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

Can J Urol. 2015 Dec;22(6):8079-84.


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.

MeSH terms

  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Lasers, Solid-State / adverse effects*
  • Lasers, Solid-State / therapeutic use
  • Lithotripsy, Laser / adverse effects*
  • Male
  • Middle Aged
  • Natural Orifice Endoscopic Surgery
  • Radiography
  • Ureteral Calculi / pathology
  • Ureteral Calculi / therapy*
  • Ureteroscopy / adverse effects*
  • Urethral Stricture / diagnostic imaging
  • Urethral Stricture / etiology
  • Urethral Stricture / surgery*