Retrograde endopyelotomy using the holmium laser: technical aspects and functional results.
BACKGROUND
Endopyelotomy is considered standard treatment for primary and secondary ureteropelvic junction obstruction. The aim of this study is to report our initial experience with the retrograde endopyelotomy technique.


METHODS
Between January 2000 and April 2003 we submitted to retrograde ureteroscopic holmium laser endopyelotomy 16 patients (9 males and 7 females) aged between 22 and 64 years. Obstruction was primary in 10 cases and secondary due to unsuccessful open pyeloplasty in the remaining six. No patient was affected by coexisting urinary lithiasis. Excretory urography and diuretic renal scintigraphy were performed preoperatively in all patients. Endopyelotomy was carried out using the holmium laser which delivered an energy level of 1.2 Joule at 10-15 Hertz. A double J ureteral stent remained indwelling postoperatively for 6 weeks and a vesical catheter for 24 hours. Average operative time was 75 minutes (range 50-90 minutes). Patients were assessed on follow-up by echotomography of the urinary tract and diuretic renal scintigraphy after 3 months and then at 6-month intervals.


RESULTS
Patients were assessed on a mean follow-up of 18 months (range 6-41). Outcome was considered successful when symptoms were resolved and renal function improved. Success was obtained in 13 patients. Two patients were submitted to pyeloplasty with positive results and the procedure on one patient was converted to pyeloplasty due to intraoperative haemorrhage. Average postoperative stay was three days (range 1-4). No patient required blood transfusion with postoperative reduction in haematocrit of 0-9%, (mean 3%). Normal daily activity resumed after 3-4 days from discharge.


CONCLUSIONS
Retrograde endopyelotomy in our initial experience is a safe and efficient technique that gives an excellent percentage of success with reduced complications and good patient compliance. The retrograde compared with the anterograde approach has the advantage of being less invasive, does not require nephrostomal derivation and further reduces hospital stay.
Seveso
Mauro
M
Department of Urology, Istituto Clinico Humanitas, Rozzano, Milan, Italy. mauro.seveso@humanitas.it
Giusti
Guido
G
Taverna
Gianluigi
G
Piccinelli
Alessandro
A
Benetti
Alessio
A
Maugeri
Orazio
O
De Zorzi
Silvia Zandegiacomo
SZ
Graziotti
Pierpaolo
P
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods