Ureteroscopic Laser Endopyelotomy in Secondary UPJ Obstruction after Pyeloplasty Failure

Abstract

Objectives: Secondary ureteropelvic junction (UPJ) obstruction after failure of open and laparoscopic repair may be challenging to resolve due to possible extensive fibrosis and the increased invasiveness of this procedure. Alternatively, ureteroscopic laser endopyelotomy may be a more acceptable procedure for patients and surgeons. We report our preliminary experience with ureteroscopic holmium laser endopyelotomy after open pyeloplasty failure and define the complications that arose and the results. Materials and Methods: We performed 6 retrograde endopyelotomies with a holmium laser for failed UPJ repairs following the Anderson-Hynes procedures. Patient follow-up was carried out every 3 months using sonography and renal scan, and again after 1 year using renal scan and urography. Results: Mean hospitalization was 2.1 days. Ureteroscopic laser endopyelotomy was successful in 4 cases (66.6%). In 2 patients, failure occurred at the third month of follow-up. Complications included 1 case of slight bleeding, which was resolved conservatively without the need for blood transfusion, and 2 cases of guidewire rupture. Conclusions: Secondary UPJ obstruction is more challenging to resolve by open or laparoscopic approach. Retrograde endopyelotomy gives a valid alternative thanks to its success rate and its better acceptance by patients. We consider retrograde laser endopyelotomy the approach to choose when faced with secondary UPJ obstruction after open or laparoscopic failures.

Long‐term outcome of secondary endopyelotomy after failed primary intervention for ureteropelvic junction obstruction

“…In those cases, the success rate of secondary endopyelotomy has ranged from 37% to 88%. 11,12,[16][17][18] We found an overall success rate of 70% with a mean follow-up of 4 years after secondary endopyelotomy. In addition, we found a trend toward a higher success rate in patients who had undergone a previous dismembered open or laparoscopic pyeloplasty (66.7%) than in patients who had been treated with an endopyelotomy (57.1%), a finding that is consistent with those in previous reports.…”

“…Since it was introduced, 14,15 endopyelotomy has been used for the treatment of UPJ obstruction after a failed primary intervention. In those cases, the success rate of secondary endopyelotomy has ranged from 37% to 88% 11,12 16–18 . We found an overall success rate of 70% with a mean follow‐up of 4 years after secondary endopyelotomy.…”

“…Although several earlier studies have evaluated the results of secondary endopyelotomy after a failed primary treatment for a UPJ obstruction, some of those reports 11,17,18 were based on a relatively brief follow-up. When compared with other studies, the follow-up of our study cohort was as long as 11.6 years (mean, 4 years), and 70% of the patients (14 of 20) were monitored for longer than 3 years.…”

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

“…They point out that with the goal of achieving the optimal long-term success rate of open surgery (93% to 97%), which is considered the gold standard treatment, endopyelotomy yields a lower long-term success rate, requires more particular inclusion criteria, and is less effective for extrinsic stenosis in comparison with the laparoscopic approach, which is parallel to open dismembered pyeloplasty in outcomes. Interestingly, most reports on endopyelotomy cover the aetiology of failed pyeloplasty resulting from open or laparoscopic management [16, 17] and have revealed an effective remedy for such cases.…”

Laser in Urology – State of the Art

“…This therapeutic modality is also an option for the treatment of even complete short ureteral obstructions [29] and secondary ureteropelvic obstruction after open and laparoscopic failures [30]. Comparing the complication rates of retrograde and antegrade endopyelotomy with Holmium:YAG laser for pelvi-ureteric junction obstruction, the retrograde approach is superior [31].…”