銩雷射或鈥雷射做輸尿管切開術的預後比較
邵郁鏵1,2吳勝堂1唐守宏1查岱龍1曹智惟1蒙恩 1于大雄1孫光煥1高建璋1
國防醫學院 三軍總醫院 外科部 泌尿外科1
桃園國軍總醫院 外科部 泌尿外科
Endoureterotomy for ureteral stricture: retrospective study of holmium laser VS thulium laser
Yu-Hua Shau1,2, Sheng-Tang Wu1, Shou-Hung Tang1, Tai-Lung Cha1 , Chih-Wei Tsao1, En Meng1, Dah-Shyong Yu1, Guang-Huan Sun1 and Chien-Chang Kao1
1.Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
2. Division of Urology, Department of surgery, Taoyuan armed forces general hospital , Taiwan
Purpose:
To compare the results of endoureterotomy for benign ureteral strictures using the holmium- yttrium-aluminum-garnet (YAG) laser and thulium laser.
Material and methods:
A total of 25 patients (12 men and 13 women, mean age 49.16 years) underwent holmium: YAG laser endoureterotomy or thulium laser for benign ureteral strictures (13 proximal, 3 middle, and 9 distal) using semirigid ureteroscopy and a 360-μm fiber at 1.2 J/pulse and 10 Hz.. After completion of the incision, a 7-Fr double-J ureteral stent was left for 6 weeks. Thereafter patients were followed by ultrasound and/or intravenous urography at 3–6 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 80 months, success was achieved in 10 (52.6%) of 19 patients(Holmium laser) and 5 of 6 patients(thulium laser). There were 10 patients who had developed recurrent strictures and were therefore considered as treatment failures. The stricture length and severity of hydronephrosis were correlated with successful outcome, but the gender, etiology, side and location of strictures did not predict the outcome.
Conclusions:
Although endoureterotomy using a holmium: YAG laser and thulium laser were associated with an equal efficacy in our series, but the longer stricture length or severe hydronephrosis patient is suitable for thulium laser. This procedure is recommended as a safe therapeutic option for the initial management of patients presenting with benign ureteral strictures because it is less invasive.