الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
Introduction : Holmium: YAG laser is a new technology, however, its outcome in management of benign ureteral strictures is not fully evaluated. We evaluate the functional outcome of this modality for management of benign ureteral strictures. Patients and Methods: Between December 2000 and December 2004, 43 patients with 34 iatrogenic and 9 postinflammatory ureteral strictures underwent retrograde ureteroscopic holmium: YAG laser endoureterotomy. All the patients had a short segment single stricture (1.5 cm) and the epsilateral renographic clearance was 20% of the total renal function. There were 26 men and 17 women with a mean age of 50.4 years. Preoperative evaluation and followup every 3 months was carried out by US, IVU and/or MRU and diuretic renogram. All patients had a ureteral stent left in place postoperatively for 46 weeks. The mean followup period was 19.4 months (range 348). We studied the criteria that could help in prediction of success including age and gender of the patient, level and length of the stricture and grade of hydronephrosis. Parameters of radioisotope renography were also studied including absolute glomerular filtration rate (GFR), split renal function as well as halftime drainage (T 1/2 ) . Moreover, the impact of the duration of the stent and development of intra or postoperative complications were studied. Results: Almost bloodless, accurate and precise incision of the strictures was easily performed. The mean operative time was 36. Perioperative complications were encountered in 2 patients (4.6%); septicemia in 1 and peritoneal irritation in 1. Our overall success rate was 60.5%. Multivariate analysis showed that the length and the level of strictures were the only independent variables that affect the success rate. The highest success rate (93%) was achieved in those strictures 0.5 cm. of patients with stricture length 1 cm showed success. Regarding the level, the highest success rate (81%) was achieved with distal strictures and the lowest success rate (22.2%) was achieved with proximal ones. Conclusion: The holmium YAG laser provides a bloodless operative field for controlled, accurate and safe endoscopic incision of ureteral strictures. We recommend this procedure particularly for initial management of short segment and distal ureteral strictures.