Gdor Yehoshua, Gabr Ahmed H, Faerber Gary J, Roberts William W, Wolf J Stuart
University of Michigan Health System, Ann Arbor, Michigan 48109-0330, USA.
J Endourol. 2008 Nov;22(11):2507-11. doi: 10.1089/end.2008.0387.
Since the holmium:yttrium-aluminum-garnet (Ho:YAG) laser is the flexible lithotrite of choice for ureteral stones, its application to ureteral strictures associated with ureteral calculi is convenient. The results of Ho:YAG laser endoureterotomy in this specific setting have not been defined. We report our experience with Ho:YAG laser endoureterotomy of ureteral strictures associated with ureteral stone treatment, with or without a history of stone impaction.
We reviewed the medical records of 13 patients with ureteral stricture related to stone treatment, with (n = 9) or without (n = 4) a history of impacted ureteral stones, who were managed with Ho:YAG laser endoureterotomy. Follow-up was obtained with radiographic imaging and renal scans.
The overall success rate was 62%, with a mean follow-up of 21 months in successful cases and a mean recurrence time of 1.6 months in failures. Outcome was not associated with length or location of the stricture. Among the nine strictures associated with impacted stones, treatment was successful in only 5 (56%). Of the four strictures that occurred after stone removal but without history of impaction, the success rate was 75%. Success was also greater for strictures managed with post-procedure stents >or=8 Fr (75%), compared to stents <or=7 Fr. (56%).
Our results suggest that laser endoureterotomy of ureteral strictures due to ureteral stone treatment without a history of impaction is associated with a reasonable success rate (75%), but that laser endoureterotomy for strictures related to impacted stones is associated with a success rate of only 56%. Larger caliber stents might be preferred in this setting.
由于钬：钇铝石榴石（Ho:YAG）激光是治疗输尿管结石的首选软性碎石设备，将其应用于输尿管结石相关的输尿管狭窄很方便。Ho:YAG激光输尿管内切开术在这种特定情况下的结果尚未明确。我们报告了我们在输尿管结石治疗相关的输尿管狭窄行Ho:YAG激光输尿管内切开术的经验，无论有无结石嵌顿史。
我们回顾了13例因结石治疗导致输尿管狭窄患者的病历，其中9例有输尿管结石嵌顿史，4例无输尿管结石嵌顿史，均接受了Ho:YAG激光输尿管内切开术治疗。通过影像学检查和肾脏扫描进行随访。
总体成功率为62%，成功病例的平均随访时间为21个月，失败病例的平均复发时间为1.6个月。结果与狭窄的长度或位置无关。在9例与嵌顿结石相关的狭窄中，仅5例（56%）治疗成功。在4例结石清除后出现但无嵌顿史的狭窄中，成功率为75%。与≤7 Fr的支架相比，术后放置≥8 Fr支架治疗狭窄的成功率也更高（75%对56%）。
我们的结果表明，对于无嵌顿史的输尿管结石治疗所致输尿管狭窄行激光输尿管内切开术，成功率较高（75%），但对于与嵌顿结石相关的狭窄行激光输尿管内切开术，成功率仅为56%。在这种情况下，可能更倾向于使用较大口径的支架。
