Endoscopic Management of Adult Orthotopic Ureterocele and Associated Calculi with Holmium Laser: Experience with 16 Patients over 4 Years and Review of Literature

摘要

Purpose: To retrospectively evaluate the safety and effectiveness of holmium laser endoscopic incision andnlaser lithotripsy in adults with orthotopic ureterocele and associated calculi.nPatients and Methods: From May 2003 to August 2007 at our center, 16 adults underwent transurethral incisionnof an ureterocele and intracorporeal holmium laser lithotripsy for associated calculi. The perioperativendata of these patients were retrospectively analyzed. The literature was reviewed to identify all the reportednoptions for management of this relatively rare condition.nResults: Ureterocele was associated with a single system in 13 patients. Two patients had bilateral ureteroceles.nFour patients had associated upper tract stones. The procedure was uneventful in all patients. The averagenpostoperative hospital stay was 19.3 hours. All patients were stone free after the procedure. Eleven patientsnwere available for follow-up at 3 and 6 months. None of these patients had any evidence of residualnureterocele and/or hydronephrosis when evaluated with intravenous urography at 3 months. Micturating cystourethrographyn(MCU) at 3 months revealed low-grade vesicoureteral reflux (VUR) in four patients; no refluxnwas found with MCU at 6 months.nConclusions: Laser endoscopic management of adult orthotopic ureterocele and associated calculi effectivelyndecompressed ureterocele and removed stones in all patients without any significant postoperative morbidity.nLow-grade VUR that may occur postoperatively resolved at 6 months. A literature review suggestsnthat the ability of the holmium laser to manage both ureterocele and calculi simultaneously should makenholmium laser management a procedure of choice at centers that possess the equipment.