Endourological treatment of ureteral strictures with the use of self-expanding stents: is it possible to completely cure the stricture endoscopically? A report on the experience with implantation of 35 stents with a two-year follow-up period; a retrospect study

Endourological treatment of ureteral strictures with the use of self-expanding stents: is it possible to completely cure the stricture endoscopically? A report on the experience with implantation of 35 stents with a two-year follow-up period; a retrospect study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Endourological treatment of ureteral strictures with the use of self-expanding stents: is it possible to completely cure the stricture endoscopically? A report on the experience with implantation of 35 stents with a two-year follow-up period; a retrospect study Filip Kowalski, Błażej Kuffel, Michał Późniak, Pavel Lipowski, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4621556/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Apr, 2025 Read the published version in World Journal of Urology → Version 1 posted 10 You are reading this latest preprint version Abstract Background: The current results of endoscopic treatment of ureteral strictures are characterized by very divergent treatment results, which is due to a wide range of criterion for including patients in the analyses and different definitions of effective treatment. In this retrospect study we wanted to introduce a possibility of curing ureteral strictures depending on their type and degree with the use of self-expanding ureteral stents (SUS). Methods: 33 patients with ureteral strictures received endourological treatment with the use of Allium® SUS (2 patients with SUS placed on both sides). Patients were divided into 2 groups: patients with uncomplicated strictures (Grp 1) and patients with complicated strictures (Grp 2). Uncomplicated stricture was defined as a single stricture below 2 cm. A complicated stricture was defined as a stricture over 2cm and/or as multiple strictures. The follow-up time was 24 months. All patients were scheduled for renoscyntygraphy during the treatment. A full therapeutic success was defined as no tight stenosis in renoscyntygraphic examination after SUS explantation. Results: In Grp 1, full therapeutic success was achieved in 80% of patients, which was statistically significant (p 3a) occurred significantly more often in Grp 2 (p = 0.046). Renal outflow during stenting was present in 70% of the patients in Grp 2. Conclusions: A full therapeutic success of endoscopic SUS-assisted treatment can be achieved in patients with a short, single ureteral stricture. In long and/or multiple strictures SUS can be used as drainage element. Ureteral strictures Endoscopy Self-expanding stents Allium Metal stents 1. Introduction Ureteral strictures constitute an important clinical problem due to increasing number of cases, which may be related to the increasing the use of high-power lasers in urological departments and, as a result, thermal narrowing of the ureters after endoscopic treatment of upper urinary tract stones[1]. The standard treatment for ureteral strictures is reconstructive surgery with complete excision of the narrowed ureter[2][3]. Endoscopy has an established but limited role in the treatment of ureteral strictures due to the high recurrence rate[4]. According to the guidelines of the European Association of Urology, the highest percentage of stricture cures using the endoscopic method, is achieved in the case of a single short ureteral stricture[5]. So far, after the standard endoscopic treatment of a stricture by dilatation or incision, a DJ stent was implemented. However, the design of the DJ stent and its small diameter (3–8F) can lead to the failure of endoscopic therapy[6][7]. Promising tools are metallic stents introduced on the urological market. Studies based on a large number of patients proved the safety and effectiveness of metallic stents[8][9]. In the Department of Urology of A. Jurasz Memorial University Hospital No. 1 in Bydgoszcz, since 2020 we have been using self-expanding ureteral stents from Allium® (SUS). After performing 70 procedures of SUS implantations for 33 patients, we decided to apply a different endoscopic management strategy in the treatment of ureteral strictures using a SUS. After dilatating the stricture, the SUS was used as a scaffold to create a new scar. The use of such a technique is based on the design of a SUS, which, when released from the delivery system (and in the absence of external barriers), opens to a diameter of 27-30F. Therefore, after dilatating the stricture and releasing it in the ureter, the SUS will exert pressure on the newly forming scar, thus preventing the formation of a tight stricture in a previously widened place. The assumptions of this surgical technique required an appropriate functional assessment of the treated kidney and ureteral stricture, hence renal scyntygraphy was planned for all patients before, during and after treatment. The performance of renal scyntygraphy in the treated group is an advantage of this study because in the previous largest publications concerning the treatment of ureteral strictures, the main measure of treatment effectiveness was radiological imaging and there was no reliable assessment of the function and outflow of urine from the kidneys[2][3][9][10][11]. 2. Method 2.1 Study Population: Patients with diagnosed ureteral stricture and renal function over 20% in renoscyntygraphy were included into the study. Patients with ureteral orifice strictures and after radiotherapy were excluded from the study. From May 2020 till November 2021, 33 patients with ureteral strictures received endourological treatment with the use of Allium® SUS. Two patients were diagnosed with both sides strictures and received treatment for both sides. Stricture length was measured during surgery in ureteropyelography and confirmed after stent implantation. The patients were divided into 2 groups: uncomplicated strictures which was defined as a single stricture below 2 cm (Grp 1) and those with complicated strictures which was stricture over 2cm and/or as multiple strictures (Grp 2). Based on previous reports regarding the recurrence of strictures in the urinary tract after over 12 months, patients were scheduled to have their SUS removed after 1 year[12][13][14]. The follow-up time was 24 months. All patients were scheduled for renoscyntygraphy before implantation, during stenting and twice after SUS explantation. Hydronephrosis was measured in ultrasound, and the presence of hydronephrosis was reported when dilatation of calices was > 3mm and of renal pelvis > 5mm. The endpoint of the study was no stenting of the ureter after the treatment and no tight stenosis in control renoscyntygraphy after SUS explantation. No tight stenosis in control renoscyntygraphy without any stenting, was described as “full therapeutic success”. 2.2 Surgical technique: All SUS implantations and explantations were performed by the same surgeon. Implantation of the SUS was carried out in four stages: identification of the stricture, dilatation, the SUS implantation, control ureteropyelography. After placement of two hydrophilic guidewires, dilatation of the stricture was done with the use of URS 6/7,5F and followed by URS 7/9,5F. Further dilatation was performed with the use of COOK disposable ureteral dilatators. Desired diameter of dilatation was 14F. Implantation of the SUS was done under C-arm after previous marking of the stricture using metal markers placed on the patient. The SUS was positioned to cover the stricture with the minimum margin of 2 cm above or below. During the SUS explantation procedure, DJ stent or nephrostomy was placed for 1 month due to the swelling of the ureter and the presence of blood clots in its lumen. After 1 month DJ stent or nephrostomy were removed. 2.3 Statistical analysis: Frequency was calculated by chi-square tests of independence. In the case of quantitative variables with a distribution close to normal, Student's t tests were used to compare independent samples for which the mean and standard deviation were assessed. In the case of quantitative variables with a distribution deviating from normal, the Mann-Whitney tests were used to calculate median and interquartile range were reported. Statistical analyses were performed using the IBM SPSS Statistics 26. The level of significance was α = 0.05. 2.4 Assumptions of the study: Our aim was to test the possibility of curing ureteral stricture depending on its type and degree of stenosis using SUS-assisted endoscopic methods with the use of reliable functional kidney test (renoscyntygraphy). 