Endopyeloureterotomy using the holmium:YAG laser for the management of adult ureteral and ureteropelvic junction obstructions.
OBJECTIVE
To determine the efficacy of endopyeloureterotomy using a holmium:YAG laser for the management of adult benign ureteral and ureteropelvic junction obstructions.


METHODS
We reviewed the clinical outcomes of eight primary procedures performed in 5 patients. The causes of the strictures were idiopathic in five and stone impaction in three procedures. All strictures except one were approached in a retrograde fashion with either a rigid (8.0 Fr) or flexible (9.3 Fr) ureteroscope. The only energy source employed was the laser, and no balloon dilation was performed. In all cases, a 4.8-Fr ureteral stent was left indwelling, and retrograde ureteropyelography was performed within 6-8 weeks to remove the catheter.


RESULTS
Follow-up was performed in all patients for a mean period of 14.9 (minimum 10) months. Two strictures in 1 patient failed to be stent free, while six strictures were patent on postoperative radiographic imaging. There were no perioperative complications.


CONCLUSIONS
Endopyeloureterotomy using a holmium:YAG laser is safe and effective. Its relative noninvasiveness and its retrograde approach make it a first-line alternative for the management of benign upper urinary tract strictures in adults.
Kobayashi
Takashi
T
Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan. selecao@remus.dti.ne.jp
Nishizawa
Koji
K
Watanabe
Jun
J
Ogura
Keiji
K
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D015607:Stents; D013997:Time Factors; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods