Holmium laser endoureterotomy for benign ureteral stricture: a single center experience

• Published in: The Journal of urology Vol. 182; no. 6; p. 2775
• Main Authors: Gnessin, Ehud, Yossepowitch, Ofer, Holland, Ronen, Livne, Pinchas M, Lifshitz, David A
• Format: Journal Article
• Language: English
• Published: United States 01-12-2009
• Subjects: Constriction, Pathologic; Female; Follow-Up Studies; Humans; Lasers, Solid-State - therapeutic use; Male; Time Factors; Ureter - surgery; Ureteral Obstruction - surgery; Urologic Surgical Procedures, Male - methods
• ISSN: 1527-3792
• DOI: 10.1016/j.juro.2009.08.051

We assessed the long-term outcome of laser endoureterotomy for benign ureteral stricture.
From a database of 69 patients who underwent retrograde laser endoureterotomy from October 2001 to June 2007 we identified 35 with a benign ureteral stricture. Clinical characteristics, operative results and functional outcomes were investigated. Success was defined as symptomatic improvement and radiographic resolution of obstruction.
Median followup was 27 months (range 10 to 72). All except 1 patient were followed at least 16 months. All patients completed clinical followup and 33 completed imaging. Of 35 patients 29 (82%) were symptom-free during followup and 26 of 33 (78.7%) were free of radiographic evidence of obstruction. All except 1 failure occurred within less than 9 months postoperatively. The success rate was higher for nonischemic strictures (100% vs 64.7%, p = 0.027) and tended to be higher for strictures 1 cm or less (89.4% vs 64.2%, p = 0.109).
Holmium laser endoureterotomy is effective for benign ureteral stricture in well selected patients. Most failures occur within less than 9 months after surgery, which may indicate a need for closer followup during postoperative year 1. Factors that might may outcome are ischemia and stricture length.