Ureteroscopic holmium laser endopyelotomy for ureteropelvic junction stenosis after pyeloplasty.
BACKGROUND
Pyeloplasty is a standard and highly successful treatment for ureteropelvic junction obstruction. However, stenosis is a late complication causing symptom recurrence. The purpose of this study was to evaluate the use of holmium laser stenosis incision-"laser endopyelotomy"-to manage this.


METHODS
Fifteen adult patients were referred for loin pain recurrence after pyeloplasty. Subsequent to ureteropelvic junction stenosis confirmation with intravenous urogram and dynamic isotope renogram investigations, the patients underwent ureteroscopic laser endopyelotomy. Eleven patients had stents in situ before endopyelotomy. Ureteric stents (7F) were placed for 6 weeks postprocedure when ureteroscopy was repeated and stents removed. All patients had repeat intravenous urogram and renograms at 3 months postprocedure.


RESULTS
Patients presented at a median of 3.2 years (range, 9 months to 8 years) after pyeloplasty (nine open dismembered, three Culp, and three laparoscopic). Three patients (all nonstented) required a second incision. All patients were discharged from hospital within 23 hours with no complications. Symptomatic improvement was documented in all of the patients, and improved drainage was recorded in the 3-month nuclear scans.


CONCLUSIONS
Laser endopyelotomy is an appropriate minimally invasive procedure for postpyeloplasty stenosis. Results are better in patients with ureteric stents in situ before the procedure.
Acher
Peter L
PL
Department of Urology, Darent Valley Hospital, Dartford, Kent, United Kingdom. pete_acher@hotmail.com
Nair
Raj
R
Abburaju
Jai S
JS
Dickinson
Ian Keith
IK
Vohra
Anil
A
Sriprasad
Seshadri
S
D000328:Adult; D006801:Humans; D007430:Intraoperative Care; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D017211:Treatment Failure; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D018666:Ureteroscopy