Result of endoscopic ureteroureterostomy with holmium:YAG laser for complete ureteral obstruction.
OBJECTIVE
Complete ureteral obstruction after pelvic surgery is traditionally managed by open repair. Recent advances in endoscopic instruments and techniques have improved the efficacy with which these conditions are treated. Here, we describe our experiences with a holmium:YAG laser in the endoscopic management of complete ureteral obstruction.


METHODS
Retrograde endoscopic ureteroureterostomy using a Ho:YAG laser was performed on five patients with complete ureteral obstruction having a mean length of 0.9 +/- 0.2 cm after gynecologic surgery. The obliterated segment was incised with a 550-microm fiber through a rigid ureteroscope and under fluoroscopic guidance. Afterward, balloon dilatation was performed. A 7F/14F endopyelotomy stent was maintained for a mean time of 7 weeks, and follow-up was conducted via radiologic imaging.


RESULTS
Recanalization was possible in all five patients immediately. One month after the initial operation, one patient exhibited a normal ureteral passage, and three other patients exhibited partial ureteral stricture. The remaining patient was lost to follow-up. Of the three patients with partial strictures, two evidenced no stricture after additional endoscopic treatment(s), and the remaining patient eventually underwent open repair. Overall, three of four (75%) patients exhibited normal excretory function without any open surgery and were symptom free with a mean follow-up time of 45 months (range 23-67 months).


CONCLUSIONS
Although the number of patients in this study was small, it appears that endoscopic ureteroureterostomy with a Ho:YAG laser may constitute a valuable option for the treatment of complete short ureteral obstructions.
Hong
Jeong Hee
JH
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Jeon
Seong Soo
SS
Lee
Kyu-Sung
KS
D000328:Adult; D000535:Aluminum; D002404:Catheterization; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006695:Holmium; D006801:Humans; D053685:Laser Therapy; D008875:Middle Aged; D011877:Radionuclide Imaging; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000000981:diagnostic imaging; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D020709:Ureteroscopes; D014519:Ureterostomy / Q000295:instrumentation* / Q000379:methods; D015019:Yttrium
C503779:yttrium-aluminum-garnet; D015019:Yttrium; D000535:Aluminum; D006695:Holmium