Endoscopic treatment of stenotic ureteral orifices using self-expanding metallic stents: comparison of two methods and evaluation of effectiveness and safety in a tertiary center.

INTRODUCTION: Ureterovesical orifice stricture (UOS) is a rare complication after bladder or pelvic floor treatment, usually related to oncological etiology. To date, the literature has not established the optimal treatment for UOS.

MATERIAL AND METHODS: In a retrospective, single-center study, we present our experience in endoscopic treatment of 15 patients with narrowed or totally closed bladder ureteral orifices. In the study group, dilatation or resection of the stricture was performed, followed by implantation of a self-expanding stent (SUS). Dilatation and resection of the stricture were assessed for efficacy and safety.

RESULTS: In the group in which UOS was treated by resection and SUS implantation, 75% full therapeutic success was noted, i.e. obtaining a patent ureter after completion of urinary tract stenting. No serious complications (Clavien-Dindo >3a) occurred in the group where resection of the UOS was performed, in contrast to the group treated by dilatation of the UOS (serious complications in 57.2%).

CONCLUSIONS: Resection of stenotic ureteral orifice tissues seems to be a more effective treatment method than their dilatation. Self-expanding stents may be a useful option in the treatment of ureteral orifice strictures, but it is necessary to perform studies comparing their safety and effectiveness with DJ stents.