INTRODUCTION - To evaluate the outcomes of ureteral strictures treatment after endoureterotomy using the holmium laser or open/laparoscopic surgery.
MATERIALS AND 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.
The Canadian journal of urology. 2015 Dec [Epub]
Victor Srougi, Guilherme P Padovani, Giovanni S Marchini, Fabio C Vicentini, Eduard Mazzucchi, Miguel Srougi
Endourology and Lithiasis Section, Division of Urology, Hospital das Clinicas, University of São Paulo, School of Medicine, Sao Paulo, Brazil.