Transurethral ureteroscopic ureterotomy assisted by a prior balloon dilation for relieving ureteral strictures

We developed a procedure to correct ureteral obstruction that consists of transurethral ureteroscopic balloon dilation of the stenotic segment followed by a ureteroscopic ureterotomy. Since February 1989 we treated 20 ureters in 19 patients with upper urinary tract obstruction, with an 85% success rate. Stenosis was primary in 4 patients, and secondary to a prior operation in 10, calculi in 4 and endometriosis in 2. The stenotic segment was pretreated with balloon dilation through an 11.5F rigid ureteroscope and then incised using a 12F optical ureterotome equipped with a cold knife. Thereafter, a 12F Double-J* catheter was left in situ for 6 weeks. Followup ranged from 4 to 55 months (mean 18). In these 19 patients obstruction resolved completely in 8 (8 ureters) and partially in 8 (9 ureters). Postoperatively, the obstruction remained unchanged in 2 patients and 1 experienced injury to the common iliac artery during the procedure. Our findings suggest that this procedure may prove beneficial in treating obstructive ureteral diseases.