Laser endopyelotomy: Minimally invasive therapy of ureteropelvic junction stenosis

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.