Ureteroscopic holmium:YAG laser endopyelotomy is effective in distinctive ureteropelvic junction obstructions.

Abstract

AimTo evaluate the effectiveness and safety of holmium:YAG (Ho:YAG) laser endopyelotomy in distinctive ureteropelvic junction obstructions (UPJO) with distinctive aetiologies.Material and methodsThirty-one patients diagnosed with UPJO of distinctive causes were included. Aetiology consisted of 7 congenital UPJO, 10 post-pyeloplasty UPJO, 7 post-lithotomy obstructions, 4 ureteropelvic junction obstructions post-extracorporeal shockwave lithotripsy stenoses and 3 post-ureteroscopic lithotriptic UPJO. Retrograde ureteroscopic Ho:YAG laser endopyelotomy was performed in all patients. Operation related parameters were studiedResultsAverage procedure duration was 46 min. Mean discharge was 1.81 days. There was no notable complication such as perforation or haemorrhage. All patients were followed for at least 12 months. The single success rate was 80.6%, leaving 6 patients undergoing secondary endopyelotomy, among whom 4 were successful while 2 required an open approach. The overall success rate was 93.5%. Failed pyeloplasty UPJO is more disposed to restenosis (p = 0.0075). Inversely implanted ureteral stent yielded a higher success rate (p = 0.0158).ConclusionsHo:YAG laser endopyelotomy is a safe, minimally invasive approach effective in both primary and secondary UPJO treatments. Implantation of inversed ureteral stents can be more beneficial.

Laparoscopic Anderson-Hynes procedure as a treatment of ureteropelvic junction obstruction caused by fibroepithelial polyp.

“…In our case the results of excretory urography (IVU) and diuretic renography were typical of UPJO; hence we did not perform any other diagnostic procedures. Even though ureteroscopic endopyelotomy has been widely reported as effective, we believe that laparoscopic pyeloplasty is the most effective procedure in the treatment of ureteropelvic junction obstruction, so a decision was made to operate on the patient laparoscopically [ 8 ]. Preoperative diagnosis of a fibroepithelial polyp may result in the decision to undertake the ureteroscopic treatment [ 9 , 10 ].…”

A complex case of abdominal pain in a patient with pelviureteric junction obstruction.

“…In 1993 Schuessler first performed successful dismembered laparoscopic pyeloplasty of a pelviureteric junction obstruction in an adult [ 6 ]. Following introduction of robotic surgery with robot-assisted techniques and other minimally invasive techniques, dismembered laparoscopic pyeloplasty has continued to be the standard treatment for PUJ obstruction [ 2 ]. Moreover, for the last decade further refinement of the laparoscopic techniques and equipment has allowed this type of surgery to be safely performed in selected cases as a 1-day procedure [ 7 ].…”

“…Dismembered laparoscopic Anderson-Hynes pyeloplasty is an established alternative to traditional treatment of pelviureteric junction (PUJ) obstruction [ 1 , 2 ]. The superiority of the laparoscopic approach includes precise dissection and therefore a minimal surgical trauma, as well as blood loss, which in turn result in short hospitalization and prompt recovery [ 3 , 4 ].…”

Endoureterotomy is not a sufficient treatment for intrinsic ureteral endometriosis.

“…Our results at the very least demonstrate non-superiority of endoureterotomy compared with ureteroureterostomy. Given the fact that endopyelotomy can hardly reach the success rate of open pyeloplasty, it is reasonable not to practise endoureterotomy in ureteral endometriosis unless otherwise indicated [17]. …”