3. Results The general characteristics of the patients, strictures and the endoscopic procedures are presented in Table 1 . In Grp 2; two SUS were implemented in ureters after kidney transplant, so side was not defined. Dilation above the diameter of the semi-rigid endoscope (7/9,5F) was possible in 60% of patients in both groups. The average duration of SUS in both groups was 10 months, although the assumed duration of maintaining SUS was 12 months, hence 33% (Grp 1) and 35% (Grp 2) of patients experienced earlier explantation of the SUS. There were no statistically significant differences in the compared groups in terms of the variables described above. In Grp 2, single strictures exceeding 2 cm occurred in 55% of patients, multiple strictures up to 2 cm long occurred in 35% of patients, and 10% had multiple strictures exceeding 2 cm. Primary ureteropelvic junction stricture was present in 1 patient Grp 1. In this case, reconstructive surgery was not performed due to the patient's high BMI and possible technical difficulties resulting from the surgical approach. The studied groups of patients did not differ statistically in terms of the etiology of the strictures. The characteristics of complications and treatment results are presented in Table 2 . Serious complications (Clavien-Dindo 3a-4a) occurred statistically more often in Grp 2. Only 5 patients did not experience any complications (4 in Grp 2 and 1 in Grp 1). 2 patients (13.3%) in Grp 1 and 5 patients (25%) in Grp 2 experienced complications of grade 3a according to the Clavien-Dindo scale. All cases of grade 3a complications were related pyonephrosis and nephrostomy was placed. 4 patients (20%) from Grp 2 required surgical treatment under general anesthesia (Clavien-Dindo 3b): 3 patients underwent reconstructive surgery for ureteropelvic junction stricture and 1 patient underwent nephrectomy due to renal hypofunction and encrusted SUS. Renal failure during SUS implantation (Clavien-Dindo 4a) occurred in 3 patients (1 patient in Grp 1, and 2 patients in Grp 2; the average renal function in renoscyntygraphy before SUS implantation was 23%). It should be noted that full renoscyntygraphy schedule wasn’t completed in patients who underwent nephrectomy. Improvement in quality of life (QoL) was assessed by authorial questioner during outpatient visits; no validated QoL questionnaires were used. Improvement in QoL was reported by 60% of patients from Grp 1 and all 15 patients after completion of treatment. In Grp 2, 65% of patients during treatment and 40% of patients after completion of treatment reported an improvement in QoL. This was a statistically significant difference in the comparison of both groups. No statistically significant differences were observed in relation to visible urinary retention in ultrasound examination and renoscyntygraphy in both groups. It was assumed that hydronephrosis occurred in 100% of patients in both groups before the treatment. The end point of the study was the achievement of a full therapeutic success. A statistically significant difference was obtained in the study groups, with 80% full therapeutic success in Grp 1 (12 patients) and 15% in Grp 2 (3 patients). Maintained urine flow during stenting, determined by renoscyntygraphy during SUS implantation, was possible in all patients from Grp 1 and 70% of the patients from Grp 2, which was also a statistically significant difference. 4. Discussion Endoscopic treatment methods have a high failure rate, which can be 85% in complicated cases[15][16]. Reconstructive surgeries are most effective, reaching over 90%, but these are a challenge for surgeons, being a time-consuming and often technically difficult procedures[17]. The reduced QoL of patients results from the frequent need for a long-term urinary tract stenting and struggling with recurrent urinary tract infections[18]. The ineffectiveness of treatment of ureteral strictures may result in the removal of the kidney or chronic stenting of the urinary tract, as May and his co-authors presented in their work analyzing the treatment of ureteral strictures in 4 urological centers over a period of 9 years [7]. Considering only complications after treatment of urinary tract stones, the frequency of strictures reaches 1–4%, hence the ureteral strictures scale is high[19]. Endoscopic treatment of ureteral strictures is based on widening the stricture by dilating it with dilators, expanding balloons or by incising the stricture. The urinary tract is an unfavorable environment for tissue healing due to the irritating effect of urine, which ultimately leads to scarring and re-stenosis. When using DJ catheters, we have limited possibilities of keeping the ureter open because the diameter of the thickest DJ catheters is 9F. Alternative for DJ stents are SUS, which can help in forming new stricture with a larger diameter. In our endoscopic technique the supply of the stricture plays a more important role than the implantation itself. Unfortunately, in 40% of patients it was not possible to obtain a larger dilatation diameter than the diameter of the semi-rigid URS (9.5F). We refrained from using any energy to achieve larger diameter of the treated stricture to avoid thermal tissue damage, hoping for less secondary scarring. SUS implantation time in Grp 1 was longer compared to Grp 2 which was related to the possibility of partial scar removal in short strictures with the use of URS forceps which prolonged the procedure. Urinary tract infections and SUS migration accounted for the highest percentage of treatment complications. Migration of SUS occurred in 26.7% of Grp 1 patients. In this group, displacement of SUS often meant the absence of tight stricture. In the case of complicated strictures, migration occurred in 15% of patients, which was related to a persistent tight stenosis that prevented SUS from migration. Complications secondary to urinary tract infections and kidney obstruction were more serious because they could result in deterioration of kidney function[7][18]. In approximately 1/3 of cases, it was necessary to remove SUS earlier, which was most often caused by urinary tract infections, bladder irritation symptoms or SUS migration. A statistically significant difference in serious complications in Grp 2 was related to the nephrectomies in that group. It should be mentioned that patients who underwent nephrectomy had borderline kidney function in renoscyntygraphy before starting treatment. Statistically significant differences in the improvement of QoL in favor of Grp 1 resulted from the fact that in this group 80% of patients achieved a full therapeutic success. In Grp 1, in cases without full therapeutic success one patient underwent nephrectomy due to its afunction revealed during stenting and two patients underwent reconstructive surgery. Importantly, in the cases of reconstructive surgery after SUS stenting, no significant differences that made the procedure difficult, such as adhesions or inflammation, were observed. After removal of SUS, a 3-month interval was maintained before reconstructive surgery. In 80% of patients in Grp 1, postoperative renoscyntygraphy resulted in ureter patency, without significant deterioration of kidney function. The high percentage of persistent hydronephrosis in the ultrasound examination after removal of SUS (71.4%) and the signs of outflow disturbances in renoscyntygraphy, but without tight stenosis in the furosemide test, indicate persistent stenosis, but with a larger diameter than before the treatment. This picture was observed endoscopically in two patients in whom endoscopic diagnostics were performed during the observation period due to suspicion of residual kidney stones. In Grp 2, the effectiveness of full therapeutic success was low and the only possible way to use SUS in that cases is urinary tract drainage, which was measured by renoscyntygraphy during stenting. However, using SUS as an element of urinary tract drainage can be problematic due to the difficult explantation procedure, which is much more complicated than exchanging DJ stent. In our center, we tried to use optical cystoscope forceps to remove SUS because of good pulling force when compared to URS forceps. When using URS forceps, SUS was often fragmented in the ureter, and this is why SUS was positioned approximately 1 cm into the bladder lumen or 1 cm into the renal pelvis lumen, which allowed to use optical cystoscope forceps during explantation. If SUS was positioned within the renal pelvis lumen, it was removed by creating a transrenal tract. Despite the doubts raised by the retrospective nature of this study, we decided to publish our data to present the treatment results based on a reliable functional test of the kidney, i.e. renoscyntygraphy. Our publication may constitute the basis for planning a prospective randomized study comparing DJ stents with SUS in modern endoscopic treatment of ureteral strictures. Developing an optimal method of endoscopic management of ureteral stricture may significantly improve treatment results. 