Operative note 20 Advanced
Ureteric stricture - endoscopic cut
What it does: slit a narrow ureter from inside.
- Slippery Terumo wire across, into the kidney.
- Swap over a 5Fr catheter for a stiff wire.
- Suture-around-ureter cause? A stent alone may cure. 3 months. Then image at 4 weeks and 3 months.
- Else: balloon, or cut (cold knife, wire, laser).
- Cut full thickness, till fat is seen.
- Direction: side, in the middle ureter. EXCEPT over the iliac vessels: cut front-inner. (Vessels sit behind the ureter there.)
- Stent 4-6 weeks. Catheter a day.
- Watch: Balloon ~55% cure. Cut ~70%.
- Watch: Over 1 cm, or poor blood supply: poor results.
- Watch: Middle ureter worse than ends: 25% vs 80%.
From the UroRef Operative Quick Guide.