Management of obliterated urinary segments using a laser fiber for access.

Abstract

We describe a modification of the cut to the light and core-through procedures using a laser fiber to gain through and through access for treatment of complete occlusion of the ureter or urethra. Three patients presented with complete obliteration of the ureter (2) and vesicourethral anastomosis (1). In each case the laser fiber was advanced through the obliterated segment under direct vision and then exchanged for a standard guide wire using an open ended catheter. Through and through access was obtained in all 3 cases and allowed subsequent incision for repair. In all 3 patients the area of incision was stented and urinary continuity was restored. Loss of access can lead to complications and termination of any endoscopic procedure. Use of the laser fiber to incise through the obliterated segment and subsequently act as a guide wire in our experience minimized the possibility for loss of access. The disadvantage is the cost of the laser fiber, which cannot be reused. Use of a laser fiber as a guide wire can be a viable and effective option for gaining access across strictures when alternative methods fail.