5. Conclusions In short (< 2cm), non-complicated strictures, a full therapeutic success of endoscopic treatment with self-expanding ureteral stents (SUS) in our material was achieved in 80%. A full therapeutic success was defined as no tight stenosis in renoscyntygraphic examination during follow-up (2 years with 2 tests). SUS in a short single stricture has high efficiency as a supportive element for formation of a new, wider scar. It must be kept in mind that a scar is still present so renal function must be monitored, and patients are in high risk for infection complications due to common hydronephrosis. As results of our study show, in long and/or multiple strictures a full therapeutic success of endoscopic treatment with SUS was low (15%), but SUS can be used in that group a drainage system (efficiency 70%). Drainage by SUS in long and/or multiple strictures can improve the quality of life, and SUS exchange can be scheduled every 2–3 years, however in that group of patient’s serious complications are more common. Abbreviations BMI body mass index SUS Self-expanding ureteral stents URS Ureterorenoscope QoL Quality of life Grp 1 Group 1 patients with uncomplicated strictures (single, short 2cm strictures). Declarations Competing Interests F.K. Paid lectures during company meetings for Allium Company. Paind hands-on training for Allium. Author Contribution Conflicts of interests: F.K. Paid lectures during company meetings for Allium Company. Paind hands-on training for Allium.Research registry UIN: researchregistry10261, www.researchregistry.comFinancial support and sponsorship: none.Approval of Ethics Committee: Collegium Medicum Ethics Committee in Bydgoszcz Approval No. KB257/2024All authors reviewed the manuscript.F.K. Study design, writing the manuscriptB.K. Collecting dataM.P. Collecting dataP.L. Collecting dataM.Cz. Collecting dataJ.W. Preparing data and tablesA.O. Statistical analysisJ.A. Supervision of the manuscriptT.D. Supervision of the manuscript Acknowledgement Statistical consultation Urszula Kajewska [email protected] consultation Prof. Aleksander Szwedek, A,Mickiewicz University in Poznań, Poland, [email protected] Data Availability Data sets generated during the current study are available from the corresponding author on reasonable request. E-mail contact: [email protected] References Moretto, S., Saita, A., Scoffone, C.M. et al. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol 42, 234 (2024). doi:10.1007/s00345-024-04933-2. Vinaya P Vasudevan, Emmanuel U Johnson, Kee Wong, Morkos Iskander, Saqib Javed, Nikhil Journal of Clinical Urology 2019 12:1, 20-31. doi:10.1177/205141581877221. Png JC, Chapple CR. Principles of ureteric reconstruction. Curr Opin Urol. 2000 May;10(3):207-12. doi: 10.1097/00042307-200005000-00004. Richter F, Irwin RJ, Watson RA, Lang EK. Endourologic management of benign ureteral strictures with and without compromised vascular supply. Urology. 2000 May;55(5):652-7. doi: 10.1016/s0090-4295(00)00484-2. D. Kitrey , F. Campos-Juanatey, P. Hallscheidt, E. Mayer, E. Serafetinidis, D.M. Sharma, M. Waterloos Guidelines Associates: H. Mahmud, K. Zimmermann. EAU Guidelines on Urological trauma. Teruaki Sugino, Kazumi Taguchi, Shuzo Hamamoto et al. Failure of endoscopic management of ureteral strictures is due to ureteroscopic lithotripsy as a cause and longer length of stricture, 28 August 2020, Research Square. doi: 10.21203/rs.3.rs-63640/v1. May PC, Hsi RS, Tran H, Stoller ML, Chew BH, Chi T, Usawachintachit M, Duty BD, Gore JL, Harper JD. The Morbidity of Ureteral Strictures in Patients with Prior Ureteroscopic Stone Surgery: Multi-Institutional Outcomes. J Endourol. 2018 Apr;32(4):309-314. doi: 10.1089/end.2017.0657. Khoo CC, Ho C, Palaniappan V, Ting A, Forster L, Kondjin-Smith M, Abboudi H, Hanna M, El-Husseiny T, Dasgupta R. Single-Center Experience with Three Metallic Ureteral Stents (Allium ® URS, Memokath™-051, and Resonance ® ) for Chronic Ureteral Obstruction. J Endourol. 2021 Dec;35(12):1829-1837. doi: 10.1089/end.2021.0208. Gao X, Di X, Chen G, Wang W, Peng L, Chen J, Wei X. Metal ureteral stents for ureteral stricture: 2 years of experience with 246 cases. Int J Surg. 2024 Jan 1;110(1):66-71. doi: 10.1097/JS9.0000000000000841. Bilotta A, Wiegand LR, Heinsimer KR. Ureteral reconstruction for complex strictures: a review of the current literature. Int Urol Nephrol. 2021 Nov;53(11):2211-2219. doi: 10.1007/s11255-021-02985-6. Yang, K., Pang, K.H., Fan, S. et al. Robotic ureteral reconstruction for benign ureteral strictures: a systematic review of surgical techniques, complications and outcomes. BMC Urol 23, 160 (2023). doi:10.1186/s12894-023-01313-7. Ishigooka M, Tomaru M, Hashimoto T, Sasagawa I, Nakada T, Mitobe K. Recurrence of urethral stricture after single internal urethrotomy. Int Urol Nephrol. 1995;27(1):101-6. doi: 10.1007/BF02575227. Perdzyński W, Adamek M. Calibration of urethra with anti-scar gel as a new preventive method for stricture recurrence after urethroplasty performed due to refractory anterior urethral stricture disease. Cent European J Urol. 2020;73(1):80-90. doi: 10.5173/ceju.2020.0050. Kahokehr AA, Granieri MA, Webster GD, Peterson AC. A Critical Analysis of Bulbar Urethroplasty Stricture Recurrence: Characteristics and Management. J Urol. 2018 Dec;200(6):1302-1307. doi: 10.1016/j.juro.2018.07.036. Mann RA, Virasoro R, DeLong JM, Estrella RE, Pichardo M, Lay RR, Espino G, Roth JD, Elliott SP. A drug-coated balloon treatment for urethral stricture disease: Two-year results from the ROBUST I study. Can Urol Assoc J. 2021 Feb;15(2):20-25. doi: 10.5489/cuaj.6661. Ghali AM, El Malik EM, Ibrahim AI, Ismail G, Rashid M. Ureteric injuries: diagnosis, management, and outcome. J Trauma. 1999 Jan;46(1):150-8. doi: 10.1097/00005373-199901000-00026. Kachrilas S, Bourdoumis A, Karaolides T, Nikitopoulou S, Papadopoulos G, Buchholz N, Masood J. Current status of minimally invasive endoscopic management of ureteric strictures. Ther Adv Urol. 2013 Dec;5(6):354-65. doi: 10.1177/1756287213505671. Heo JE, Kang SK, Lee J, Koh D, Kim MS, Lee YS, Ham WS, Jang WS. Outcomes of single-port robotic ureteral reconstruction using the da Vinci SP ® Investig Clin Urol. 2023 Jul;64(4):373-379. doi: 10.4111/icu.20230005. Vallée M, Bey E, Bouiller K, le Goux C, Pimpie R, Tourret-Arnaud J, Lina G, Figueiredo S, Chauvin A, Gavazzi G, Malavaud S, Sotto A, Bruyère F. Epidemiology and risk factors for ureteral stent-associated urinary tract infections in non-transplanted renal patients: a systematic review of the literature. World J Urol. 2021 Oct;39(10):3845-3860. doi: 10.1007/s00345-021-03693-7. Sunaryo PL, May PC, Holt SK, Sorensen MD, Sweet RM, Harper JD. Ureteral Strictures Following Ureteroscopy for Kidney Stone Disease: A Population-based Assessment. J Urol. 2022 Dec;208(6):1268-1275. doi: 10.1097/JU.0000000000002929. Tables Table 1 Characteristics of the patients, surgery procedures and strictures. Uncomplicated strictures (single, 2cm) Grp2 N = 15 stents N = 20 stents M ± SD / n (%)/ MD ( IQR ) M ± SD / n (%)/ MD ( IQR ) p Age [years] 58.20 ± 13.60 51.85 ± 12.12 0.155 Sex (Male/Female) 9 (60.0%) / 6 (40%) 9 (45.0%) / 11 (65%) 0.380 Ureter (Left / Right) 6 (40.0%) / 9 (60%) 9 (50.0%)* / 9 (50%)* 0.566 Implantation time [min.] 45.00 (30.00–55.00) 32.50 (26.25–40.00) 0.100 Explantation time [min.] 25.00 (13.75–35.00) 26.00 (22.50–31.25) 0.593 Possible dilatation diameter over 9,5F 9 (60.0%) 12 (60.0%) 1.000 Time of stenting [months] 9.53 ± 4.39 10.06 ± 3.98 0.725 Necessity of explantation before scheduled time 5 (33.3%) 7 (35.0%) 1.000 Migration of SUS 4 (26.7%) 3 (15.0%) 0.430 Unplaiting of the SUS during explantation 8 (57.1%) 6 (33.3%) 0.283 Explantation with the use of cystoscope Single stricture 15 (100.0%) 11 (55.0%) 0.011 Stricture lenght [cm] < 0.001 2 cm 0 (0.0%) 13 (65.0%) Iatrogenic strictures 12 (80.0%) 14 (70.0%) 0.700 - Stone treatment (URSL, RIRS, ureterolithotomy) 10 (66.6%) 8 (40%) - Stricture after ureteropelvic plastic surgery 0 2 (10%) - Gynecological procedures (without radiotherapy) 2 (13.3%) 0 - Renal transplant 0 2 (10%) - Surgical procedures (without radiotherapy) 0 2 (10%) Non-iatrogenic strictures 3 (20%) 6 (30%) 