Holmium Laser Incision Technique for Ureteral Stricture Using a Small-Caliber Ureteroscope

BACKGROUND AND OBJECTIVES The holmium laser has a short absorption depth in tissue and possesses excellent properties both in ablation and hemostasis. We have performed endoscopic incision for ureteral stricture using the holmium laser through a small-caliber ureteroscope. METHODS This method was used on five patients and seven ureters. The etiology of the stricture was stone scar in two patients, ureteroenteroanastomosis of Indiana urinary pouch in two, and primary in one. We used an 8F semi-rigid or 6.9F flexible ureteroscope. No prior procedures, such as balloon dilation, were necessary in any of the cases. The stricture was incised with the holmium laser using a 365-microm fiber through the working channel of the ureteroscope. The holmium laser operated at a wavelength of 2100 nm, with an output of 1.0 J/pulse at a rate of 10 Hz. After completion of the incision, a 12F Double-J catheter was left in for six weeks. RESULTS The mean operative time was 89 minutes. The stricture resolved completely in all cases at an average follow-up of 8.6 months. CONCLUSIONS The holmium laser incision for ureteral stricture using a small-caliber ureteroscope is an easy-to-perform, safe and effective procedure.