Retrograde balloon dilation as a therapeutic option for post-gynecologic surgery ureteral stricture followed by ureteroureterostomy: a comparative study regarding stricture length
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: To evaluate the success rate of balloon dilation and the factors possibly influencing the outcomes of balloon dilation for the ureteric strictured portion of ureteroureterostomy (UUS) site in patients with post-gynecologic surgeries. Methods: A single institution data base was screened for the patients who received balloon dilation for a treatment of ureteral stricture diagnosed after gynecologic surgery. Overall 114 patients underwent primary intra-operative UUS due to ureteral injury during gynecologic surgery. Among them, 102 patients received balloon dilation, and their medical records were retrospectively reviewed. Success of balloon dilation was defined as the condition that requires no further clinical interventions after 6 months from balloon dilation. Results: The ureter injury rate of women treated with open radical abdominal hysterectomy was highest (32 cases, 31.4%). 60 patients (60.8%) showed successful outcomes regarding dilation. All patients underwent technically successful dilation with a full expansion of balloon during the procedure, but 40 patients (39.2%) were clinically unsuccessful as they showed a recurrence of ureteral stricture on the previous balloon dilation site after the first dilation procedure. Univariate logistic regression analyses showed that stricture length >2 cm was a significant predictor of successful dilation (odds ratio, 0.751; 95% confidence interval, 0.634-0.901; p-value, 0.030), but it failed to achieve independent predictor status in multivariate analysis. Conclusion: Balloon dilation can an effective alternative treatment option for strictured portion of the primary UUS in post-gynecologic surgery patients when its length is <2 cm.
Abstract
Background: To evaluate the success rate of balloon dilation and the factors possibly influencing the outcomes of balloon dilation for the ureteric strictured portion of ureteroureterostomy (UUS) site in patients with post-gynecologic surgeries. Methods: A single institution data base was screened for the patients who received balloon dilation for a treatment of ureteral stricture diagnosed after gynecologic surgery. Overall 114 patients underwent primary intra-operative UUS due to ureteral injury during gynecologic surgery. Among them, 102 patients received balloon dilation, and their medical records were retrospectively reviewed. Success of balloon dilation was defined as the condition that requires no further clinical interventions after 6 months from balloon dilation. Results: The ureter injury rate of women treated with open radical abdominal hysterectomy was highest (32 cases, 31.4%). 60 patients (60.8%) showed successful outcomes regarding dilation. All patients underwent technically successful dilation with a full expansion of balloon during the procedure, but 40 patients (39.2%) were clinically unsuccessful as they showed a recurrence of ureteral stricture on the previous balloon dilation site after the first dilation procedure. Univariate logistic regression analyses showed that stricture length >2 cm was a significant predictor of successful dilation (odds ratio, 0.751; 95% confidence interval, 0.634-0.901; p-value, 0.030), but it failed to achieve independent predictor status in multivariate analysis. Conclusion: Balloon dilation can an effective alternative treatment option for strictured portion of the primary UUS in post-gynecologic surgery patients when its length is <2 cm.
참고문헌 (22)
- Nakada SY, "Campbell-Walsh urology", pp.1104~1147 (2016), Elsevier
- Janoff D, "Smith’s textbook of endourology", pp.285~290 (2007), BC Decker
- Dowling RA, "Iatrogenic ureteral injury", J Urol, 135, pp.912~915 (1986)
- Fry DE, "Iatrogenic ureteral injury", Arch Surg, 118, pp.454~457 (1983)
- Ostrzenski A, "A review of laparoscopic ureteral injury in pelvic surgery", Obstet Gynecol Surv, 58, pp.794~799 (2003)
- Manoucheri E, "Ureteral injury in laparoscopic gynecologic surgery", Rev Obstet Gynecol, 5, pp.106~111 (2012)
- Paick JS, "Management of postoperatively detected iatrogenic lower ureteral injury: should ureteroureterostomy really be abandoned?", Urology, 67, pp.237~241 (2006)
- Nie Z, "Comparison of urological complications with primary ureteroureterostomy versus conventional ureteroneocystostomy", Clin Transplant, 24, pp.615~619 (2010)
- Helfand BT, "Reconstruction of late-onset transplant ureteral stricture disease", BJU Int, 107, pp.982~987 (2011)
- Frankman EA, "Lower urinary tract injury in women in the United States, 1979-2006", Am J Obstet Gynecol, 202, pp.495~ (2010)
- Ozdemir E, "Urinary complications of gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics and gynecology operations", Clin Exp Obstet Gynecol, 38, pp.217~220 (2011)
- Gilmour DT, "Lower urinary tract injury during gynecologic surgery and its detection by intraoperative cystoscopy", Obstet Gynecol, 94, pp.883~889 (1999)
- Wu HH, "The detection of ureteral injuries after hysterectomy", J Minim Invasive Gynecol, 13, pp.403~408 (2006)
- Han CM, "Outcome of laparoscopic repair of ureteral injury: follow-up of twelve cases", J Minim Invasive Gynecol, 19, pp.68~75 (2012)
- Gomel V, "Intraoperative management of ureteral injury during operative laparoscopy", Fertil Steril, 55, pp.416~419 (1991)
- Nezhat C, "Laparoscopic repair of ureter resected during operative laparoscopy", Obstet Gynecol, 80, pp.543~544 (1992)
- Cholkeri-Singh A, "Laparoscopic ureteral injury and repair: case reviews and clinical update", J Minim Invasive Gynecol, 14, pp.356~361 (2007)
- Bhayani SB, "Transplant ureter stricture: acucise endoureterotomy and balloon dilation are effective", J Endourol, 17, pp.19~22 (2003)
- Haberal M, "Surgical complications after kidney transplantation", Exp Clin Transplant, 14, pp.587~595 (2016)
- He B, "Classification of ureteral stenosis and associated strategy for treatment after kidney transplant", Exp Clin Transplant, 11, pp.122~127 (2013)
- Ooms LSS, "Antegrade balloon dilatation as a treatment option for posttransplant ureteral strictures: case series of 50patients", Exp Clin Transplant, 16, pp.150~155 (2018)
- Ambani SN, "Ureteral stents for impassable ureteroscopy", J Endourol, 27, pp.549~553 (2013)