Efficacy and safety of laser endoureterotomy for the treatment of ureteral strictures with length ≤ 10 mm

Introduction: Ureteral strictures are severe and difficult to treat disorders and significantly affect the quality of life of patients. Endoscopic laser ureterotomy is a minimally invasive procedure that is increasingly used for the management of ureteral strictures. Objective:The objective of our study is to evaluate the efficacy and safety of Holmium laser endoureterotomy in the treatment of ureteral strictures with length ≤ 10 mm. Material and methods:A retrospectively collected database of 21 patients who unederwent laser endoureterotomy for uretereral strictures with length ≤ 10 mm between January 2018 and January 2021 in the Clinic of Endourology and SWL, Military Medical Academy, Sofia, Bulgaria was reviewed. The endoureterotomy was performed under direct vision using a semirigid or flexible ureteroscope. Confirmation of obstruction and the results of the intervention were obtained by combinations of retrograde ureteropyelography, ultrasonography and CT. Success was defined as symptomatic relief and the absence of obstruction from the radiographic studies. Results: Patients’ mean age was 57.5±12 years and male-to-female ratio – 52.4%/47.6%. Mean length of the ureteral stricture was 7.2±2 mm. Eighteen of the patients (85.7%) were with secondary ureteral structures mainly with anamnesis for previous endoscopic surgery for impacted ureteral stones. There were no intraoperative complications. In 20 of the patients (95.2%) stent JJ 7 Fr was put postoperatively. The stent JJ was removed mean 84.2±51.6 days after the procedure. The success rate after the endoureterotomy was 85,7% (18/21), while 3 cases(14.3%) presented with a recurrent stricture. The mean follow-up period was 30.5±14.9 months. Conclusions: Ureteroscopicholmium:YAG laser endoureterotomyfor the treatment of ureteral strictures is a minimally invasive, short-stay out-patient procedure associated with a good success rate and less morbidity.