Retrograde ureteroscopic endopyelotomy using the holmium : YAG laser

Purpose: We defined the safety and efficacy of retrograde ureteroscopic end opyelotomy using the holmium:YAG laser. Methods and Materials: Between July 1996 and December 1999 a total of 28 re nal units in 21 women and 6 men 7 to 75 years old (mean age 43.5) with uret eropelvic junction obstruction were treated at our institution with retrogr ade ureteroscopic endopyelotomy. Ureteropelvic junction obstruction was bil ateral in 1 case, primary in 20 and secondary in 8. Endoluminal ultrasound was done before endopyelotomy in all cases. Patients with renal calculi und erwent antegrade percutaneous nephrostolithotomy and traditional cold knife endopyelotomy. Endoluminal ultrasound revealed posterior and lateral cross ing vessels in 5 patients, who did not undergo the endoscopic approach. Ret rograde endopyelotomy was performed using the holmium:YAG laser in 23 cases and electrode incision with pure cutting current in 5. Postoperatively a u reteral stent remained indwelling for an average of 6 weeks. Thereafter pat ients were followed with serial ultrasound, excretory urography and renal s can at 3 to 6-month intervals. Results: We evaluated 28 upper urinary tracts, including 19 (67.9%) with hi gh insertion ureteropelvic junction obstruction and 9 with an annular stric ture. As directed by ultrasound images, the incision location was posterola teral, posterior, lateral and posteromedial in 16, 5, 4 and 3 cases, respec tively. Followup was available in all cases at a mean of 10 months (range 3 to 35). Success, defined as improved drainage on radiographic study and ab sent clinical symptoms, was achieved in 19 of the 23 patients (83%) treated with the holmium:YAG laser. Repeat laser incision resulted in a successful outcome in 2 of the 4 treatment failures. There were no acute surgical com plications. Conclusions: Retrograde ureteroscopic endopyelotomy with the holmium:YAG la ser is safe and minimally invasive therapy for primary and secondary ureter opelvic junction obstruction. Endoluminal ultrasound aids in decision makin g when retrograde endopyelotomy is done.