輸尿管狹窄氣球擴張手術後類固醇輔助治療:單一醫學中心經驗

許靖承 林承家

基隆長庚醫院 外科部 泌尿科

Adjuvant steroid therapy after ureter balloon dilatation for ureter stricture: single center experience

Ching-Cheng Hsu, Cheng-Chia Lin

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

Purpose:

Ureter stricture was a challenging complication after treatment for urolithiasis. The management of ureter stricture includes endourologic method, re-implantation, and reconstruction surgery. The endourologic method had a high recurrence rate but a low complication rate and was less invasive. However, the success rate remained low and often required long-term double J placement. Steroid plays some role in the management of urethra stricture, we would like to investigate if adjuvant steroid therapy can improve the success rate of endourologic treatment for ureter stricture.

Material and methods:

A retrospective analysis of patients who received ureter balloon dilatation with adjuvant steroid therapy at Keelung Chang-gung Memorial hospital was included. The protocol of adjuvant steroid therapy was IV Hydrocortisone 100mg Once after the procedure, followed by oral prednisolone 5mg BID for 7 days then oral prednisolone 5mg QD for 7 days. Patient demographic including, age, sex, previous management of urolithiasis history, characteristic of stricture: gross pattern under ureteroscope, intra-operative retrograde pyelography, segment was recorded. First-time ureteroscope evaluation for stricture will be arranged under general anesthesia 1 month later. The primary outcome was the rate of success: defined as double J removal. The secondary outcome was the gross pattern of the stricture. Major adverse events related to endourological procedures and systemic steroid therapy were recorded.

Results:

A total of 16 cases were included for analysis. The success rate was 11/16 (68%). 8/16 (50%) patients had a previous endourological dilatation history. 1 patient received the allium stent and was regarded as not successful. No major adverse events were reported after steroid therapy.

Conclusion:

Adjuvant steroid therapy achieves a success rate of 68% after endourologic balloon dilatation. The major adverse event was not reported. Further large-scale study was required for the clinical safety and efficacy.