1282 EFFICACY OF HOLMIUM: YAG LASER ENDOURETEROTOMY FOR LONG URETERAL STRICTURES

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THE JOURNAL OF UROLOGY姞

1280 URETEROSCOPIC EVALUATION AND TREATMENT OF CHRONIC UNILATERAL HEMATURIA: ANALYSIS OF THE LATEST 20 CASES Soichi Mugiya*, Masao Nagata, Yutaka Kurita, Seiichiro Ozono, Hamamatsu, Japan INTRODUCTION AND OBJECTIVES: Chronic unilateral hematuria is characterized by intermittent or continuous gross hematuria that cannot be diagnosed using standard radiology and hematology methods. We have evaluated patients with unilateral renal hematuria to determine the cause of bleeding and reported the usefulness of ureteroscopic treatment for this condition (J Urol 178: 517, 2007). Our experience and the technique have improved with time. We report our recent experience with patients who had chronic unilateral hematuria and were treated ureteroscopically. METHODS: From March 2005 to June 2009, 20 patients were referred to our institution for the evaluation and treatment of chronic unilateral hematuria. Radiology and hematology tests failed to reveal the source of hematuria and showed normal findings. Preoperative urine cytology also showed no abnormalities, and subsequently all the patients were investigated ureteroscopically. In the case of a lesion being identified after complete inspection of the collecting systems, the bleeding site was treated ureteroscopically with a laser (holmium: YAG and/or neodymium: YAG) or electrocoagulation. RESULTS: 20 patients who were evaluated for gross unilateral hematuria, including 9 males and 11 females 18 to 82 years old (mean age 41). Hematuria was on the left side in 14 patients. The entire ureter and intrarenal collecting systems were inspected in all patients. Discrete lesions were found ureteroscopically in 19 patients, including minute venous rupture in 15 and hemangioma on a renal papilla in 4. In the remaining one patient, since gross hematuria disappeared before the ureteroscopic procedure, the source of hematuria could not be detected by ureteroscopic evaluation. 19 patients with detected lesions were treated ureteroscopically with a laser or electrocoagulation since active bleeding spots were recognized during the ureteroscopic procedure. In all treated patients hematuria resolved with no recurrence during a median follow-up of 16 months (range 5 to 56). CONCLUSIONS: A patient in whom the cause of hematuria is unknown should undergo ureteroscopic evaluation, and ureteroscopic treatment is an excellent method for chronic unilateral hematuria. Source of Funding: None

1281 THE METALLIC URETERAL STENT: 12-MONTH OUTCOMES Anthony Polcari*, Cory Hugen, Ahmer Farooq, John Milner, Thomas Turk, Maywood, IL INTRODUCTION AND OBJECTIVES: Upper urinary tract obstruction is one of the most common problems faced by urologists. Patients with benign obstruction who are not candidates for definitive reconstruction and those with malignant disease of the retroperitoneum are often managed with ureteral stents on a chronic basis. Traditional polymer stents require exchange every 3-4 months, exposing the patient to repeated procedural risks and incurring a significant social and financial burden. In addition, polymer stents fail to provide adequate drainage in a significant proportion of patients with malignant disease. The Resonance (Cook Urological, Spencer, IN) metallic stent was developed to provide a more durable alternative, allowing 12 month dwell times. We report our 1-year outcomes with this stent. METHODS: Data were prospectively collected on all patients undergoing metallic ureteral stent placement at our institution beginning July 2007. Patient age, sex, etiology of obstruction, previous method of drainage, serial creatinine levels, and intra- and post-operative complications were recorded. RESULTS: 41 stents were placed in 31 patients between 7/07 and 11/09. 19 patients had a least 1 year of follow-up and were

Vol. 183, No. 4, Supplement, Monday, May 31, 2010

included in the analysis. The etiology of obstruction was benign in 13/19 (68%) and malignant in 6/19 (32%). Adequate drainage was maintained in 17/19 (84%) patients, 12/13 (92%) with benign and 5/6 (83%) with malignant obstruction. There were no cases of stent migration, intraoperative complications, or significant encrustation upon exchange at one year. The metallic stent was discontinued in one patient due to recurrent gross hematuria. Two patients experienced urinary symptoms requiring exchange for a polymer stent. One of these improved with a polymer stent and the other eventually required nephrostomy placement for intractable LUTS. Five patients have been managed with the metallic stent for over two years. Additionally, the metallic stent allowed discontinuation of nephrostomy tubes in 2 patients with malignant disease. CONCLUSIONS: Metallic ureteral stents provide effective upper tract drainage for patients with both benign and malignant upper tract obstruction. They are well-tolerated and can be maintained in situ for 12 months without significant encrustation. The metallic stent should be considered for all patients requiring long-term upper urinary tract drainage. Source of Funding: None

1282 EFFICACY OF HOLMIUM: YAG LASER ENDOURETEROTOMY FOR LONG URETERAL STRICTURES Nick Pardalidis*, Nick Andriopoulos, Angelos Karamanis, Eleni Kosmaoglou, Athens, Greece INTRODUCTION AND OBJECTIVES: The management of long ureteral strictures (above 2cm) is usually challenging. Endourology techniques, such us laser endoureterotomy is an alternative treatment of long ureteral strictures. ␩olmium: YAG laser possesses cutting and coagulating properties contributing to less morbidity. We report our experience with the laser endoureterotomy and evaluate the long term over five years clinical and radiographic success of the method. METHODS: 26 patients (18 men and 8 women) underwent holmium laser endoureterotomy for iatrogenic ureteral strictures (13 proximal, 6 mid and 7 distal). The stricture approach was made in a retrograde fashion using either semirigid or flexible ureteroscope and the energy source was a laser micro fiber, set at 1 Joule and 10Hz. A full thickness incision of the stenotic segment up to the periureteral fat was performed. Successful cut was verified with presence of contrast media extravasation. Indwelling stents were left in place in all of our patients for 4-6 weeks postoperatively. Follow up was obtained with radiographic imaging in 1, 3, 6, 12 months and thereafter every year following the procedure. RESULTS: Success was defined as both relief of symptoms and radiographic resolution of the obstruction on intravenous pyelography or diuretic renography or both. 6 of the patients developed recurrent strictures in less than six months. These were considered failure and were treated in an open technique. Overall, 20 out of 26 patients (77%) are clinically well with no evidence of stricture recurrence on the radiographic imaging for long ureteral strictures after five years. CONCLUSIONS: Holmium laser is an ideal tool for safe and effective endoureterotomy and is associated with a long term success rate for long ureteral strictures. Source of Funding: None