Faculty Collaboration Database

Long-term results of antegrade endoureterotomy using the holmium laser in patients with ureterointestinal strictures. Urology 2001 Dec;58(6):924-9

Date

12/18/2001

Pubmed ID

11744460

DOI

10.1016/s0090-4295(01)01396-6

Scopus ID

2-s2.0-0035668611 (requires institutional sign-in at Scopus site)   42 Citations

Abstract

OBJECTIVES: To investigate the effectiveness and morbidity of percutaneous laser endoureterotomy in the management of ureterointestinal anastomotic strictures after radical cystectomy and urinary diversion.

METHODS: Between May 1997 and August 2000, 19 percutaneous endoureterotomy incisions, including 3 repeated incisions, were performed on 15 patients with a mean age of 61 years (range 41 to 80) to treat ureterointestinal strictures. A total of 16 renal units were treated (9 left, 7 right), including one bilateral procedure. All procedures were performed using a 200-micrometer holmium laser fiber in antegrade fashion with a 7.5F flexible ureteroscope. A nephroureteral stent was left in place for 4 to 6 weeks postoperatively. Success was defined as radiologic improvement and/or the ability to return to full activity in the absence of flank pain, infection, or the need for ureteral stents or nephrostomy tubes.

RESULTS: With a median follow-up of 20.5 months (range 9 to 41), the overall success rate was 57% (8 of 14 renal units). Two patients were lost to follow-up. The mean operative time was 91 minutes, and no perioperative complications occurred. Three patients required repeated endoureterotomies, with two requiring open reimplantation. Overall, the endoureterotomy failed in 6 patients in the series, with five of the six failures involving left-sided strictures.

CONCLUSIONS: Percutaneous endoureterotomy is an effective, minimally invasive treatment option for patients with ureterointestinal strictures after urinary diversion. Better visualization and a more precise incision may make the holmium laser a safer cutting modality than alternative methods in patients with ureteroenteric strictures. Patients with left-sided ureterointestinal strictures should be cautioned that endourologic management might have a lower success rate.

Author List

Laven BA, O'Connor RC, Steinberg GD, Gerber GS

Author

Robert Corey O'Connor MD Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Anastomosis, Surgical
Constriction, Pathologic
Cystectomy
Female
Follow-Up Studies
Humans
Intestinal Diseases
Intestines
Laser Therapy
Male
Middle Aged
Ureter
Ureteral Diseases
Urinary Diversion