Endoscopic pyelotomy is a minimally invasive procedure that is increasingly
used for the management of ureteropelvic junction (UPJ) obstruction. We re
port the results and advantages in the management of UPJ obstruction using
a ureteroscopic retrograde laser-assisted approach (laser endopyelotomy; LE
P), Thirty-four patients were treated between December 1994 and June 1997 b
y this new technique. Twenty-seven obstructions were primary. The mean time
of follow-up is 18 months. An indwelling ureteral catheter was placed 3 we
eks prior to treatment, Intraoperatively, after the removal of the stent, a
guidewire was passed across the stenosis, and the ureter was entered with
a semirigid ureteroscope, The LEP was then performed under visual control u
sing a contact laser fiber until all obstructive fibers had been cut, Follo
w-up examinations included sonography, intravenous urography, and, in uncle
ar cases, a radionuclide renal scan with furosemide application after 3 mon
ths. The success rate was 85%, The most important factor influencing the ou
tcome was the grade of hydronephrosis, Postoperative side effects have been
minimal, and minor complications occurred in only 5 patients (15%), Laser
endopyelotomy is a minimally invasive procedure with less morbidity for the
treatment of UPJ obstruction. Only patients with a severe extrinsic cause
of obstruction should be excluded from this technique. These cases can be a
pproached laparoscopically.