Long-term Efficacy Of Holmium Laser Endoureterotomy For Benign Ureteral Strictures

Main Category: Urology / Nephrology
Article Date: 18 Jul 2006 - 2:00 PDT

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UroToday.com - This Cleveland Clinic study determined the long-term clinical and radiographic success of holmium laser endoureterotomy for nonobliterative benign ureteral strictures.

The 19 iatrogenic ureteral strictures included 7 proximal ureter, 7 mid ureter, and 5 distal ureter. The procedure was performed with a semirigid ureteroscope and a 360-micron holmium laser probe at 1 J and 10 Hz.

Using a strict definition of success as both relief of symptoms and radiographic resolution of obstruction by intravenous pyelography or diuretic renography, the investigators found that at a median follow-up of 3 years, a success rate of 68.4% was achieved in 13 of 19 patients.

The factors that seem to correlate with failure in this group were similar to those reported previously by other investigators. These factors included reduced ipsilateral renal function, previous endoscopic treatment for the stricture disease, multiple endoscopic procedures for stones on the ipsilateral side, and relatively long (2-3cm) strictures.

In the majority of the patients failure uniformly was evident within three months of the endoureterotomy.

Therefore, while holmium laser endoureterotomy appears to be an effective and safe form of initial treatment of ureteral strictures, it should be reserved for those less than 2 cm in length and with satisfactory ipsilateral renal function.

By Elspeth McDougal, MD

References:
Urol 67:894-897, 2006
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