Efficacy and safety of retrograde laser endopyelotomy in the treatment of strictures of thepyeloureteral segment

Introduction: Retrograde endoscopic laser pyelotomy is a minimally invasive procedure that is increasingly used for the management of ureteropelvic junction (UPJ) strictures. Holmium laser has been recognized as having ideal qualities for cutting tissue, namely, precision and minimal thermal spread. Objective: The objective of our study is to evaluate the efficacy and safety of Holmium laser endopyelotomy in the treatment of ureteropelvic junction strictures. Material and methods: A retrospectively collected database of 14 patients who unederwent laser endopyelotomy for UPJ strictures between January 2017 and January 2020 in the Clinic of Endourology and SWL, Military Medical Academy, Sofia, Bulgaria was reviewed. Confirmation of obstruction and the results of the intervention were obtained by combinations of retrograde ureteropyelography, ultrasonography and CT. The endopyelotomy was performed under direct vision using a semirigid or a flexible ureteroscope. The first postoperative and latest radiographic follow-up studies were compared with the preoperative studies to determine whether the obstruction was resolved, unchanged, or worsened. Success was defined as symptomatic relief and the absence of obstruction from the radiographic studies. Results: Patients’ mean age was 50.2±12.7 years and male-to-female ratio – 57.1%/42.9%. Congenital obstruction of the UPJ was observed in 5 patients(35.7%). Nine of the patients(64.3%) were with secondary strictures of the UPJ – 5 people(35.7%) had a previous open pyeloplastic, 4(28.6%) had an anamnesis of impacted stones in the UPJ in the past. Mean length of the UPJ stricture was 10.3±2.8 mm. Six of the patients (42.9%) were with severe degree of hydronephrosis, 7 (50%) were with moderate hydronephrosis and 1 (7,1%) were with mild degree of hydronephrosis There were no intraoperative complications. Mean hospital stay was 3.6±1.2 days. In all of the patients pyelostent Retromax Plus 7/14 Fr was put postoperatively. The pyelostent was removed 4 to 6 weeks (mean 5 weeks) after the procedure. The success rate after the endopyelotomy was 85,7% (12/14), while 2 cases (14.3%) needed the placement of stent JJ 5 months after the intervention. Conclusions: Ureteroscopic laser endopyelotomy is a minimally invasive, short-stay outpatient procedure associated with a good success rate that is a method of choice mostly for secondary UPJ strictures. It is a minimally invasive procedure with less morbidity for the treatment of UPJ obstruction.