Ureteroscopic Holmium Laser Endopyelotomy
Streem S

INTRODUCTION: Several options are now available for minimally invasive management of ureteropelvic junction (UPJ) obstruction, and the respective role of each of these alternative forms of intervention is still being defined.

PURPOSE: This videotape was made to better illustrate the actual technique of ureteroscopic Holmium laser endopyelotomy in an effort to increase its utilization throughout the urologic community.

MATERIALS AND METHODS: The procedure is accomplished with a short, semi-rigid ureteroscope in women, and either a flexible or long, semi-rigid ureteroscope in men, and A 360-micron Holmium laser fiber is employed, using an energy level of 1 joule at 12 to 15 Hertz. The endopyelotomy incision extends completely through the ureteral mucosa and musculature under direct vision. At the completion of the incision, a standard 14/7 French endopyelotomy stent is placed in pre-stented patients, or alternatively, an 8 French stent in non pre-stented patients.

RESULTS: The procedure, which has been associated with few minor complications and no major complications, has achieved a success rate significantly exceeding that of fluoroscopic hot-wire balloon incision.

CONCLUSIONS: Ureteroscopic Holmium laser endopyelotomy allows a precise pyeloureterotomy incision under direct vision. The result is a lower complication rate and higher success rate than other currently utilized transureteral procedures. Ureteroscopic Holmium laser endopyelotomy has become our technique of choice for management of UPJ obstruction not associated with upper tract stones.

Journal of Endourology, Vol. 13 Supplement 1, A147, Sep 1999

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