0.300 - Endometriosis 1 (6.7%) 3 (15%) - Retroperitoneal fibrosis 0 1 (5%) - Inflamatory diseases 1 (6.7%) 2 (10%) - Primary stricture of ureteropelvic junction 1 (6.7%) 0 M – average; SD – standard deterioration; n – sample size; MD – median IQR – interquartile range; p – statistical significance *Two patients from Grp 2 were patients with after renal transplant so side was not defined. Table 2 Complications and treatment outcomes. Uncomplicated strictures (single, 2cm) Grp 2 N = 15 stents N = 20 stents M ± SD / n (%)/ MD ( IQR ) M ± SD / n (%)/ MD ( IQR ) p Serious complications (Clavien Dindo > 3a) 3 (20.0%) 11 (55.0%) 0.046 Complications [Clavien - Dindo] 0.088 0 1 (6.7%) 4 (20.0%) 1 1 (6.7%) 0 (0.0%) 2 10 (66.7%) 5 (25.0%) 3A 2 (13.3%) 5 (25.0%) 3B 0 (0.0%) 4 (20.0%) 4A 1 (6.7%) 2 (10.0%) Renoscyntygraphy [GFR] (before SUS implantation) 35.00 ± 11.68 34.29 ± 11.07 0.870 Renoscyntygraphy [%] (before SUS implantation) 43.25 ± 11.17 47.60 ± 11.19 0.325 Renoscyntygraphy [GFR] (during stenting) 38.50 ± 16.28 30.76 ± 10.21 0.140 Renoscyntygraphy [%] (during stenting) 43.70 ± 14.48 45.27 ± 12.42 0.775 Renoscyntygraphy [GFR] (after SUS explantation) 36.73 ± 11.41 29.00 ± 9.44 0.137 Renoscyntygraphy [%] (after SUS explantation) 43.17 ± 14.17 43.88 ± 11.08 0.907 Better Quality of Life during stenting 9 (60.0%) 13 (65.0%) 1.000 Better Quality of Life after stenting 15 (100.0%) 8 (40.0%) < 0.001 Hydronephrosis during stenting 8 (53.3%) 15 (75.0%) 0.282 Hydronephrosis after explantation < 12months 10 (71.4%) 14 (87.5%) 0.378 Hydronephrosis after explantation 12–24 months 6 (60.0%) 6 (85.7%) 0.338 Full therapeutic success 12 (80.0%) 3 (15.0%) < 0.001 Feasible renal outflow during stenting 15 (100.0%) 14 (70.0%) 0.020 M – average; SD – standard deterioration; n – sample size; MD – median IQR – interquartile range; p – statistical significance Additional Declarations Competing interest reported. F.K. Paid lectures during company meetings for Allium Company. Paind hands-on training for Allium. Cite Share Download PDF Status: Published Journal Publication published 01 Apr, 2025 Read the published version in World Journal of Urology → Version 1 posted Editorial decision: Revision requested 05 Dec, 2024 Reviews received at journal 31 Oct, 2024 Reviewers agreed at journal 22 Oct, 2024 Reviews received at journal 20 Oct, 2024 Reviewers agreed at journal 20 Oct, 2024 Reviewers agreed at journal 15 Oct, 2024 Reviewers invited by journal 22 Aug, 2024 Editor assigned by journal 26 Jun, 2024 Submission checks completed at journal 26 Jun, 2024 First submitted to journal 22 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4621556","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":322803033,"identity":"9a5fb1e7-df68-4158-a15f-690a60df8ff6","order_by":0,"name":"Filip Kowalski","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIie2PMQuCQBiGv+PgXExXQ6i/YDQJRX8lCZzqPwiCLeZcU//C+USwRZqDa2hqvmiRcugUXNW2oHs++HiH9xleAInkN0G0+hoQAC4CUXo4tULEoX0V8DcKVqvUpVgspZS/riOiZ85z9orHGgbEH+sW5ewuk0N0nxLDTc1NxCYBBjw8xC1KrlrpIEydwFA8cxMyJBSCB70U/eS/7ZAt+ilqIRRwMxMK5nQqw5yILV69xbV3HlsFGPmtW7QcJzdeXke6nk0vRcnmx62f8EeLUoMC2oT6ex39ipI2oUdZIpFI/o4PXqBU9as//QAAAAAASUVORK5CYII=","orcid":"","institution":"Antoni Jurasz University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Filip","middleName":"","lastName":"Kowalski","suffix":""},{"id":322803034,"identity":"6ada73a0-a9e7-4b10-9d0a-0eab4286c8de","order_by":1,"name":"Błażej Kuffel","email":"","orcid":"","institution":"Antoni Jurasz University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Błażej","middleName":"","lastName":"Kuffel","suffix":""},{"id":322803035,"identity":"73f4fe8f-790a-47dd-860d-3ea270bf0151","order_by":2,"name":"Michał Późniak","email":"","orcid":"","institution":"Antoni Jurasz University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Michał","middleName":"","lastName":"Późniak","suffix":""},{"id":322803036,"identity":"b4a1928f-1beb-455f-aee4-d0dd1c4e36ba","order_by":3,"name":"Pavel Lipowski","email":"","orcid":"","institution":"Antoni Jurasz University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pavel","middleName":"","lastName":"Lipowski","suffix":""},{"id":322803037,"identity":"52a7bc5f-40d3-4fb0-9f26-5f203b6a2b27","order_by":4,"name":"Michal Czarnogorski","email":"","orcid":"","institution":"Antoni Jurasz University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Michal","middleName":"","lastName":"Czarnogorski","suffix":""},{"id":322803038,"identity":"53dd86ad-1189-49c8-b556-826fb154c983","order_by":5,"name":"Jacek Wilamowski","email":"","orcid":"","institution":"Antoni Jurasz University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jacek","middleName":"","lastName":"Wilamowski","suffix":""},{"id":322803039,"identity":"1699e4f9-4d22-41de-a450-9d85d95a7211","order_by":6,"name":"Adam Ostrowski","email":"","orcid":"","institution":"Antoni Jurasz University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Adam","middleName":"","lastName":"Ostrowski","suffix":""},{"id":322803040,"identity":"677bcaf6-5231-4fcd-8f84-94ba8a3c9534","order_by":7,"name":"Jan Adamowicz","email":"","orcid":"","institution":"Antoni Jurasz University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jan","middleName":"","lastName":"Adamowicz","suffix":""},{"id":322803041,"identity":"fa3b01bb-81b7-4ac0-8183-f8f68aaa9d31","order_by":8,"name":"Tomasz Drewa","email":"","orcid":"","institution":"Antoni Jurasz University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tomasz","middleName":"","lastName":"Drewa","suffix":""}],"badges":[],"createdAt":"2024-06-22 10:48:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4621556/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4621556/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00345-025-05574-9","type":"published","date":"2025-04-01T15:57:37+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80082058,"identity":"12aa4d86-fa53-445a-a2d8-08c9a5fbef68","added_by":"auto","created_at":"2025-04-07 16:06:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":869863,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4621556/v1/47423bb9-a4c7-4761-9fd6-2973911874e2.pdf"}],"financialInterests":"Competing interest reported. F.K. Paid lectures during company meetings for Allium Company. Paind hands-on training for Allium.","formattedTitle":"Endourological treatment of ureteral strictures with the use of self-expanding stents: is it possible to completely cure the stricture endoscopically? A report on the experience with implantation of 35 stents with a two-year follow-up period; a retrospect study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eUreteral strictures constitute an important clinical problem due to increasing number of cases, which may be related to the increasing the use of high-power lasers in urological departments and, as a result, thermal narrowing of the ureters after endoscopic treatment of upper urinary tract stones[1]. The standard treatment for ureteral strictures is reconstructive surgery with complete excision of the narrowed ureter[2][3]. Endoscopy has an established but limited role in the treatment of ureteral strictures due to the high recurrence rate[4]. According to the guidelines of the European Association of Urology, the highest percentage of stricture cures using the endoscopic method, is achieved in the case of a single short ureteral stricture[5]. So far, after the standard endoscopic treatment of a stricture by dilatation or incision, a DJ stent was implemented. However, the design of the DJ stent and its small diameter (3\u0026ndash;8F) can lead to the failure of endoscopic therapy[6][7]. Promising tools are metallic stents introduced on the urological market. Studies based on a large number of patients proved the safety and effectiveness of metallic stents[8][9]. In the Department of Urology of A. Jurasz Memorial University Hospital No. 1 in Bydgoszcz, since 2020 we have been using self-expanding ureteral stents from Allium\u0026reg; (SUS). After performing 70 procedures of SUS implantations for 33 patients, we decided to apply a different endoscopic management strategy in the treatment of ureteral strictures using a SUS. After dilatating the stricture, the SUS was used as a scaffold to create a new scar. The use of such a technique is based on the design of a SUS, which, when released from the delivery system (and in the absence of external barriers), opens to a diameter of 27-30F. Therefore, after dilatating the stricture and releasing it in the ureter, the SUS will exert pressure on the newly forming scar, thus preventing the formation of a tight stricture in a previously widened place. The assumptions of this surgical technique required an appropriate functional assessment of the treated kidney and ureteral stricture, hence renal scyntygraphy was planned for all patients before, during and after treatment. The performance of renal scyntygraphy in the treated group is an advantage of this study because in the previous largest publications concerning the treatment of ureteral strictures, the main measure of treatment effectiveness was radiological imaging and there was no reliable assessment of the function and outflow of urine from the kidneys[2][3][9][10][11].