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[摘要]:Background. The management of ureteral strictures in transplanted kidney is challenging. Open surgical treatment is effective but entails significant convalescence. Holmium: yttrium-aluminum-garnet (Ho:YAG) laser endoureterotomy is useful for other types of ureteral obstruction, and we aimed to assess its long-term success for strictures of transplant kidney ureters.Methods. We reviewed the course of 12 kidney transplant patients managed with Ho:YAG laser endoureterotomy and/or percutaneous ureteroscopic balloon dilatation for ureterovesical anastornotic strictures or ureteropelvic junction obstruction. Success was defined as stable serum creatinine and no hydronephrosis on follow-up.Results. Of the patients, nine had ureterovesical anastornotic strictures. Of the six treated with balloon dilatation and Ho:YAG laser endoureterotomy, the success rate was 67% (58 months mean follow-up). Both strictures with failure were longer than 10 mm. Of the three patients treated with balloon dilatation only, there was success in only one (14 months follow-up) and both strictures with failure were shorter than 10 mm. There were three patients treated for ureteropelvic junction obstruction, one with balloon dilatation and two with balloon dilatation plus Ho:YAG laser endoureterotomy, all successfully (57 months mean follow-up). Overall, of the eight strictures 10 mm or shorter, there was success rate in six (75%), with 52 months mean follow-up, including Five of five (100%) treated with laser endoureterotomy and one of three (33%) treated with only balloon dilation.Conclusions. Our results suggest that Ho:YAG laser endoureterotomy should be a first line treatment for ureteral strictures of length 10 mm or shorter in kidney transplant patients. |
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