Ureteroscopic Holmium Laser Endopyelotomy for Primary Ureteropelvic Junction Obstruction
Hobart M, Streem S

PURPOSE: To describe our initial experience using the Holmium laser as an energy source when performing a retrograde ureteroscopic endopyelotomy.

MATERIALS AND METHODS: 5 women and 2 men (mean age 43 years) were treated. A semi-rigid 6.5F uretero-scope was used in the 5 female patients, and a 7.5F flexible ureteroscope was used in the 2 men. The endopyelotomy incision was accomplished with the laser set at 1.0-1.2 Joules, and 10-15 Hertz. The incision was carried through the UPJ for a distance of 1.0-2.0 cm until retroperitoneal fat was visualized. An 8F or 14/7F endopyeloto-my stent was left in situ for 4 weeks, and initial follow up IVPs were obtained 4 weeks after stent removal. A successful outcome was defined as resolution of symptoms and clear decrease in hydronephrosis on post-endopyeloto-my radiographs.

RESULTS: Hospital stay was 1 night in all patients. There were no major complications; however, 1 patient developed stent obstruction requiring exchange at 2 weeks. At follow-up approaching 1 year, 6 patients have clear success.

CONCLUSIONS: While the length of follow up is short, ureteroscopic holmium laser endopyelotomy appears to be a safe and effective alternative endourologic technique for the management of UPJ obstruction. Since the procedure is performed under direct vision, it allows assurance of a complete incision of the UPJ and avoidance of potential crossing vessels.

Journal of Endourology, Vol. 13 Supplement 1, A84, Sep 1999

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