\u003c/p\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Population:\u003c/h2\u003e \u003cp\u003ePatients with diagnosed ureteral stricture and renal function over 20% in renoscyntygraphy were included into the study. Patients with ureteral orifice strictures and after radiotherapy were excluded from the study. From May 2020 till November 2021, 33 patients with ureteral strictures received endourological treatment with the use of Allium\u0026reg; SUS. Two patients were diagnosed with both sides strictures and received treatment for both sides. Stricture length was measured during surgery in ureteropyelography and confirmed after stent implantation. The patients were divided into 2 groups: uncomplicated strictures which was defined as a single stricture below 2 cm (Grp 1) and those with complicated strictures which was stricture over 2cm and/or as multiple strictures (Grp 2). Based on previous reports regarding the recurrence of strictures in the urinary tract after over 12 months, patients were scheduled to have their SUS removed after 1 year[12][13][14]. The follow-up time was 24 months. All patients were scheduled for renoscyntygraphy before implantation, during stenting and twice after SUS explantation. Hydronephrosis was measured in ultrasound, and the presence of hydronephrosis was reported when dilatation of calices was \u0026gt;\u0026thinsp;3mm and of renal pelvis\u0026thinsp;\u0026gt;\u0026thinsp;5mm. The endpoint of the study was no stenting of the ureter after the treatment and no tight stenosis in control renoscyntygraphy after SUS explantation. No tight stenosis in control renoscyntygraphy without any stenting, was described as \u0026ldquo;full therapeutic success\u0026rdquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Surgical technique:\u003c/h2\u003e \u003cp\u003eAll SUS implantations and explantations were performed by the same surgeon. Implantation of the SUS was carried out in four stages: identification of the stricture, dilatation, the SUS implantation, control ureteropyelography. After placement of two hydrophilic guidewires, dilatation of the stricture was done with the use of URS 6/7,5F and followed by URS 7/9,5F. Further dilatation was performed with the use of COOK disposable ureteral dilatators. Desired diameter of dilatation was 14F. Implantation of the SUS was done under C-arm after previous marking of the stricture using metal markers placed on the patient. The SUS was positioned to cover the stricture with the minimum margin of 2 cm above or below. During the SUS explantation procedure, DJ stent or nephrostomy was placed for 1 month due to the swelling of the ureter and the presence of blood clots in its lumen. After 1 month DJ stent or nephrostomy were removed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Statistical analysis:\u003c/h2\u003e \u003cp\u003eFrequency was calculated by chi-square tests of independence. In the case of quantitative variables with a distribution close to normal, Student's t tests were used to compare independent samples for which the mean and standard deviation were assessed. In the case of quantitative variables with a distribution deviating from normal, the Mann-Whitney tests were used to calculate median and interquartile range were reported. Statistical analyses were performed using the IBM SPSS Statistics 26. The level of significance was α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Assumptions of the study:\u003c/h2\u003e \u003cp\u003eOur aim was to test the possibility of curing ureteral stricture depending on its type and degree of stenosis using SUS-assisted endoscopic methods with the use of reliable functional kidney test (renoscyntygraphy).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eThe general characteristics of the patients, strictures and the endoscopic procedures are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In Grp 2; two SUS were implemented in ureters after kidney transplant, so side was not defined. Dilation above the diameter of the semi-rigid endoscope (7/9,5F) was possible in 60% of patients in both groups. The average duration of SUS in both groups was 10 months, although the assumed duration of maintaining SUS was 12 months, hence 33% (Grp 1) and 35% (Grp 2) of patients experienced earlier explantation of the SUS. There were no statistically significant differences in the compared groups in terms of the variables described above. In Grp 2, single strictures exceeding 2 cm occurred in 55% of patients, multiple strictures up to 2 cm long occurred in 35% of patients, and 10% had multiple strictures exceeding 2 cm. Primary ureteropelvic junction stricture was present in 1 patient Grp 1. In this case, reconstructive surgery was not performed due to the patient's high BMI and possible technical difficulties resulting from the surgical approach. The studied groups of patients did not differ statistically in terms of the etiology of the strictures.\u003c/p\u003e \u003cp\u003eThe characteristics of complications and treatment results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Serious complications (Clavien-Dindo 3a-4a) occurred statistically more often in Grp 2. Only 5 patients did not experience any complications (4 in Grp 2 and 1 in Grp 1). 2 patients (13.3%) in Grp 1 and 5 patients (25%) in Grp 2 experienced complications of grade 3a according to the Clavien-Dindo scale. All cases of grade 3a complications were related pyonephrosis and nephrostomy was placed. 4 patients (20%) from Grp 2 required surgical treatment under general anesthesia (Clavien-Dindo 3b): 3 patients underwent reconstructive surgery for ureteropelvic junction stricture and 1 patient underwent nephrectomy due to renal hypofunction and encrusted SUS. Renal failure during SUS implantation (Clavien-Dindo 4a) occurred in 3 patients (1 patient in Grp 1, and 2 patients in Grp 2; the average renal function in renoscyntygraphy before SUS implantation was 23%). It should be noted that full renoscyntygraphy schedule wasn\u0026rsquo;t completed in patients who underwent nephrectomy. Improvement in quality of life (QoL) was assessed by authorial questioner during outpatient visits; no validated QoL questionnaires were used. Improvement in QoL was reported by 60% of patients from Grp 1 and all 15 patients after completion of treatment. In Grp 2, 65% of patients during treatment and 40% of patients after completion of treatment reported an improvement in QoL. This was a statistically significant difference in the comparison of both groups. No statistically significant differences were observed in relation to visible urinary retention in ultrasound examination and renoscyntygraphy in both groups. It was assumed that hydronephrosis occurred in 100% of patients in both groups before the treatment.\u003c/p\u003e \u003cp\u003eThe end point of the study was the achievement of a full therapeutic success. A statistically significant difference was obtained in the study groups, with 80% full therapeutic success in Grp 1 (12 patients) and 15% in Grp 2 (3 patients). Maintained urine flow during stenting, determined by renoscyntygraphy during SUS implantation, was possible in all patients from Grp 1 and 70% of the patients from Grp 2, which was also a statistically significant difference.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eEndoscopic treatment methods have a high failure rate, which can be 85% in complicated cases[15][16]. Reconstructive surgeries are most effective, reaching over 90%, but these are a challenge for surgeons, being a time-consuming and often technically difficult procedures[17]. The reduced QoL of patients results from the frequent need for a long-term urinary tract stenting and struggling with recurrent urinary tract infections[18]. The ineffectiveness of treatment of ureteral strictures may result in the removal of the kidney or chronic stenting of the urinary tract, as May and his co-authors presented in their work analyzing the treatment of ureteral strictures in 4 urological centers over a period of 9 years [7]. Considering only complications after treatment of urinary tract stones, the frequency of strictures reaches 1\u0026ndash;4%, hence the ureteral strictures scale is high[19].