Volume 14, Supplement 1
Original Article / Published: April 2026
DOI: https://www.doi.org/10.57045/jemis/1410426.pp20-21
K.Hristov, O. Gatsev, V. Todorova, K. Petkova, I. Saltirov
Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
Abstract
Introduction: Ureteral strictures represent a challenging clinical condition that can significantly impair patients’ quality of life. Endoscopic ureterotomy has emerged as a minimally invasive treatment option increasingly applied in their management. The holmium: yttrium-aluminium-garnet (Ho:YAG) laser is widely used in urology due to its precision and limited thermal damage to surrounding tissues.
Objective: The aim of this study is to assess the safety and efficacy of holmium laser endoureterotomy in the treatment of different length ureteral strictures.
Matherials and methods: A retrospective analysis was performed on 30 patients who underwent laser endoureterotomy for ureteral strictures between January 2022 and January 2025 at the Clinic of Urology, Military Medical Academy, Sofia, Bulgaria. The procedure was carried out under direct vision using either a semirigid or flexible ureteroscope. Obstruction and treatment outcomes were assessed using a combination of retrograde ureteropyelography, ultrasonography, and CT imaging. Postop-erative and long-term follow-up imaging were compared with preoperative findings to evaluate whether the obstruction was resolved, unchanged, or worsened. Treatment success was defined as symptomatic improvement and absence of radiological obstruction.
Results: Patient’s mean age was 56.5±11 years and male-to-female ratio – 53%/47%. Mean length of the ureteral stricture was 7.8±2 mm. Five of the patients (16%) were with severe degree of hydronpehrosis, 17 (57%) were with moderate hydronephrosis and 8 (27%) were with mild degree of hydronephrosis. Twenty – five of the patients (83%) were with secondary ureteral structures mainly with anamnesis for previous endoscopic surgery for impacted ureteral stones. There were no intraoperative complications. Mean hospital stay was 3±1 days. In 27 of the patients (90%) stent JJ 7 Fr was put postoperatively. The stent JJ was removed mean 72±55 days after the procedure. The success rate after the endoureterotomy was 80% (24/30), while 6 cases(20%) presented with a recurrent stricture. Stricture length was significantly greater in the group of patients with recurrence 11.1±3 mm vs 7±2 mm in patients wth no reccurence ( p=0.018). The mean follow-up period was 34±17 months.
Conclusion: Ureteroscopic laser endoureterotomy represents a minimally invasive procedure associated with high success rates and short hospitalization. The holmium:YAG laser provides precise tissue cutting and excellent hemostasis with compatibility across small-caliber rigid and flexible endoscopes. The length of the ureteral stricture may be one of the important predictive factors for the success of the treatment with this minimally invasive approach.
Keywords:
ureteral stricture, laser endoureterotomy, hydronephrosis
How to cite this article:
K.Hristov, O. Gatsev, V. Todorova, K. Petkova, I. Saltirov. Impact of ureteral stricture length on outcomes of laser endoureterotomy. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2026; 14(1): 20-21
Corresponding author:
Dr. Konstantin Hristov
Clinic of Urology
Military Medical Academy of Sofia
Department of Urology and Nephrology, Clinic of Urology
3 “Georgi Sofiiski” blvd., Sofia 1606
Email: konstantin.hristovv@gmail.com