title: Holmium:yttrium-aluminum-garnet laser endoureterotomy for the treatment of transplant kidney ureteral strictures.
abstract: BACKGROUND
  The management of ureteral strictures in transplanted kidney is challenging. Open surgical treatment is effective but entails significant convalescence. Holmium:yttrium-aluminum-garnet (Ho:YAG) laser endoureterotomy is useful for other types of ureteral obstruction, and we aimed to assess its long-term success for strictures of transplant kidney ureters.
  
  
  METHODS
  We reviewed the course of 12 kidney transplant patients managed with Ho:YAG laser endoureterotomy and/or percutaneous ureteroscopic balloon dilatation for ureterovesical anastomotic strictures or ureteropelvic junction obstruction. Success was defined as stable serum creatinine and no hydronephrosis on follow-up.
  
  
  RESULTS
  Of the patients, nine had ureterovesical anastomotic strictures. Of the six treated with balloon dilatation and Ho:YAG laser endoureterotomy, the success rate was 67% (58 months mean follow-up). Both strictures with failure were longer than 10 mm. Of the three patients treated with balloon dilatation only, there was success in only one (14 months follow-up) and both strictures with failure were shorter than 10 mm. There were three patients treated for ureteropelvic junction obstruction, one with balloon dilatation and two with balloon dilatation plus Ho:YAG laser endoureterotomy, all successfully (57 months mean follow-up). Overall, of the eight strictures 10 mm or shorter, there was success rate in six (75%), with 52 months mean follow-up, including five of five (100%) treated with laser endoureterotomy and one of three (33%) treated with only balloon dilation.
  
  
  CONCLUSIONS
  Our results suggest that Ho:YAG laser endoureterotomy should be a first line treatment for ureteral strictures of length 10 mm or shorter in kidney transplant patients.
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, MI 48109-0330, USA.
authors.forename: Yehoshua
authors.initials: Y
authors.lastname: Gdor
authors.forename: Ahmed H
authors.initials: AH
authors.lastname: Gabr
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Faerber
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002404:Catheterization / Q000379:methods; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*; D014519:Ureterostomy / Q000379:methods*; D015019:Yttrium
chemical_list: D015019:Yttrium