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 report the results and advantages in the management of UPJ obstruction using a ureteroscopic retrograde laser-assisted approach (laser endopyelotomy; LEP). Thirty-four patients were treated between December 1994 and June 1997 by this new technique. Twenty-seven obstructions were primary. The mean time of follow-up is 18 months. An indwelling ureteral catheter was placed 3 weeks 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 using a contact laser fiber until all obstructive fibers had been cut. Follow-up examinations included sonography, intravenous urography, and, in unclear cases, a radionuclide renal scan with furosemide application after 3 months. The success rate was 85%. The most important factor influencing the outcome 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 approached laparoscopically.