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RESEARCH PRODUCT

Holmium Laser Endoureterotomy With the Lovaco Technique for the Treatment of Ureterointestinal Stenosis: Step by step.

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Abstract Objective To describe holmium laser endoureterotomy with the Lovaco technique for the treatment of ureterointestinal stenosis. This common problem after cystectomy represents a surgical challenge, with endourological techniques being useful in this context. We present a technique that has been described before, but which we consider useful and decisive. The key points and difficult aspects of the technique are shown, along with our experience with it. Methods We collected data on cases of ureterointestinal stenosis treated using holmium laser endoureterotomy with the Lovaco technique, in a prospective manner, between January 2017 and January 2018. Intraoperative data, postoperative complications, and success rate were recorded. Cases, where there was an improvement of renal function, and the cause that led to surgery was resolved, were considered to be successful. Results Nine endoureterotomies were performed in 7 male patients (2 bilateral), all of them had an ileal conduit. The average age was 68 years, and the average surgery time was 75 minutes. There were no intraoperative complications in any surgery. One patient was readmitted to the hospital 48 hours after discharge, due to febrile urinary tract infection. Of the 7 patients, 1 died shortly after surgery due to a tumor, and another has a short follow-up time. Of the remaining 5 patients, we have considered surgery to have an 80% success rate. The minimum follow-up was 4 months, the maximum was 13 months. Conclusion We consider endoureterotomy with the Lovaco technique a useful and decisive surgery for the treatment of ureterointestinal stenosis, being a reproducible technique. In comparison to other similar techniques, it has advantages such as being safer and not requiring the use of flexible material. The use of holmium laser allows a precise incision and good visibility. Larger series and a longer follow-up are needed to obtain weighty conclusions.