title: Result of endoscopic ureteroureterostomy with holmium:YAG laser for complete ureteral obstruction.
abstract: 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.
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jeong Hee
authors.initials: JH
authors.lastname: Hong
authors.forename: Seong Soo
authors.initials: SS
authors.lastname: Jeon
authors.forename: Kyu-Sung
authors.initials: KS
authors.lastname: Lee
mesh_terms: 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
chemical_list: C503779:yttrium-aluminum-garnet; D015019:Yttrium; D000535:Aluminum; D006695:Holmium