Is Addition of Ureteric Cutting Balloon Prior to Dilatation of Benign Ureteric Strictures with Paclitaxel-Coated Balloon Feasible? A Single-Centre Experience

Background/Objectives: Benign ureteric strictures most commonly arise iatrogenically after procedures such as ureteroscopy or uretero-ileal anastomosis. Whilst surgical reconstruction is gold-standard, endoluminal treatment is recommended for short strictures and is an excellent option for unsuitable, comorbid, previously operated or irradiated patients. Failure rates are higher than surgical management, however. Paclitaxel-coated balloons (PCBs) for endoluminal management have been shown to inhibit smooth muscle-cell proliferation and improve re-stenosis rates. In vascular stenosis, cutting-balloon pre-dilatation before PCB dilatation is used to give more-controlled dilatation and deeper drug penetration, with fewer complications and recurrences. Methods: We retrospectively reviewed eight consecutive patients who underwent treatment of benign ureteric stricture with cutting balloon prior to PCB at a tertiary Sydney hospital, assessing safety, feasibility and short-term outcomes. Via antegrade nephrostomy or retrograde cystoscopic wire access, strictures were pre-dilated with a cutting balloon, then dilated with a Paclitaxel-coated balloon. The primary outcome was ureteric patency on imaging at 3 months, 1 year and latest follow-up; secondary outcomes were renal function (creatinine, estimated glomerular filtration rate [eGFR]) and Clavien-Dindo complications. Results: Eight patients (four women, four men; median age 63 years, range 49–78) underwent 13 cutting-balloon-plus-PCB procedures between April and July 2025. Aetiologies included uretero-ileal anastomotic stricture (50%), previous impacted calculus (25%), open pyelotomy (12.5%) and pelvic radiotherapy (12.5%); mean stricture length was 15 mm (ranging from 10 to 30 mm). Five patients (62.5%) had no recurrence after a single procedure, two were stricture-free after re-dilatation and one had persistent obstruction after three dilatations. Overall, 87.5% of patients were stricture-free at latest follow-up (median 20 months, ranging from 1.6 to 24). eGFR improved in all six patients with paired available biochemical data. Complications comprised one febrile urinary tract infection (UTI) (Clavien–Dindo II) and one ureteric perforation (Clavien–Dindo IIIa). Conclusions: This small case series suggests cutting-balloon pre-dilatation before paclitaxel-coated balloon dilatation of benign ureteric strictures is technically feasible; however, safety and long-term outcomes are still to be compared with PCB alone.