Laser applications in endourology: Endopyelotomy

Retrograde endopyelotomy has emerged as a minimally invasive alternative to treat ureteropelvic junction obstruction (UPJO), characterized by hydronephrosis due to intrinsic or extrinsic obstruction of the ureteropelvic junction. This review aims to present the technique, outcomes, and complications of the retrograde laser endopyelotomy.

A literature review was conducted in June 2025 without time or language limits, using the MEDLINE and Scopus databases. This review followed the PRISMA system rules.

The overall success rate across all studies, primarily performed using Holmium:YAG lasers, ranged from 44 to 89%, with a mean success rate of 77.2% and a mean follow-up time of 23.2months (ranging from 10 to 76months). Laser settings ranged from 0.8 to 2.5J and 10 to 20Hz (∼1J-10Hz-10W), using 200 to 365μm laser fibers. Success was inconsistently defined across studies, ranging from symptom resolution to imaging-based criteria. Most of the complications were Clavien grade I, with uncomplicated urinary tract infections being the most common. Hospital stays were generally short, with most patients discharged within 1 to 3days.

The retrograde laser endopyelotomy approach for the treatment of UPJO is effective and safe. However, it still remains a second-line choice. Further studies, especially comparative including Thulium lasers, would help to define the best laser source for endopyelotomy.