Utilidad del laser de holmium: yag en la sección endoscópica de la estenosis ureteral / Usefulness of the holmium: yag laser in the endoscopic section of ureteral stenosis

La incidencia de la estenosis ureteral es frecuente en nuestro medio. En los últimos tiempos, debido al masivo empleo de técnicas endourológicas, ha aumentado su incidencia. Su etiología representa un factor decisivo para el resultado final del tratamiento, pero existen además características comunes a todas las estenosis que influyen de forma muy importante en el éxito final: tiempo de evolución, longitud de la estenosis, localización de la misma y función de la unidad renal afecta. En los últimos años se ha incrementado la utilización de diferentes técnicas endourológicas para el tratamiento de las estenosis del aparato urinario superior, que vienen a sustituir a la técnica abierta tradicional. La endoureterotomía con láser de Holmium:YAG presenta ventajas frente a otras técnicas endourológicas empleadas, ya que permite una incisión precisa con visión directa sobre la estenosis ureteral. Además, con las fibras de láser se cosigue una flexibilidad/deflexión del ureteroscopio, que permite alcanzar, en la inmensa mayoría de los casos, la zona estenótica. A la hora de realizar la incisión sobre la pared ureteral, ésta debe ser completa, actuándose sobre todas las capas del uréter hasta visualizar la grasa periureteral, teniendo siempre en cuenta las relaciones del uréter con las estructuras vecinas, especialmente las vasculares, para evitar lesionarlas. Su efectividad y fácil manejo, permiten obtener una elevada tasa de éxitos, con resolución de la patología estenótica, y una muy baja tasa de complicaciones. Por todo ello, debe incluirse a la endoureterotomía retrógrada con láser de Holmium:YAG en la primera línea del tratamiento de las estenosis ureterales de tipo benigno (AU)

Objectives: The incidence of ureteral stenosis is frequent in our environment. Lately, due to the massive use of endourological techniques its incidence has increased. Etiology represents a decisive factor for the final result of treatment, but there are also common characteristics to all stenosis that influence very importantly the final success: time of evolution, length of the stenosis, side and function of the affected renal unit. Over the last years, the use of endourological techniques for the treatment of upper urinary tract stenosis, that substitute the traditional open technique, have increased. Holmium:YAG laser endoureterotomy presents advantages in comparison with other endourological techniques, because it enables a precise incision with direct vision of the ureteral stenosis. Moreover, with laser fibers ureteroscopes achieve a degree of flexibility/ deflection that enables us to reach in most cases the stenotic area. At the time of incision of the ureteral wall, it should be complete, acting on all ureteral layers down to the periureteral fat, always having in mind the anatomic relationships of the ureter with neighbour structures, mainly vascular, to avoid injuries. Its effectiveness and easy management permits a high success rate, with resolution of the stenosis and a very low complication rate. After all the anterior, holmium laser retrograde endoureterotomy should be included as a first line treatment for benign ureteral stenosis (AU)

[Usefulness of the holmium:yag laser in the endoscopic section of ureteral stenosis]. / Utilidad del láser de holmium:yag en la sección endoscópica de la estenosis ureteral.

OBJECTIVES: The incidence of ureteral stenosis is frequent in our environment. Lately, due to the massive use of endourological techniques its incidence has increased. Etiology represents a decisive factor for the final result of treatment, but there are also common characteristics to all stenosis that influence very importantly the final success: time of evolution, length of the stenosis, side and function of the affected renal unit. Over the last years, the use of endourological techniques for the treatment of upper urinary tract stenosis, that substitute the traditional open technique, have increased. Holmium:YAG laser endoureterotomy presents advantages in comparison with other endourological techniques, because it enables a precise incision with direct vision of the ureteral stenosis. Moreover, with laser fibers ureteroscopes achieve a degree of flexibility/deflection that enables us to reach in most cases the stenotic area. At the time of incision of the ureteral wall, it should be complete, acting on all ureteral layers down to the periureteral fat, always having in mind the anatomic relationships of the ureter with neighbour structures, mainly vascular, to avoid injuries. Its effectiveness and easy management permits a high success rate, with resolution of the stenosis and a very low complication rate. After all the anterior, holmium laser retrograde endoureterotomy should be included as a first line treatment for benign ureteral stenosis.