Transluminal dilatation of ureteropelvic junction strictures, ureteral strictures, and strictures at ureteroneocystostomy sites.

Ureteral strictures are categorized by age, etiology, location, and length of stricture. On the basis of history, the status of vascular perfusion of the involved ureteral segment and possible presence of devitalization are projected. Transluminal dilatation of ureteral strictures can be performed via a retrograde or antegrade approach. The age of the stricture and status of vascular supply to the involved and adjacent segments of the ureter are the most critical criteria influencing long-term results of transluminal dilatation. The technique of bougie dilatation and placement of balloons across strictures at various sites is discussed. The advantages of bougie versus balloon dilatation and the need for postdilatation stenting to preclude restricturing are analyzed. In fresh strictures, not complicated by devascularization, a 90 per cent salutary response to transluminal dilatation can be anticipated, regardless of location of the stricture, ureteroneocystostomy, or ureteroileostomy. Most poor results of transluminal dilatation occur in strictures compromised by severe devascularization attendant to surgical procedures, radiation therapy, fulminating inflammatory processes, neoplasms, or any combination of these. Decompression and drainage of the kidney by an internalized stent are advocated for the treatment of strictures caused by recurrent and uncontrolled neoplasm.