輸尿管狹窄以鈥雷射及銩雷射內視鏡輸尿管切開術之回溯性研究 

劉家睿、邵郁樺、吳勝堂、查岱龍、曹智惟、蒙恩、于大雄、孫光煥、高建璋

國防醫學院三軍總醫院外科部泌尿外科

國軍桃園總醫院外科部

Endoureterotomy for Ureteral Stricture: A Retrospective Study of Holmium Versus Thulium Lasers

Chia-Ruei Liu1, Yu-Hua Shao1,2, Sheng-Tang Wu1, Tai-Lung Cha1, Chih-Wei Tsao1, En Meng1, Dah-Shyong Yu1, Guang-Huan Sun1, Chien-Chang Kao1

1Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China

2Department of surgery, Taoyuan Armed Forces General Hospital, Taiwan

Background:

To compare the results of endoureterotomy for benign ureteral strictures by using holmium: yttrium-aluminum-garnet (Ho:YAG) and thulium lasers.

Methods:

A total of 25 patients (15 men and 10 women, mean age: 49.16 years) underwent endoureterotomy with either Ho:YAG or thulium lasers for benign ureteral strictures (13 proximal, 3 middle, and 9 distal), using semirigid ureteroscopy and a 365-lm fiber (Ho-YAG laser) at 1.2 J/pulse and 10 Hz, or a 300-lm fiber (thulium laser) at 8W to 15W. Following incision, a 7-Fr double-J ureteral stent was left for 4 to 6 weeks. Thereafter, patients were followed-up using ultrasonography and/or intravenous urography at 3- to 6-month intervals.

Results:

Success was defined as the absence of symptoms, plus radiographic resolution of obstructions, as assessed by diuretic renography and/or intravenous urography. With a mean follow-up of 43 months, success was achieved in 10 (52.6%) of 19 patients treated with Ho:YAG laser and in 5 (83.3%) of 6 patients treated with thulium laser. A total of 10 patients developed recurrent strictures and were considered to have treatment failures. Stricture length and the severity of hydronephrosis were correlated with successful outcome. Sex, etiology, side, and stricture location did not predict outcome.

Conclusion:

Although endoureterotomies using Ho:YAG and thulium lasers had equal efficacy, our analysis revealed that a patient with longer stricture length or severe hydronephrosis is more suitable to receive thulium laser. This general laser procedure is recommended as a safe therapeutic option for the initial management of patients presenting with benign ureteral strictures because it is less invasive.