Long-term follow-up of Acucise incision of ureteropelvic junction obstruction and ureteral strictures

Abstract

Objectives: There are few data on the long-term effectiveness of various endoureterotomy procedures. One such technique for the treatment of ureteral strictures and ureteropelvic junction (UPJ) obstruction utilizes a recently developed ureteral cutting balloon catheter, Acucise. This device may be used under fluoroscopic guidance alone, which significantly reduces operating time. The purpose of this study is to determine the long-term efficacy of the Acucise balloon in treatment of ureteral strictures and UPJ obstruction.

Methods: Fifteen patients have been treated with the Acucise balloon, with an average follow-up of 21.6 months. Five of the patients have been followed for more than 2 years, and 11 of the patients had greater than 1 year follow-up.

Results: The overall success rate, defined as resolution of obstruction radiographically or disappearance of symptoms, or both, was 73%, with only 4 overt failures. All but one of the procedures were completed in 45 minutes or less, and 13 of the 15 patients were treated as outpatients. There were two significant complications. Seventy-five percent (3 of 4) of the treatment failures occurred within the first 4 months following original procedure. Of the 4 total failures. 2 patients had ureteral strictures greater than 2 cm in length, which were likely ischemic in nature secondary to previous surgeries. One patient, with a primary UPJ obstruction, was found to have a crossing vessel at subsequent open pyeloplasty.

Conclusions: The Acucise cutting balloon offers the urologist a rapid and effective alternative for the management of ureteral strictures and UPJ obstruction. In our experience, early results (3 to 4 months) are usually indicative of long-term success. Proper patient selection may further improve long-term results of this simple, innovative technique.