Editing Management of Upper Urinary Tract Obstruction (section)

==== Endourologic procedures ====

*'''<span style="color:#ff0000">Best management for ureteral strictures < 2 cm with no previous intervention is an endoscopic approach</span>'''
*'''<span style="color:#ff0000">Contraindications (1):</span>'''
*# '''<span style="color:#ff0000">Strictures >2cm</span>''' because dilation alone is unlikely to be successful
*'''<span style="color:#ff0000">Options (2): balloon dilation or endoureterotomy</span>'''
**'''<span style="color:#ff0000">Balloon dilation'''
*** After 10 minutes of tamponade, the balloon is deflated and withdrawn. An internal stent is passed over a guidewire still in place, which is left indwelling for 2-4 weeks.
*** '''Follow-up diuretic renography''' is usually performed ≈1 month after stent extraction and at 6- to 12-month intervals thereafter
*** Success rates range from 50-76%, long-term outcomes are unfavorable
*** '''Best results obtained in patients with iatrogenic, non-anastomotic strictures such as those secondary to ureteroscopic instrumentation'''. In that setting, a success rate of 85% was achieved compared with a rate of 50% for anastomotic strictures
** '''<span style="color:#ff0000">Endoureterotomy'''
*** '''<span style="color:#ff0000">The position for the incision is chosen as a function of the level of the ureter involved. In general</span>'''
**** '''Lower ureteral strictures are incised in an anteromedial direction to stay away from the iliac vessels'''
**** '''Upper ureteral strictures are incised laterally or posterolaterally'''
*** The incision can be performed using a cold knife, a cutting electrode, or a holmium laser