LONG-TERM RESULTS OF ENDOURETEROTOMY FOR BENIGN URETERAL AND URETEROENTERIC STRICTURES

Purpose: We reviewed the results of endoureterotomy for benign uretera l and ureteroenteric strictures to determine efficacy and factors asso ciated with a successful outcome. Materials and Methods: Followup was available for 69 patients undergoing 77 endoureterotomies. Success was defined as symptomatic improvement and radiographic resolution of obs truction. Kaplan-Meier survival curves were constructed and data were analyzed with a Cox proportional hazards model. Results: None of 9 pro cedures in patients with the ipsilateral kidney contributing less than 25% of total renal function was successful. Among the 38 remaining be nign ureteral stricture treatments with ipsilateral function 25% or gr eater with a median followup of 28.4 months among successful cases the 3-year success rate was 80%. No procedure failed beyond 11 months and there were 25 patients at risk beyond this point. Among the 30 remain ing ureteroenteric stricture treatments with ipsilateral function 25% or greater the success rates at 1, 2 and 3 years were 73, 51 and 32%, respectively. Failures were noted during the first 36 months but none occurred later and 5 patients were at risk beyond this point. Overall, complete or tight strictures were less successfully treated. A nonisc hemic etiology, a stent 12F or greater and injection of triamcinolone into the bed of the incised stricture were associated with better outc ome for strictures longer than 1 cm. Conclusions: Endoureterotomy of b enign ureteral strictures is associated with an excellent outcome (80% success at 3 years). Endoscopic treatment of ureteroenteric stricture s is less successful but still offers a reasonable first step (32% 3-y ear success rate). For all strictures failure is likely if ipsilateral renal function is poor. For strictures longer than 1 cm. use of a ste nt 12F or greater and injection of triamcinolone appear to be benefici al.