HOLMIUM-YAG LASER ENDOURETEROTOMY FOR TREATMENT OF URETERAL STRICTURE

Objectives. Endourologic techniques ranging from balloon dilation to e ndoincision with electrocautery, cold knife, and lasers have been incr easingly used in recent years for the treatment of ureteral strictures . While the long-term results may not be as reliable or as durable as traditional reconstructive surgical techniques, they can be accomplish ed with much less morbidity. Recently, the holmium:yttrium-aluminum-ga rnet [YAG] laser, which possesses both cutting and coagulating propert ies, has been demonstrated to have many applications in urology. We re port our experience with this laser in the endoscopic treatment of ure teral strictures. Methods. We reviewed the charts and follow-up histor y of 22 patients in whom the holmium:YAG laser was used to treat urete ral strictures from a variety of causes and including those in uretero enteric anastomoses. Strictures were either approached in a retrograde fashion with a 6.9F ureteroscope or antegrade with flexible instrumen ts in the cases involving ureteroenteric strictures. The only energy s ource employed was the laser, followed by balloon dilation. Indwelling stents were left in place for at least 4 weeks postoperatively and fo llow-up was obtained with radiographic imaging. Results. A minimum 9-m onth follow-up was available for 18 patients. There were 5 patients wh o had developed recurrent strictures and were therefore considered tre atment failures. Each of these patients failed in less than 3 months a nd all had either lengthy or complex strictures noted at the time of s urgery. One patient was lost to follow-up and three recent patients ha ve follow-up of 3 to 6 months showing no evidence of recurrent strictu re formation. Overall, 16 of 21 (76%) patients are clinically well wit h no evidence of stricture recurrence. Conclusions. Endoureterotomy fo r ureteral stricture disease is a minimally invasive, less morbid, but ultimately less successful, alternative to open surgical reconstructi on. Stricture length and etiology remain the most important determinan ts of success. The holmium:VAC laser, with its ability to precisely cu t tissue and provide hemostasis and its multiuse potential and compati bility with small rigid and flexible endoscopic instruments, is an ide al tool for performing endoureterotomy. (C) 1997, Elsevier Science inc . All rights reserved.