Long-term results of endourologic and percutaneous management of ureteral strictures in bilharzial patients.

We have managed 164 bilharzial ureteral strictures endourologically. The site was at the pelviureteral junction in 4, at the pelvic inlet in 22, juxtavesical in 78, and intramural in 60. These lesions were categorized according to the line of management. Type I or simple stricture, present in 116 cases, was managed by retrograde bougie dilation to 16F. Dilation was preceded by transurethral ureterotomy in 54 cases. Type II or difficult strictures (24 cases) were managed by percutaneous antegrade dilation. Type III or complicated strictures (24 cases) were managed by antegrade placement of a guidewire down to the bladder followed by transureteral meatotomy and bougie dilation in one sitting under C-arm fluoroscopy. Three types of stenting procedures and diversion were used according to the length of the stricture and the quality of renal function. After 6 to 72 months, an overall successful clinical outcome with decompression of the upper urinary system and improved drainage pattern was achieved in 87.8% (144 cases) v only 50% in patients with strictures longer than 2 cm. Postoperative reflux was seen in 21 cases (18%) of Type I strictures compared with 4 (17%) of Type II and 13 (54%) of Type III strictures. We concluded that this scheme of combined endourologic management for ureteral strictures is safe, simple, and less traumatic and produces excellent results. It should be the approach of choice, although it needs special equipment and operator experience. Open surgery should be restricted to the lesions that prove undilatable on both retrograde and antegrade procedures.