Kobayashi Takashi, Nishizawa Koji, Watanabe Jun, Ogura Keiji
Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan.
Urol Int. 2003;71(2):204-6. doi: 10.1159/000071848.
To determine the efficacy of endopyeloureterotomy using a holmium:YAG laser for the management of adult benign ureteral and ureteropelvic junction obstructions.
We reviewed the clinical outcomes of eight primary procedures performed in 5 patients. The causes of the strictures were idiopathic in five and stone impaction in three procedures. All strictures except one were approached in a retrograde fashion with either a rigid (8.0 Fr) or flexible (9.3 Fr) ureteroscope. The only energy source employed was the laser, and no balloon dilation was performed. In all cases, a 4.8-Fr ureteral stent was left indwelling, and retrograde ureteropyelography was performed within 6-8 weeks to remove the catheter.
Follow-up was performed in all patients for a mean period of 14.9 (minimum 10) months. Two strictures in 1 patient failed to be stent free, while six strictures were patent on postoperative radiographic imaging. There were no perioperative complications.
Endopyeloureterotomy using a holmium:YAG laser is safe and effective. Its relative noninvasiveness and its retrograde approach make it a first-line alternative for the management of benign upper urinary tract strictures in adults.
确定钬激光输尿管肾盂内切开术治疗成人良性输尿管及输尿管肾盂连接部梗阻的疗效。
我们回顾了5例患者接受的8例初次手术的临床结果。狭窄原因5例为特发性，3例为结石嵌顿。除1例狭窄外，其余所有狭窄均通过硬性（8.0 Fr）或软性（9.3 Fr）输尿管镜逆行处理。唯一使用的能量源是激光，未进行球囊扩张。所有病例均留置一根4.8 Fr输尿管支架，术后6 - 8周行逆行输尿管肾盂造影以拔除导管。
所有患者均接受了平均14.9个月（最短10个月）的随访。1例患者的2处狭窄未能拔除支架，而6处狭窄术后影像学检查显示通畅。无围手术期并发症。
钬激光输尿管肾盂内切开术安全有效。其相对无创性及逆行入路使其成为治疗成人良性上尿路狭窄的一线替代方法。
