Retrograde ureteroscopic endopyelotomy using the holmium:YAG laser.

Abstract

We report our experience of retrograde ureteroscopic endopyelotomy using the holmium laser for ureteropelvic junction (UPJ) obstruction not associated with upper tract stones. We carried out this procedure on five patients through an 8-Fr semirigid ureteroscope. The ureter was not stented before the procedure and balloon dilation was not necessary before retrograde insertion of the ureteroscope. The obstruction was incised with the holmium laser using a 200 microm fiber in a linear fashion. After completion of the incision, a 12-Fr double-J ureteral stent was left for 6 weeks. Thereafter, patients were monitored with renal scan and/or ultrasound and excretory urography at 3-6 month intervals. Hydronephrosis was obviously improved in four cases (80%) at an average follow up of 12.8 months (4-23 months). Although the number of treated patients was small, retrograde ureteroscopic endopyelotomy for UPJ obstruction using the holmium laser achieved good results. We recommend that this procedure be used initially because it is less invasive and has a favorable outcome.