Endourological Management of Benign Ureteral Strictures Factors affecting success Mohamed Nady*, Gamal Abdel Malik*, Mohamed Shalaby**, Ismail Khalaf*** *Department of Urology, Al Azhar University, Assiut; **Department of Urology, Assiut University, Assiut; ***Department of Urology, Al Azhar University, Cairo, Egypt Purpose: To evaluate endoscopic management of ureteral strictures and factors affecting its outcomes. Materials and methods: We prospectively evaluated 44 patients with 49 ureteral strictures who were endoscopically treated in a period from January, 2005, to June, 2008, at our institutions. Inclusion criteria comprised ureteral stricture associated with partial obstruction less than 2cm length, and ureter can be identified distal to the stricture. The patients with ureteral stricture of a non functioning kidney, ureteropelvic junction obstruction, malignant stricture or ureteroen- teric anastomotic stricture were excluded. The evaluation criteria included, symptoms improvement, radiological renal integrity, and intraoperative or postoperative complications. Twenty three strictures were treated by Holmium: YAG laser endoureterotomy and 26 strictures were treated by ureteral balloon dilatation. Usually the largest possible stent (7 or 8 F) was placed for 8 to 12 weeks. Results: The mean patient age was 39.6 years (range 21 to 67) and all of the patients were male but 10. The mean fol- low up period was 13.4 months (range 9 to 24). Iatrogenic ureteral strictures were observed in 11, history of impacted stone in 32 strictures, bilharzial ureteral stricture in 4, and no detectable cause in the last two. Twelve ureteral strictures were recurrent. The stricture length, etiology and recurrence play an important role in the selection and outcome of treat- ment. The overall success rate was 80.8% for primary balloon dilatation, 82.6% for Holmium: YAG laser endouretero- tomy. Conclusions: Endoscopic management of stricture ureter may be the procedure of choice for the initial management of short, non recurrent ureteral strictures with good renal integrity. Keywords: laser, ureter, endoureterotomy, stricture, dilatation Abstract Introduction Gynecological surgery continues to be the major iatro- genic cause of benign ureteral strictures, followed by abdominal trauma and surgical procedures; while the incidence is 0.5% to 11% after upper ureteral manip- ulation 1 . In addition, non iatrogenic ureteral strictures include patients with stone disease or chronic inflam- matory disorders 2 . The objectives for intervention are to preserve renal function, eliminate ureteral obstruc- tion, then reducing morbidity and cost 3 . The increasing use of minimally invasive procedures in urology has led to an increasing use of endoscopic methods for ini- tial treatment 4 . With a wide variety of therapeutic options available, the urologist is often faced with a therapeutic dilemma. In this study, we present our experience of endoscopic management for ureteral strictures with special emphasis on factors determining success. Materials and methods This was a prospective analysis of 49 ureteral stric- tures in 44 patients (34 males and 10 females), who underwent endoscopic treatment during the period of time from January, 2005, to June, 2008. The patients were included in the study if they had ureteral stricture associated with incomplete obstruction to the urinary flow, stricture length less than 2cm, and the ureter dis- tal to the stricture can be easily identified. The patients with ureteral stricture of a non functioning kidney, uretero pelvic junction obstruction, malignant stricture N. Nady et al. 17 p17-22.qxd 26/12/2009 09:38 Page 13