A total of 196 patients with ureteral stricture underwent balloon dilation between January 2012 and August 2022 at the Peking University First Hospital, Miyun Hospital, Emergency General Hospital, and Jian Gong Hospital. Baseline data and follow-up data were complete for 127 patients, including 97 patients with balloon dilation and 30 patients with balloon dilation combined with endoureterotomy (Figure 1 and Table 1 ). The patient’s phone number was empty and wrong, and the patient or his family members refused to follow up and lost contact. Clinical data, including general clinical data, perioperative data, balloon parameters at the time of surgery, and follow-up results, were collected in our Reconstruction of the Urinary Tract: Epidemiology and Result (RECUTTER) database [18 (link)].
Postoperative results of ureteral stenosis patients were collected at 3 months, 6 months, and 1 year after surgery, and the results of balloon dilatation treatment were evaluated at different periods and patients in each period were divided into two groups (failure group and non-failure group). One of the following conditions resulted in patients being allocated to the failure group: the reappearance of ureteral stricture and worsening of hydronephrosis on routine imaging (intravenous pyelogram, renal scan, retrograde pyelogram, ultrasound); the need for the repositioning of the DJ tube/nephrostomy tube; or surgical treatment. The remaining patients were allocated to the non-failure group.
The risk factor analysis included the following criteria: (a) patients with ureteral strictures detected through ureteroscopy or imaging. Imaging examinations include intravenous urography, computed tomography urogram, and magnetic resonance urography; (b) treatment with balloon dilation only and with technical success. Technical success is defined as the ability of the ureteroscope and guidewire to pass through the balloon-dilated ureteral stricture and successful retention of a double J ureteral stent. Exclusion criteria: (a) contraindication to surgery; (b) combined pregnancy; (c) conditions that the investigator needed to exclude; (d) incomplete data; and (e) a combined history of malignancy. The surgical outcome 3 months postoperatively was considered as the endpoint. In an analysis of risk factors for the failure of balloon dilatation alone, data from 97 patients were considered valid.
To compare the efficacy of balloon dilation versus balloon dilation combined with endoureterotomy in the treatment of lower segment ureteral stricture, patients with multi-segmental strictures were excluded.
The endpoint was clarified by a telephone follow-up, and the true validity of the clinical data was verified in 127 patients. The information collected included gender, age, BMI, preoperative renal function (preoperative creatinine, preoperative urea nitrogen, preoperative blood eGFR), ureteral stricture length, ureteral stricture site, whether there was a history of urologic surgery, balloon circumference, balloon pressure, and duration of dilation. The risk factors for recurrence after the balloon dilation of ureteral stricture were investigated according to whether the patients’ surgical outcome had failed or been successful, as of the endpoint.
A total of 127 patients with complete data after follow-up were included in this study. There were 97 patients with balloon dilatation alone and 30 patients with balloon dilatation combined with endoureterotomy. There were 67 patients with lower segment ureteral stricture, of which 30 received balloon dilatation combined with endoureterotomy and 37 received balloon dilatation alone. Among 97 patients who underwent balloon dilatation alone, 10 patients had multiple ureteral stenosis, 4 patients had middle ureteral stenosis, and 83 patients had upper and lower ureteral stenosis.
This study was designed and conducted in accordance with the principles of the Declaration of Helsinki (revised 2013) and was approved by the Ethics Committee of Peking University First Hospital. Individual consent was waived due to the retrospective nature of this study.
Postoperative results of ureteral stenosis patients were collected at 3 months, 6 months, and 1 year after surgery, and the results of balloon dilatation treatment were evaluated at different periods and patients in each period were divided into two groups (failure group and non-failure group). One of the following conditions resulted in patients being allocated to the failure group: the reappearance of ureteral stricture and worsening of hydronephrosis on routine imaging (intravenous pyelogram, renal scan, retrograde pyelogram, ultrasound); the need for the repositioning of the DJ tube/nephrostomy tube; or surgical treatment. The remaining patients were allocated to the non-failure group.
The risk factor analysis included the following criteria: (a) patients with ureteral strictures detected through ureteroscopy or imaging. Imaging examinations include intravenous urography, computed tomography urogram, and magnetic resonance urography; (b) treatment with balloon dilation only and with technical success. Technical success is defined as the ability of the ureteroscope and guidewire to pass through the balloon-dilated ureteral stricture and successful retention of a double J ureteral stent. Exclusion criteria: (a) contraindication to surgery; (b) combined pregnancy; (c) conditions that the investigator needed to exclude; (d) incomplete data; and (e) a combined history of malignancy. The surgical outcome 3 months postoperatively was considered as the endpoint. In an analysis of risk factors for the failure of balloon dilatation alone, data from 97 patients were considered valid.
To compare the efficacy of balloon dilation versus balloon dilation combined with endoureterotomy in the treatment of lower segment ureteral stricture, patients with multi-segmental strictures were excluded.
The endpoint was clarified by a telephone follow-up, and the true validity of the clinical data was verified in 127 patients. The information collected included gender, age, BMI, preoperative renal function (preoperative creatinine, preoperative urea nitrogen, preoperative blood eGFR), ureteral stricture length, ureteral stricture site, whether there was a history of urologic surgery, balloon circumference, balloon pressure, and duration of dilation. The risk factors for recurrence after the balloon dilation of ureteral stricture were investigated according to whether the patients’ surgical outcome had failed or been successful, as of the endpoint.
A total of 127 patients with complete data after follow-up were included in this study. There were 97 patients with balloon dilatation alone and 30 patients with balloon dilatation combined with endoureterotomy. There were 67 patients with lower segment ureteral stricture, of which 30 received balloon dilatation combined with endoureterotomy and 37 received balloon dilatation alone. Among 97 patients who underwent balloon dilatation alone, 10 patients had multiple ureteral stenosis, 4 patients had middle ureteral stenosis, and 83 patients had upper and lower ureteral stenosis.
This study was designed and conducted in accordance with the principles of the Declaration of Helsinki (revised 2013) and was approved by the Ethics Committee of Peking University First Hospital. Individual consent was waived due to the retrospective nature of this study.
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