Holmium:YAG laser for treatment of strictures of vesicourethral anastomosis after radical prostatectomy.
OBJECTIVE
Strictures of the vesicourethral anastomosis (VUA) following radical prostatectomy tend to recur. We used the holmium:YAG laser for treatment of recurrent stricture of the VUA. We evaluated the technique and its efficacy.


METHODS
In 10 patients, the Ho:YAG laser was used with a 365-mum fiber at a setting of 2 J and frequency 10 to 20 Hz, creating a deep incision of the scar tissue at the 6 o'clock position. This was followed by a vaporizing resection of the remaining scar tissue between 3 and 9 o'clock. We aimed to vaporize up to well-vascularized surrounding tissue. Retrospectively, the charts were reviewed for hospital stay, voiding complaints, recurrence of stenosis, complications, and flow rates. The mean follow-up was 18 months.


RESULTS
There were no operative complications. After removal of the catheter, all patients could void without difficulty. No re-treatment was needed for recurrent stenosis. Any existing irritative voiding complaints or incontinence did not change after treatment. In all patients, the flow pattern improved: the mean maximum flow rate increased, and the mean postvoiding residual volume decreased.


CONCLUSIONS
The Ho:YAG laser seems to be a safe and effective treatment for first or recurrent strictures of the VUA after radical prostatectomy.
Lagerveld
Brunolf W
BW
Department of Urology, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands. b.w.lagerveld@amc.uva.nl
Laguna
M Pilar
MP
Debruyne
Frans M J
FM
De La Rosette
Jean J M C H
JJ
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery; D014563:Urodynamics