Long-term results of percutaneous endourologic management of renal infundibular stricture.

ABSTRACT

PURPOSE: The long-term result of percutaneous endourologic management in the relief of infundibular stricture is not clear. We reviewed the long-term efficacy in our series of patients. PATIENTS AND METHODS: Twenty-seven patients underwent percutaneous endourologic management between August 1990 and February 1996. This study included the 21 who could be followed for more than 2 years (mean 4.8 years). The causes of stricture were tuberculosis (N = 18; 86%) and stone (N = 3; 14%). We made a cold-knife incision in eight patients; the others underwent only dilation with fascial dilators from 20F to 30F. Success was defined as symptomatic improvement and radiographic resolution of obstruction. RESULTS: The overall success rate was 76% (16 of 21). Seven of the eleven patients (64%) with concomitant ureteral stricture had a successful result. In the nine patients with multiple infundibular strictures, five procedure (56%) were successful. The success rates of the cold-knife or fascial dilator were 88% (7 of 8) and 69% (8 of 13), respectively. In the five patients in whom the procedure failed, ureteral stricture was associated in four and multiple infundibular strictures in four. All of them had tuberculous infundibular strictures. No significant difference in the success rate was observed according to the duration of indwelling catheter. There was no significant complication except pyelonephritis in four patients, which was controlled with conservative treatment. CONCLUSIONS: Percutaneous endourologic management is an effective and safe procedure to treat renal infundibular stricture. Risk factors for failure are multiple infundibular strictures and concomitant ureteral stricture. If the procedure does fail, other treatments have not been compromised. Cold-knife incision seems to be more effective than dilation.