\u003c/p\u003e \u003cp\u003eEndoscopic treatment of ureteral strictures is based on widening the stricture by dilating it with dilators, expanding balloons or by incising the stricture. The urinary tract is an unfavorable environment for tissue healing due to the irritating effect of urine, which ultimately leads to scarring and re-stenosis. When using DJ catheters, we have limited possibilities of keeping the ureter open because the diameter of the thickest DJ catheters is 9F. Alternative for DJ stents are SUS, which can help in forming new stricture with a larger diameter. In our endoscopic technique the supply of the stricture plays a more important role than the implantation itself. Unfortunately, in 40% of patients it was not possible to obtain a larger dilatation diameter than the diameter of the semi-rigid URS (9.5F). We refrained from using any energy to achieve larger diameter of the treated stricture to avoid thermal tissue damage, hoping for less secondary scarring. SUS implantation time in Grp 1 was longer compared to Grp 2 which was related to the possibility of partial scar removal in short strictures with the use of URS forceps which prolonged the procedure. Urinary tract infections and SUS migration accounted for the highest percentage of treatment complications. Migration of SUS occurred in 26.7% of Grp 1 patients. In this group, displacement of SUS often meant the absence of tight stricture. In the case of complicated strictures, migration occurred in 15% of patients, which was related to a persistent tight stenosis that prevented SUS from migration. Complications secondary to urinary tract infections and kidney obstruction were more serious because they could result in deterioration of kidney function[7][18]. In approximately 1/3 of cases, it was necessary to remove SUS earlier, which was most often caused by urinary tract infections, bladder irritation symptoms or SUS migration. A statistically significant difference in serious complications in Grp 2 was related to the nephrectomies in that group. It should be mentioned that patients who underwent nephrectomy had borderline kidney function in renoscyntygraphy before starting treatment. Statistically significant differences in the improvement of QoL in favor of Grp 1 resulted from the fact that in this group 80% of patients achieved a full therapeutic success. In Grp 1, in cases without full therapeutic success one patient underwent nephrectomy due to its afunction revealed during stenting and two patients underwent reconstructive surgery. Importantly, in the cases of reconstructive surgery after SUS stenting, no significant differences that made the procedure difficult, such as adhesions or inflammation, were observed. After removal of SUS, a 3-month interval was maintained before reconstructive surgery.\u003c/p\u003e \u003cp\u003eIn 80% of patients in Grp 1, postoperative renoscyntygraphy resulted in ureter patency, without significant deterioration of kidney function. The high percentage of persistent hydronephrosis in the ultrasound examination after removal of SUS (71.4%) and the signs of outflow disturbances in renoscyntygraphy, but without tight stenosis in the furosemide test, indicate persistent stenosis, but with a larger diameter than before the treatment. This picture was observed endoscopically in two patients in whom endoscopic diagnostics were performed during the observation period due to suspicion of residual kidney stones. In Grp 2, the effectiveness of full therapeutic success was low and the only possible way to use SUS in that cases is urinary tract drainage, which was measured by renoscyntygraphy during stenting. However, using SUS as an element of urinary tract drainage can be problematic due to the difficult explantation procedure, which is much more complicated than exchanging DJ stent. In our center, we tried to use optical cystoscope forceps to remove SUS because of good pulling force when compared to URS forceps. When using URS forceps, SUS was often fragmented in the ureter, and this is why SUS was positioned approximately 1 cm into the bladder lumen or 1 cm into the renal pelvis lumen, which allowed to use optical cystoscope forceps during explantation. If SUS was positioned within the renal pelvis lumen, it was removed by creating a transrenal tract.\u003c/p\u003e \u003cp\u003eDespite the doubts raised by the retrospective nature of this study, we decided to publish our data to present the treatment results based on a reliable functional test of the kidney, i.e. renoscyntygraphy. Our publication may constitute the basis for planning a prospective randomized study comparing DJ stents with SUS in modern endoscopic treatment of ureteral strictures. Developing an optimal method of endoscopic management of ureteral stricture may significantly improve treatment results.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eIn short (\u0026lt;\u0026thinsp;2cm), non-complicated strictures, a full therapeutic success of endoscopic treatment with self-expanding ureteral stents (SUS) in our material was achieved in 80%. A full therapeutic success was defined as no tight stenosis in renoscyntygraphic examination during follow-up (2 years with 2 tests). SUS in a short single stricture has high efficiency as a supportive element for formation of a new, wider scar. It must be kept in mind that a scar is still present so renal function must be monitored, and patients are in high risk for infection complications due to common hydronephrosis. As results of our study show, in long and/or multiple strictures a full therapeutic success of endoscopic treatment with SUS was low (15%), but SUS can be used in that group a drainage system (efficiency 70%). Drainage by SUS in long and/or multiple strictures can improve the quality of life, and SUS exchange can be scheduled every 2\u0026ndash;3 years, however in that group of patient\u0026rsquo;s serious complications are more common.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSUS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSelf-expanding ureteral stents\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eURS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUreterorenoscope\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eQoL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eQuality of life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGrp 1\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGroup 1 patients with uncomplicated strictures (single, short \u0026lt;\u0026thinsp;2cm stricture)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGrp 2\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGroup 2 patients with complicated strictures (multiple and/or long\u0026thinsp;\u0026gt;\u0026thinsp;2cm strictures).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cp\u003eF.K. Paid lectures during company meetings for Allium Company. Paind hands-on training for Allium.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConflicts of interests: F.K. Paid lectures during company meetings for Allium Company. Paind hands-on training for Allium.Research registry UIN: researchregistry10261, www.researchregistry.comFinancial support and sponsorship: none.Approval of Ethics Committee: Collegium Medicum Ethics Committee in Bydgoszcz Approval No. KB257/2024All authors reviewed the manuscript.F.K. Study design, writing the manuscriptB.K. Collecting dataM.P. Collecting dataP.L. Collecting dataM.Cz. Collecting dataJ.W. Preparing data and tablesA.O. Statistical analysisJ.A. Supervision of the manuscriptT.D. Supervision of the manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eStatistical consultation Urszula Kajewska [email protected] consultation Prof. Aleksander Szwedek, A,Mickiewicz University in Poznań, Poland, [email protected]\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData sets generated during the current study are available from the corresponding author on reasonable request. E-mail contact: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMoretto, S., Saita, A., Scoffone, C.M. et al. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol 42, 234 (2024). doi:10.1007/s00345-024-04933-2.\u003c/li\u003e\n\u003cli\u003eVinaya P Vasudevan, Emmanuel U Johnson, Kee Wong, Morkos Iskander, Saqib Javed, Nikhil Journal of Clinical Urology 2019 12:1, 20-31. doi:10.1177/205141581877221.\u003c/li\u003e\n\u003cli\u003ePng JC, Chapple CR. Principles of ureteric reconstruction. Curr Opin Urol. 2000 May;10(3):207-12. doi: 10.1097/00042307-200005000-00004.