Ablation of urethral strictures using contact chisel crystal firing neodymium:YAG laser.

PURPOSE: The technique for ablation of urethral strictures using the contact crystal tip firing neodymium:YAG laser was evaluated for adequacy and long-term durability of the ablation.

MATERIALS AND METHODS: A total of 42 male spinal cord injured patients with suspected urethral strictures approximately 1 to 4 cm. long was evaluated. The strictures were localized and the men underwent endoscopic laser ablation using a contact laser chisel probe (2.5 or 3.5 mm.) screwed onto the end of a semirigid fiber. The usual power setting was 25 to 35 watts. Circumferential vaporization of fibrous tissue was done to achieve complete ablation. For pinpoint strictures with dense fibrosis, subsurface buttonholes were also made to vaporize and ablate expediently all fibrous tissue. A catheter was usually left indwelling overnight only. Estimated blood loss was 25 to 50 ml.

RESULTS: All patients were followed for a mean of 28.2 months (range 12 to 46). Of the patients 39 (93%) have adequate voiding and have maintained durability of the stricture ablation. Laser ablation was successfully repeated in 1 patient with initial failure and in 2 with partial failure. Both patients were well for 7 to 18 months. No patient required bougie dilation.

CONCLUSIONS: For strictures of the urethra the success rate following ablation was greater than that after other reported techniques. Contact laser ablation is simple to perform, with the least morbidity following the procedure, and it can be easily repeated for lasting results.