Clinical Application Of Balloon Dilation Under Ureteroscope In The Treatment Of Urethral Stricture

Objective: Ureteral stricture is a common and refractory disease.If not treated in time,long-term ureteral stricture can lead to hydronephrosis on the affected side,irreversible renal injury and,more seriously,renal failure.Therefore,it has attracted the attention of urologists and constantly explore new ways of treatment.Ureteroscopic balloon dilatation is one of the minimally invasive operations.This paper retrospectively analyzes the safety and clinical efficacy of ureteroscopic balloon dilatation in the treatment of ureteral stricture,so as to make clinicians have a deeper understanding of the clinical value of ureteroscopic balloon dilatation in the treatment of ureteral stricture.Methods: The clinical data of patients with ureteral stricture treated by ureteroscopic balloon dilatation in the fourth affiliated Hospital of Guangxi Medical University from April 2019 to March2020 were analyzed retrospectively.There were 4 males and 5 females,the age was 31-58 years old,the average age was 46.5 years old,all were unilateral benign ureteral stricture,6 cases were left ureteral stricture and 3 cases were right ureteral stricture.The stenotic segment was located in the upper ureter in 4 cases,in the middle segment in 1case,and in the lower segment in 4 cases.The length of the stenosis was about 0.5-2cm.The main causes of stricture were as follows:ureteroscopic holmium laser lithotripsy in 6 cases,ureteral orthopedic surgery in 2 cases,and the cause of stricture was unclear in 1 case.Among them,there were 3 cases of ureteral stricture with renal calculi,4 cases of ureteral stricture with ureteral calculi and 2 cases of simple ureteral stricture;all the affected kidneys had hydronephrosis;the clinical symptoms of the patients were mainly distension,pain and discomfort of the affected side.At the same time,1 case was complicated with urination because of single kidney,and the anuric patient underwent nephrostomy before operation.Two patients with renal calculi with stricture located in the upper segment were treated with retrograde balloon dilatation under ureteroscope,while the other 7patients were treated with retrograde balloon dilatation under ureteroscopy.At the same time,ureteral calculi were treated with holmium laser in patients with stricture and ureteral calculi.1-2 F4.7double J tubes were routinely retained after operation,and the follow-up period was 6-12 months.After operation,the patients were reexamined every 3 months,urinary color ultrasound or urinary CT were reexamined and the improvement of clinical symptoms was asked.Results: All the operations were completed successfully,including anterograde balloon dilatation under ureteroscope in 2 cases,retrograde balloon dilatation in 7 cases,simple balloon dilatation in 2 cases,holmium laser lithotripsy in 4 cases and holmium laser lithotripsy in 3cases.The operation time was 26-125 minutes(mean 72.7 minutes).There were no serious complications such as ureteral perforation,segment separation and massive bleeding.The patients mainly had gross hematuria after operation,and the hematuria disappeared after intravenous drug hemostasis.The duration of hematuria was about 1-2days,and discharged from hospital 2-5 days after operation,with an average of 3.7 days.The double J tubes were pulled out 3 months after operation and followed up for 6-12 months.7 patients with hydronephrosis were relieved and their clinical symptoms were significantly improved,and 2 patients with hydronephrosis worsened.Among them,1 case showed aggravation of low back pain 6 months after operation and color ultrasound examination of urinary system showed aggravation of hydronephrosis.Laparoscopic ureteral bladder replantation was performed directly after operation,and the postoperative recovery was good,and no recurrence of stricture was found.The other case underwent urinary color timeout 12 months after operation,which indicated that the hydronephrosis was aggravated and then changed to laparoscopic pyeloureteroplasty.At present,no recurrence of stricture was found in the follow-up.Conclusion: For ureteral stricture,ureteroscopic balloon dilatation is a relatively safe and effective minimally invasive treatment with short operation time and less injury,and the patients can recover quickly after operation.Moreover,under the direct vision of ureteroscope,the operation is relatively simple and convenient,and the field of vision is clear,so it is worth applying and popularizing in clinic.