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

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 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.