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Retrograde endoureteropyelotomy with the holmium:YAG laser. Initial experience
C S Biyani1, P A Cornford, C S Powell
1Countess of Chester Hospital, UK.
Objective:
To evaluate the safety and efficacy of the holmium:YAG laser in the management of pelviureteric junction (PUJ) obstruction.
Patients And Methods:
Between November 1994 and February 1996, 8 patients with 5 primary and 3 secondary PUJ obstructions underwent retrograde ureteroscopic holmium:YAG laser endopyelotomy. A 320- to 365-micron (Slimline, Coherent) fibre was used to deliver the laser energy. A posterolateral endopyelotomy was performed under visual monitoring. All patients had a ureteral stent left in place postoperatively for 6 weeks and a renogram was performed after 3 months. The mean follow-up was 12.4 months (3-24 months).
Results:
Almost bloodless, accurate and layered division of the PUJ was easily performed. The average procedure time was 37.5 min. Our overall success rate was 87.5%.
Conclusion:
The holmium:YAG laser is a safe, reliable laser with adequate coagulative properties and precise cutting abilities. This allows a 'bloodless' operative field for controlled, accurate and safe endoscopic division of the PUJ.