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Case Reports
. 2022 Oct 10:14:351-358.
doi: 10.2147/RRU.S371856. eCollection 2022.

The "Cut-to-the-Light" Technique Laser Endoureterotomy for Complete Ureteral Obstruction Resurfaces! A New Application of an Old Technique

Naim Yarak  1 , Skander Zouari  1 , Omar Karray  1 , Walid Sleiman  1 , Alaa Abdelwahab  1 , Stéphane Bart  1 , Maher Abdessater  1
Affiliations
Case Reports

The "Cut-to-the-Light" Technique Laser Endoureterotomy for Complete Ureteral Obstruction Resurfaces! A New Application of an Old Technique

Naim Yarak et al. Res Rep Urol. .

Abstract

Objective: To describe our new endoscopic approach in treating iatrogenic ureteral stenosis using the "cut-to-The-light" technique.

Methods: Case of a 54 year-old female patient who underwent a right percutaneous nephrolithotomy to treat a staghorn calculus with two subsequent complimentary ureteroscopies complicated by a severe proximal ureteral obstruction. An antegrade flexible uretereroscope and a retrograde rigid ureteroscope were used to locate the stenosis. With the aid of a 365-µm Ho: YAG laser fiber (settings 0.4 J, 12 Hz), we managed to successfully create a small incision in the stenotic lesion, the rigid ureterscopy light was clearly seen by the antegrade flexible ureteroscope and a through-and-through guidewire was then placed, securing the ureter. Ureteral dilatation was then performed followed by a full thickness incision of the ureteral stenosis. A single 8Fr, 28 cm double J ureteral stent was finally placed after stone fragmentation.

Results: The operating time was 200 mins. No blood loss. No fever or signs of UTI were seen shortly after the operation. The Foley catheter was successfully removed at day one post-op. The hospital stay was short of only 2 days.

Conclusion: The "cut-to-the-light" technique is a new application in the arsenal of ureteral stricture treatment that has been scarcely described in the literature before. The use of this method seems to offer excellent outcomes thus demonstrating the importance of this minimally invasive technique as an alternative to conventional invasive methods used. We believe that studies with larger samples and longer follow up are needed in order to fully determine the benefits of this method and to assess and reveal its suitable application and its drawbacks.

Keywords: laser endoureterotomy; ureteral stenosis; ureteroscopy; “cut-to-the-light” technique.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Portal phase of the computed tomography (CT) of the abdomen and pelvis with IV contrast injection showing a proximal ureteral and calyceal dilatation, a lower calyceal stone and a tapering of the right ureter (arrows). (A) Coronal view. (B) Axial view.
Figure 2
Figure 2
X-ray fluoroscopique image (A) and schema (B) of the stenotic ureter.
Figure 3
Figure 3
The stenotic lesion as seen by the antegrade flexible ureteroscope.
Figure 4
Figure 4
Ho: YAG laser incision of the stenotic lesion using the antegrade ureteroscope.
Figure 5
Figure 5
Guidewire was passed from antegrade ureteroscopy (A and B). Illumination of the obstruction by the retrograde approach (C).
Figure 6
Figure 6
Stenotic area post laser endoureterotomy and ureteral dilatation.
See this image and copyright information in PMC

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