title: Endoscopic management of adult orthotopic ureterocele and associated calculi with holmium laser: experience with 16 patients over 4 years and review of literature.
abstract: OBJECTIVE
  To retrospectively evaluate the safety and effectiveness of holmium laser endoscopic incision and laser lithotripsy in adults with orthotopic ureterocele and associated calculi.
  
  
  METHODS
  From May 2003 to August 2007 at our center, 16 adults underwent transurethral incision of an ureterocele and intracorporeal holmium laser lithotripsy for associated calculi. The perioperative data of these patients were retrospectively analyzed. The literature was reviewed to identify all the reported options for management of this relatively rare condition.
  
  
  RESULTS
  Ureterocele was associated with a single system in 13 patients. Two patients had bilateral ureteroceles. Four patients had associated upper tract stones. The procedure was uneventful in all patients. The average postoperative hospital stay was 19.3 hours. All patients were stone free after the procedure. Eleven patients were available for follow-up at 3 and 6 months. None of these patients had any evidence of residual ureterocele and/or hydronephrosis when evaluated with intravenous urography at 3 months. Micturating cystourethrography (MCU) at 3 months revealed low-grade vesicoureteral reflux (VUR) in four patients; no reflux was found with MCU at 6 months.
  
  
  CONCLUSIONS
  Laser endoscopic management of adult orthotopic ureterocele and associated calculi effectively decompressed ureterocele and removed stones in all patients without any significant postoperative morbidity. Low-grade VUR that may occur postoperatively resolved at 6 months. A literature review suggests that the ability of the holmium laser to manage both ureterocele and calculi simultaneously should make holmium laser management a procedure of choice at centers that possess the equipment.
authors.affiliation: Department of Urology, R.G. Stone Urological Research Institute, Mumbai, India. drhemendrashah@yahoo.co.in
authors.forename: Hemendra N
authors.initials: HN
authors.lastname: Shah
authors.forename: Hiren
authors.initials: H
authors.lastname: Sodha
authors.forename: Amit A
authors.initials: AA
authors.lastname: Khandkar
authors.forename: Shabbir
authors.initials: S
authors.lastname: Kharodawala
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Hegde
authors.forename: Manish
authors.initials: M
authors.lastname: Bansal
mesh_terms: D003558:Cystoscopy; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D017602:Lithotripsy, Laser; D008297:Male; D012189:Retrospective Studies; D014518:Ureterocele / Q000601:surgery*; D014545:Urinary Calculi / Q000628:therapy*