Percutaneous ureteral incision with a small-caliber flexible ureteroscope

We reviewed the results of percutaneous ureteral incisions for ureteroenteroanastomotic stricture using the holmium laser. We performed this procedure through a 6.9-F flexible ureteroscope on 3 ureters in 3 patients. Balloon dilation was not necessary prior to insertion of the ureteroscope. The stricture was incised with the holmium laser with a 200-microm fiber through the working channel of the ureteroscope. After completion of the incision, a 12-F double-J ureteral stent was left in situ for 6 weeks. Thereafter, patients were followed with repeated renal scans, ultrasound, or both, and excretory urography at 3- to 6-month intervals. The stricture resolved completely in all cases at an average follow-up of 25.3 months (16 to 32 months). Although the number of treated patients was small, percutaneous ureteral incision for ureteroenteroanastomotic stricture using the holmium laser was associated with a good outcome. We recommend this procedure be considered initially because it is less invasive and has a favorable outcome.