746 - Endoluminal Radiofrequency Ablation (ELRA) for Refractory Ureteral Strictures

Learning Objectives: To review the role of endoluminal radiofrequency ablation (ELRA) in the management of refractory ureteral strictures and illustrate its potential application through a case series.

Background: The ELRA bipolar electrode catheter, originally designed for biliary obstructions and malignant biliary strictures, was applies to treat ureteral strictures in five patients between January 2023 and December 2024. All patients included had recurrent strictures despite standard interventions and were poor candidates for surgical reconstruction. Ablation was performed under fluoroscopic guidance with subsequent ureteral stent placement.

Clinical Findings/Procedure Details: Case 1: Distal ureteral stricture post-cystectomy/neobladder. Initially patent after ablation, though developed recurrent obstruction after downsizing catheter a week later.
Case 2: Bilateral strictures post-cystectomy and chemoradiation. Initially patent bilaterally, complicated by tube migration and fungal UTI seven months later.
Case 3: Left ureteral stricture post-radiation. Patent ureter, stent removed at four months with no complications at two years follow-up.
Case 4: Left distal ureteral stricture post-TURBT. Patent ureter, no further complications at one month follow-up
Case 5: Right distal ureteral stricutre post-radiation. Initially patent ureter complicated by urosepsis requiring hospitalization one month later.

Conclusion and/or Teaching Points: ELRA may be a feasible salvage therapy for ureteral strictures refractory to conventional approaches. Early results suggest short-term safety and patency, though delayed infectious complications are possible. Larger studies and long-term follow-up are needed to clarify durability, complication rates, and patient selection criteria.