\u003c/li\u003e\n\u003cli\u003eRichter F, Irwin RJ, Watson RA, Lang EK. Endourologic management of benign ureteral strictures with and without compromised vascular supply. Urology. 2000 May;55(5):652-7. doi: 10.1016/s0090-4295(00)00484-2.\u003c/li\u003e\n\u003cli\u003eD. Kitrey , F. Campos-Juanatey, P. Hallscheidt, E. Mayer, E. Serafetinidis, D.M. Sharma, M. Waterloos Guidelines Associates: H. Mahmud, K. Zimmermann. EAU Guidelines on Urological trauma.\u003c/li\u003e\n\u003cli\u003eTeruaki Sugino, Kazumi Taguchi, Shuzo Hamamoto et al. Failure of endoscopic management of ureteral strictures is due to ureteroscopic lithotripsy as a cause and longer length of stricture, 28 August 2020, Research Square. doi: 10.21203/rs.3.rs-63640/v1.\u003c/li\u003e\n\u003cli\u003eMay PC, Hsi RS, Tran H, Stoller ML, Chew BH, Chi T, Usawachintachit M, Duty BD, Gore JL, Harper JD. The Morbidity of Ureteral Strictures in Patients with Prior Ureteroscopic Stone Surgery: Multi-Institutional Outcomes. J Endourol. 2018 Apr;32(4):309-314. doi: 10.1089/end.2017.0657.\u003c/li\u003e\n\u003cli\u003eKhoo CC, Ho C, Palaniappan V, Ting A, Forster L, Kondjin-Smith M, Abboudi H, Hanna M, El-Husseiny T, Dasgupta R. Single-Center Experience with Three Metallic Ureteral Stents (Allium\u003csup\u003e\u0026reg;\u003c/sup\u003eURS, Memokath\u0026trade;-051, and Resonance\u003csup\u003e\u0026reg;\u003c/sup\u003e) for Chronic Ureteral Obstruction. J Endourol. 2021 Dec;35(12):1829-1837. doi: 10.1089/end.2021.0208.\u003c/li\u003e\n\u003cli\u003eGao X, Di X, Chen G, Wang W, Peng L, Chen J, Wei X. Metal ureteral stents for ureteral stricture: 2 years of experience with 246 cases. Int J Surg. 2024 Jan 1;110(1):66-71. doi: 10.1097/JS9.0000000000000841.\u003c/li\u003e\n\u003cli\u003eBilotta A, Wiegand LR, Heinsimer KR. Ureteral reconstruction for complex strictures: a review of the current literature. Int Urol Nephrol. 2021 Nov;53(11):2211-2219. doi: 10.1007/s11255-021-02985-6. \u003c/li\u003e\n\u003cli\u003eYang, K., Pang, K.H., Fan, S. et al. Robotic ureteral reconstruction for benign ureteral strictures: a systematic review of surgical techniques, complications and outcomes. BMC Urol 23, 160 (2023). doi:10.1186/s12894-023-01313-7.\u003c/li\u003e\n\u003cli\u003eIshigooka M, Tomaru M, Hashimoto T, Sasagawa I, Nakada T, Mitobe K. Recurrence of urethral stricture after single internal urethrotomy. Int Urol Nephrol. 1995;27(1):101-6. doi: 10.1007/BF02575227.\u003c/li\u003e\n\u003cli\u003ePerdzyński W, Adamek M. Calibration of urethra with anti-scar gel as a new preventive method for stricture recurrence after urethroplasty performed due to refractory anterior urethral stricture disease. Cent European J Urol. 2020;73(1):80-90. doi: 10.5173/ceju.2020.0050.\u003c/li\u003e\n\u003cli\u003eKahokehr AA, Granieri MA, Webster GD, Peterson AC. A Critical Analysis of Bulbar Urethroplasty Stricture Recurrence: Characteristics and Management. J Urol. 2018 Dec;200(6):1302-1307. doi: 10.1016/j.juro.2018.07.036. Mann RA, Virasoro R, DeLong JM, Estrella RE, Pichardo M, Lay RR, Espino G, Roth JD, Elliott SP. A drug-coated balloon treatment for urethral stricture disease: Two-year results from the ROBUST I study. Can Urol Assoc J. 2021 Feb;15(2):20-25. doi: 10.5489/cuaj.6661.\u003c/li\u003e\n\u003cli\u003eGhali AM, El Malik EM, Ibrahim AI, Ismail G, Rashid M. Ureteric injuries: diagnosis, management, and outcome. J Trauma. 1999 Jan;46(1):150-8. doi: 10.1097/00005373-199901000-00026.\u003c/li\u003e\n\u003cli\u003eKachrilas S, Bourdoumis A, Karaolides T, Nikitopoulou S, Papadopoulos G, Buchholz N, Masood J. Current status of minimally invasive endoscopic management of ureteric strictures. Ther Adv Urol. 2013 Dec;5(6):354-65. doi: 10.1177/1756287213505671.\u003c/li\u003e\n\u003cli\u003eHeo JE, Kang SK, Lee J, Koh D, Kim MS, Lee YS, Ham WS, Jang WS. Outcomes of single-port robotic ureteral reconstruction using the da Vinci SP\u003csup\u003e\u0026reg;\u003c/sup\u003e Investig Clin Urol. 2023 Jul;64(4):373-379. doi: 10.4111/icu.20230005.\u003c/li\u003e\n\u003cli\u003eVall\u0026eacute;e M, Bey E, Bouiller K, le Goux C, Pimpie R, Tourret-Arnaud J, Lina G, Figueiredo S, Chauvin A, Gavazzi G, Malavaud S, Sotto A, Bruy\u0026egrave;re F. Epidemiology and risk factors for ureteral stent-associated urinary tract infections in non-transplanted renal patients: a systematic review of the literature. World J Urol. 2021 Oct;39(10):3845-3860. doi: 10.1007/s00345-021-03693-7.\u003c/li\u003e\n\u003cli\u003eSunaryo PL, May PC, Holt SK, Sorensen MD, Sweet RM, Harper JD. Ureteral Strictures Following Ureteroscopy for Kidney Stone Disease: A Population-based Assessment. J Urol. 2022 Dec;208(6):1268-1275. doi: 10.1097/JU.0000000000002929.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the patients, surgery procedures and strictures.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUncomplicated strictures\u003c/p\u003e \u003cp\u003e(single, \u0026lt;2cm)\u003c/p\u003e \u003cp\u003eGrp1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComplicated strictures\u003c/p\u003e \u003cp\u003e(multiply and/or \u0026gt;\u0026thinsp;2cm) Grp2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15 stents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;20 stents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e/ \u003cem\u003en\u003c/em\u003e (%)/ \u003cem\u003eMD\u003c/em\u003e (\u003cem\u003eIQR\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e/ \u003cem\u003en\u003c/em\u003e (%)/ \u003cem\u003eMD\u003c/em\u003e (\u003cem\u003eIQR\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge [years]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.20\u0026thinsp;\u0026plusmn;\u0026thinsp;13.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.85\u0026thinsp;\u0026plusmn;\u0026thinsp;12.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (Male/Female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (60.0%) / 6 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (45.0%) / 11 (65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUreter (Left / Right)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (40.0%) / 9 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (50.0%)* / 9 (50%)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImplantation time [min.]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.00 (30.00\u0026ndash;55.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.50 (26.25\u0026ndash;40.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExplantation time [min.]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.00 (13.75\u0026ndash;35.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.00 (22.50\u0026ndash;31.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePossible dilatation diameter over 9,5F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime of stenting [months]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNecessity of explantation before scheduled time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMigration of SUS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnplaiting of the SUS during explantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExplantation with the use of cystoscope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle stricture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (55.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStricture lenght [cm]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (65.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIatrogenic strictures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Stone treatment (URSL, RIRS, ureterolithotomy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (66.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Stricture after ureteropelvic plastic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Gynecological procedures (without radiotherapy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Renal transplant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Surgical procedures (without radiotherapy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-iatrogenic strictures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Endometriosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Retroperitoneal fibrosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Inflamatory diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Primary stricture of ureteropelvic junction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eM\u003c/em\u003e \u0026ndash; average; \u003cem\u003eSD\u003c/em\u003e \u0026ndash; standard deterioration; \u003cem\u003en\u003c/em\u003e \u0026ndash; sample size; \u003cem\u003eMD\u003c/em\u003e \u0026ndash; median \u003cem\u003eIQR\u003c/em\u003e \u0026ndash; interquartile range; \u003cem\u003ep\u003c/em\u003e \u0026ndash; statistical significance\u003c/p\u003e \u003cp\u003e*Two patients from Grp 2 were patients with after renal transplant so side was not defined.