title: Holmium: YAG laser endoureterotomy for ureterointestinal strictures.
abstract: OBJECTIVE
  The management of ureterointestinal stricture in patients who have undergone urinary diversion can be challenging. Endourological techniques have been increasingly used in recent years for ureteral stricture. While long-term results may not be as reliable or durable as those of traditional open reconstructive surgical techniques, associated morbidity is much less. The holmium (Ho):YAG laser, which has cutting and coagulating properties, has been demonstrated to have many applications in urology. We report our experience with and long-term results of Ho:YAG laser endoureterotomy for ureterointestinal strictures.
  
  
  METHODS
  We reviewed the charts and followup history of 23 patients in whom the Ho:YAG laser was used to treat ureterointestinal anastomotic stricture. Strictures were treated percutaneously via the antegrade approach with flexible endoscopes and the holmium laser. A reversed 12/6Fr endopyelotomy stent was left indwelling for 6 weeks postoperatively. Success was defined as symptomatic improvement and radiographic resolution of obstruction.
  
  
  RESULTS
  Between 1993 and 2000, 23 patients with a mean age of 61 years underwent endo-ureterotomy using the Ho:YAG laser for 24 ureterointestinal stricture. An overall success rate of 71% (17 of 24 cases) was achieved at a mean followup of 22 months. The success rate of holmium laser endoureterotomy for ureterointestinal stricture at 1, 2 and 3 years was 85%, 72% and 56%, respectively. Seven patients had recurrent strictures of which 4 developed 16 months or more postoperatively. No complications were noted.
  
  
  CONCLUSIONS
  Ho:YAG laser endoureterotomy for ureterointestinal stricture disease is a minimally invasive endourological procedure that may provide more durable results than other modalities used for endoureterotomy. The Ho:YAG laser with its ability to cut tissue precisely and provide hemostasis combined with its versatility and compatibility with flexible endoscopes is an ideal instrument for safely performing endoureterotomy.
authors.affiliation: Division of Urology, University of Western Ontario, London, Ontario, Canada.
authors.forename: James D
authors.initials: JD
authors.lastname: Watterson
authors.forename: Mario
authors.initials: M
authors.lastname: Sofer
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Wollin
authors.forename: Linda
authors.initials: L
authors.lastname: Nott
authors.forename: John D
authors.initials: JD
authors.lastname: Denstedt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D018666:Ureteroscopy; D014547:Urinary Diversion / Q000009:adverse effects*