conservative treatment. Conclusions: Percutaneous endourologic management is an effective and safe procedure to treat renal infundibular stricture. Risk factors for failure a re multiple infundibular strictures and concomitant ureteral stricture. If the procedure does fail, other treatments have not been compromised. Cold-k nife incision seems to be more effective than dilation.