title: Congenital megaureter in adults: endoscopic management with holmium: YAG laser--preliminary experience.
abstract: OBJECTIVE
  We report our experience with the holmium laser in the endoscopic management of primary obstructive megaureter (POM) in adults.
  
  
  METHODS
  From February 1997 to September 1998, three women and one man 26 to 63 years old underwent ureteroscopic endoureterotomy for POM with symptomatic vesicoureteral junction obstruction. The left ureter was more commonly affected than the right (R:L 1:3). The diagnosis of POM was based on a clinical history, intravenous urography, diuretic renography (T 1/2), and micturating cystogram. Endoureterotomy of the juxtavesical and intramural part of the ureter was performed in a retrograde fashion using the holmium laser. Incision of the subepithelial part of the ureter and the ureteral orifice was avoided. A pigtail stent was left in situ for 6 weeks. Postoperatively, patients were assessed at 3 months and yearly thereafter. The mean follow-up was 30.5 months.
  
  
  RESULTS
  All patients demonstrated symptomatic and radiologic improvement.
  
  
  CONCLUSIONS
  Endoscopic incision of POM in adults with the holmium laser is safe, simple, and minimally invasive. This procedure should be considered as an initial approach for patients who have failed conservative treatment. However, further follow-up is necessary to determine its long-term efficacy.
authors.affiliation: Department of Urology, Countess of Chester Hospital, UK. shekharbiyani@hotmail.com
authors.forename: C S
authors.initials: CS
authors.lastname: Biyani
authors.forename: C S
authors.initials: CS
authors.lastname: Powell
mesh_terms: D000328:Adult; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016896:Treatment Outcome; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery*