Success of Laser Endoureterotomy of Ureteral Strictures Associated with Ureteral Stones Is Related to Stone Impaction

摘要

Purpose: Since the holmium:yttrium-aluminum-garnet (Ho:YAG) laser is the flexible lithotrite of choice fornureteral stones, its application to ureteral strictures associated with ureteral calculi is convenient. The resultsnof Ho:YAG laser endoureterotomy in this specific setting have not been defined. We report our experience withnHo:YAG laser endoureterotomy of ureteral strictures associated with ureteral stone treatment, with or withoutna history of stone impaction.nMethods: We reviewed the medical records of 13 patients with ureteral stricture related to stone treatment, withn(n u0002 9) or without (n u0002 4) a history of impacted ureteral stones, who were managed with Ho:YAG laser endoureterotomy.nFollow-up was obtained with radiographic imaging and renal scans.nResults: The overall success rate was 62%, with a mean follow-up of 21 months in successful cases and a meannrecurrence time of 1.6 months in failures. Outcome was not associated with length or location of the stricture.nAmong the nine strictures associated with impacted stones, treatment was successful in only 5 (56%). Of thenfour strictures that occurred after stone removal but without history of impaction, the success rate was 75%.nSuccess was also greater for strictures managed with post-procedure stents u00038 Fr (75%), compared to stents u00047nFr. (56%).nConclusions: Our results suggest that laser endoureterotomy of ureteral strictures due to ureteral stone treatmentnwithout a history of impaction is associated with a reasonable success rate (75%), but that laser endoureterotomynfor strictures related to impacted stones is associated with a success rate of only 56%. Largerncaliber stents might be preferred in this setting.