Open Access

ARTICLE

Outcomes of surgical treatment of ureteral strictures after laser ureterolithotripsy for impacted stones

Victor Srougi, Guilherme P. Padovani, Giovanni S. Marchini, Fabio C. Vicentini, Eduardo Mazzucchi, Miguel Srougi

Endourology and Lithiasis Section, Division of Urology, Hospital das Clinicas, University of São Paulo, School of Medicine, Sao Paulo, Brazil
Address correspondence to Dr. Victor Srougi, Department of Urology, Hospital das Clínicas de São Paulo, Av Enéas de Carvalho Aguiar, 255, São Paulo, SP, Brazil 05403-000

Canadian Journal of Urology 2015, 22(6), 8079-8084.

Abstract

Introduction: To evaluate the outcomes of ureteral strictures treatment after endoureterotomy using the holmium laser or open/laparoscopic surgery.
Material 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.
Conclusion: 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.

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