Bougienage as a stage of treatment
Most often, bougienage is not an independent treatment, but a way to pass an instrument or stent through a stricture: for example, with a tight narrowing of the orifice after a TUR or radiation therapy, in order to then perform ureteroscopy or install a stent for long-term drainage. Bougies are carried out strictly along the conductor, which eliminates perforation. A lasting effect is achieved in 40–60% of cases, therefore, after bougienage, ultrasound monitoring is required after 1 and 3 months, and in case of relapse, ureteroplasty is discussed.
Causes and signs of ureteral stricture
Narrowing of the ureter develops after trauma during stone removal, radiation therapy, surgery on the pelvic organs, tuberculosis, long-term stone retention; congenital strictures occur in the ureteropelvic segment. Manifested by hydronephrosis, dull pain in the lower back, infections, decreased kidney function. The diagnosis is made by MSCT urography and retrograde ureteropyelography, renal function is assessed by scintigraphy.
Endoscopic treatment or plastic surgery
Bougienage and balloon dilatation are minimally invasive methods for short (up to 1–1.5 cm) loose strictures without severe ischemia: effectiveness is 50–70%, recovery is fast, but relapses are frequent. For extended, dense, radial and recurrent strictures, reconstructive surgery is indicated - ureteroureteroanastomosis, ureterocystoneoanastomosis or pyeloplasty with an effectiveness of 85–95%. The endoscopic method can be tried first if kidney function is intact.
