title: Outcomes of surgical treatment of ureteral strictures after laser ureterolithotripsy for impacted stones.
abstract: BACKGROUND
  To evaluate the outcomes of ureteral strictures treatment after endoureterotomy using the holmium laser or open/laparoscopic surgery.
  
  
  METHODS
  From a database of 1101 patients that underwent semi-rigid holmium laser ureterolithotripsy from 2003 to 2013, we performed a search for patients treated for ureteral stricture. Parameters analyzed included patient demographic, stone burden, and ureteral stricture characteristics. Treatment included holmium laser endoureterotomy for stenosis ≤ 1 cm and open/laparoscopic repair for stenosis > 1 cm or for failed endoscopic treatment. Outcomes and complications were assessed. Success was defined as symptom improvement and radiographic obstruction resolution.
  
  
  RESULTS
  Of all the patients, 32 (2.8%) evolved with ureteral stenosis and all had impacted calculi at the time of surgery. Twenty-two patients with complete follow up were studied. After a mean follow up of 18.5 months (range 3-70), the success rates for endoureterotomy and open/laparoscopic stricture repair group were 50% and 82%, respectively. The hospitalization period was significantly shorter for patients who had undergone endoureterotomy (2.7 +/- 1.4 days versus 4.8 +/- 1.4 days; p = 0.003). Only minor complications occurred in both groups.
  
  
  CONCLUSIONS
  The rate of ureteral stricture after holmium laser ureterolithotripsy for impacted calculi is higher than reported for non-impacted stones. Holmium laser endoureterotomy for stenosis shorter than 1 cm treated half of the cases. Open/laparoscopic repair had good outcomes in cases of longer stenosis.
authors.affiliation: Endourology and Lithiasis Section, Division of Urology, Hospital das Clinicas, University of São Paulo, School of Medicine, Sao Paulo, Brazil.
authors.forename: Victor
authors.initials: V
authors.lastname: Srougi
authors.forename: Guilherme P
authors.initials: GP
authors.lastname: Padovani
authors.forename: Giovanni S
authors.initials: GS
authors.lastname: Marchini
authors.forename: Fabio C
authors.initials: FC
authors.lastname: Vicentini
authors.forename: Eduard
authors.initials: E
authors.lastname: Mazzucchi
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053844:Lasers, Solid-State / Q000009:adverse effects* / Q000627:therapeutic use; D017602:Lithotripsy, Laser / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D011859:Radiography; D014514:Ureteral Calculi / Q000473:pathology / Q000628:therapy*; D018666:Ureteroscopy / Q000009:adverse effects*; D014525:Urethral Stricture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*