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComplications and treatment outcomes.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUncomplicated strictures\u003c/p\u003e \u003cp\u003e(single, \u0026lt;2cm)\u003c/p\u003e \u003cp\u003eGrp 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComplicated strictures\u003c/p\u003e \u003cp\u003e(multiply and/or \u0026gt;\u0026thinsp;2cm)\u003c/p\u003e \u003cp\u003eGrp 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15 stents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;20 stents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e/ \u003cem\u003en\u003c/em\u003e (%)/ \u003cem\u003eMD\u003c/em\u003e (\u003cem\u003eIQR\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003eSD\u003c/em\u003e/ \u003cem\u003en\u003c/em\u003e (%)/ \u003cem\u003eMD\u003c/em\u003e (\u003cem\u003eIQR\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerious complications (Clavien Dindo\u0026thinsp;\u0026gt;\u0026thinsp;3a)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (55.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.046\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications [Clavien - Dindo]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenoscyntygraphy [GFR] (before SUS implantation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.00\u0026thinsp;\u0026plusmn;\u0026thinsp;11.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.29\u0026thinsp;\u0026plusmn;\u0026thinsp;11.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.870\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenoscyntygraphy [%] (before SUS implantation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.25\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.60\u0026thinsp;\u0026plusmn;\u0026thinsp;11.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenoscyntygraphy [GFR] (during stenting)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.50\u0026thinsp;\u0026plusmn;\u0026thinsp;16.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.76\u0026thinsp;\u0026plusmn;\u0026thinsp;10.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenoscyntygraphy [%] (during stenting)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.70\u0026thinsp;\u0026plusmn;\u0026thinsp;14.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.27\u0026thinsp;\u0026plusmn;\u0026thinsp;12.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenoscyntygraphy [GFR] (after SUS explantation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.73\u0026thinsp;\u0026plusmn;\u0026thinsp;11.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.00\u0026thinsp;\u0026plusmn;\u0026thinsp;9.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenoscyntygraphy [%] (after SUS explantation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.17\u0026thinsp;\u0026plusmn;\u0026thinsp;14.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.88\u0026thinsp;\u0026plusmn;\u0026thinsp;11.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBetter Quality of Life during stenting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (65.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBetter Quality of Life after stenting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydronephrosis during stenting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (53.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydronephrosis after explantation\u0026thinsp;\u0026lt;\u0026thinsp;12months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (87.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.378\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydronephrosis after explantation 12\u0026ndash;24 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (85.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull therapeutic success\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeasible renal outflow during stenting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eM\u003c/em\u003e \u0026ndash; average; \u003cem\u003eSD\u003c/em\u003e \u0026ndash; standard deterioration; \u003cem\u003en\u003c/em\u003e \u0026ndash; sample size; \u003cem\u003eMD\u003c/em\u003e \u0026ndash; median \u003cem\u003eIQR\u003c/em\u003e \u0026ndash; interquartile range; \u003cem\u003ep\u003c/em\u003e \u0026ndash; statistical significance\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Ureteral strictures, Endoscopy, Self-expanding stents, Allium, Metal stents","lastPublishedDoi":"10.21203/rs.3.rs-4621556/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4621556/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eThe current results of endoscopic treatment of ureteral strictures are characterized by very divergent treatment results, which is due to a wide range of criterion for including patients in the analyses and different definitions of effective treatment. In this retrospect study we wanted to introduce a possibility of curing ureteral strictures depending on their type and degree with the use of self-expanding ureteral stents (SUS).\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003e33 patients with ureteral strictures received endourological treatment with the use of Allium\u0026reg; SUS (2 patients with SUS placed on both sides). Patients were divided into 2 groups: patients with uncomplicated strictures (Grp 1) and patients with complicated strictures (Grp 2). Uncomplicated stricture was defined as a single stricture below 2 cm. A complicated stricture was defined as a stricture over 2cm and/or as multiple strictures. The follow-up time was 24 months. All patients were scheduled for renoscyntygraphy during the treatment. A full therapeutic success was defined as no tight stenosis in renoscyntygraphic examination after SUS explantation.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eIn Grp 1, full therapeutic success was achieved in 80% of patients, which was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to Grp 2. Serious complications (Clavien-Dindo\u0026thinsp;\u0026gt;\u0026thinsp;3a) occurred significantly more often in Grp 2 (p\u0026thinsp;=\u0026thinsp;0.046). Renal outflow during stenting was present in 70% of the patients in Grp 2.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eA full therapeutic success of endoscopic SUS-assisted treatment can be achieved in patients with a short, single ureteral stricture. In long and/or multiple strictures SUS can be used as drainage element.\u003c/p\u003e","manuscriptTitle":"Endourological treatment of ureteral strictures with the use of self-expanding stents: is it possible to completely cure the stricture endoscopically? A report on the experience with implantation of 35 stents with a two-year follow-up period; a retrospect study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-17 19:16:47","doi":"10.21203/rs.3.rs-4621556/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-05T20:37:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-31T06:52:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249980549313807519196158642180800273074","date":"2024-10-23T02:28:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-20T18:24:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237399002728932720513945583841833126967","date":"2024-10-20T18:02:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87355550746253465395903328103786528712","date":"2024-10-15T20:33:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-22T17:53:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-26T15:32:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-26T08:22:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Urology","date":"2024-06-22T10:46:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"833eec0d-5755-4f53-9ba5-41eee4707709","owner":[],"postedDate":"July 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-07T16:01:32+00:00","versionOfRecord":{"articleIdentity":"rs-4621556","link":"https://doi.org/10.1007/s00345-025-05574-9","journal":{"identity":"world-journal-of-urology","isVorOnly":false,"title":"World Journal of Urology"},"publishedOn":"2025-04-01 15:57:37","publishedOnDateReadable":"April 1st, 2025"},"versionCreatedAt":"2024-07-17 19:16:47","video":"","vorDoi":"10.1007/s00345-025-05574-9","vorDoiUrl":"https://doi.org/10.1007/s00345-025-05574-9","workflowStages":[]},"version":"v1","identity":"rs-4621556","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4621556","identity":"rs-4621556","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}