Initial Experience with Endoscopic Holmium: YAG Laser Urethrotomy for Incomplete Urethral Stricture

Sang Hoon Choi; Yong Seong Lee; Nak Gyeu Choi; Hyung Joo Kim

doi:10.4111/kju.2009.50.3.246

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Choi, Lee, Choi, and Kim: Initial Experience with Endoscopic Holmium: YAG Laser Urethrotomy for Incomplete Urethral Stricture

Original Article

Korean J Urol 2009;50(3):246-250.

Published online: 19 March 2009

DOI: https://doi.org/10.4111/kju.2009.50.3.246

Initial Experience with Endoscopic Holmium: YAG Laser Urethrotomy for Incomplete Urethral Stricture

Sang Hoon Choi, Yong Seong Lee, Nak Gyeu Choi, Hyung Joo Kim

From the Department of Urology, Hallym University College of Medicine, Seoul, Korea

Correspondence to: Hyung Joo Kim Department of Urology, Hallym University College of Medicine, 94-200, 2-ga, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul 150-179, Korea TEL: 02-2639-5470 FAX: 02-2632-5383 E-mail: urokhj@hallym.or.kr

Received 3 June 2008 Accepted 11 February 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Endoscopic holmium:yttrium-aluminum-garnet (Ho:YAG) laser urethrotomy is an alternative method in the management of urethral strictures. We report our initial experience in 15 cases of evaluating the therapeutic efficacy of the holmium laser for treating incomplete urethral strictures.

Materials and Methods

Endoscopic holmium laser urethrotomy was primarily performed on 15 patients with incomplete urethral stricture. Exclusion criteria were complete urethral stricture and previous treatment of urethral stricture. Retrograde urethrography and uroflowmetry were performed preoperatively and were carried out as follow-up studies postoperatively.

Results

Successful results without recurrence were achieved in 8 of 15 patients. When we classified the results by stricture length, the success rate was 80% in strictures less than 2 cm, whereas there was no therapeutic effect in strictures over 2 cm. When we classified the results by etiology, the number of successful results in strictures with an inflammatory, trauma, iatrogenic, or unknown cause was 2 (2/8), 3 (3/4), 2 (2/2), and 1 (1/1), respectively. In 7 patients who failed treatment, we repeated holmium laser urethrotomy in 5 patients and urethroplasty in 2 patients. No operative complications occurred in any patients.

Conclusions

Endoscopic holmium laser urethrotomy is a safe and effective minimally invasive therapeutic modality in cases of stricture less than 2 cm. Further data from long-term follow-up are necessary to compare the success rate with that of conventional urethrotomy and urethroplasty.

Keywords: Holmium, Urethral stricture, Internal urethrotomy

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Fig. 1.

Retrograde urethrogram showing incomplete urethral stricture (arrow).

Fig. 2.

Postoperative retrograde urethrogram showing good patency.

Table 1.

Characteristics of the patients

	Etiology	Length (cm)	Preoperative Qmax (ml/s)	Postoperative 1 month Qmax (ml/s)	Postoperative 3 months Qmax (ml/s)	Postoperative 6 months Qmax (ml/s)
1	Trauma	0.3	10	28	28	26
2	Trauma	0.8	9	25	25	24
3	Inflammatory	1.6	8	16	16	12
4	Inflammatory	4.7	4	6	6	5
5	Inflammatory	1.2	8	23	22	23
6	Inflammatory	2.5	7	19	16	10
7	Inflammatory	2.3	7	14	14	13
8	Unknown	1.4	8	25	24	22
9	Iatrogenic	0.7	9	27	27	28
10	Inflammatory	1.8	8	12	10	5
11	Trauma	1.2	8	25	25	24
12	Inflammatory	3.3	5	13	13	11
13	Trauma	0.4	11	23	23	22
14	Iatrogenic	1.1	8	21	21	20
15	Inflammatory	3.8	6	13	12	7

Qmax: maximum flow rate

Table 2.

Number of successful results in relation to etiology and length of urethral stricture

	No. of patients	No. of success
Length of stricture
＜2 cm	10	8/10
≥2 cm	5	0/5
Etiology
Inflammatory	8	2/8
Trauma	4	3/4
Iatrogenic	2	2/2
Unknown	1	1/1

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