Zhelezko O. Endoscopic treatment of acquired strictures of ureters

The dissertation work presents a new theoretical generalization and new solving of scientific problem: improving of differentiated and individual approach to the rational choice of treatment strategy in patients with acquired strictures of the upper urinary tract using endoscopic recanalisation of strictures.This paper presents the results of examination and treatment of 126 patients with acquired strictures of the ureters and pelvic-ureteral segment. For endoscopic restoration of adequate upper urinary tract passability in the presence of acquired strictures we applied two methods - endoscopic bouginage of strictures and balloon dilatation. It is shown that the effectiveness of endoscopic bouginage of acquired strictures of upper urinary tract (UUT) is much lower, than balloon dilatation. Of 30 patients who carried bouginage of stricture in 14 (46,7 ± 9,1 %) was detected recurrence of stricture during one year, while of 96 patients after balloon dilatation only in 6 (6,3 ± 2,5 %), p <0,01. To all of these patients (20) repeated recanalisation - balloon dilatation of stricture was made, including 14 patients with installation of stent with floating oil.The indications for endoscopic recanalisation were worked out, the main risk factors of acquired strictures of UUT were determined, and mechanisms of balloon dilatation and telescopic bouginage were theoretically and scientifically grounded. The high efficiency of endoscopic treatment of strictures of UUT was proved, that allows using it wide as an alternative surgical treatment. Clinical effect of treatment reaches 91 % in case of strictures with length ranging 0,5 - 1,5 cm and is achieved on conditions that the function of kidney is preserved.