Retrograde endopyelotomy using Holmium-Yag laser for uretero-pelvic junction obstruction

Objective. - To evaluate our results of retrograde laser endopyelotomy for uretero-pelvic junction obstruction. Material and methods. - Retrospective study of 27 consecutive retrograde laser endopyelotomies performed on 24 patients over a six years period (June 1999 to July 2005). Sixteen stenoses were primary. The level of obstruction was severe in 13 patients and moderate in 14 patients. A polar pedicle was diagnosed by pre-operative CT-angiography in seven cases. Balloon dilatation was performed in 17 procedures. A double J ureteral stent remained in place for six weeks mean. We evaluated results by a clinical examination and an excretory urography (at 1 and 6 months then annually). Mean follow-up was 35 +/- 22.7 months. Results. - Mean operating time and mean length of hospital stay were 49.8 +/- 17.9 min and four days (range: 2-10 days). Two cases of pyelonephritis were observed. The overall success was 70%. In the eight unresolved cases, the failure appeared at 2.7 +/- 1 month mean. Success criteria were moderate level of obstruction and primary junction. Here, patients so selected have 100% of success. Conclusion. - Study confirmed retrograde laser endopyelotomy was safety with a short length of hospital stay. This minimally invasive procedure should be reserved to primary moderate stenoses without polar pedicle. (C) 2008 Elsevier Masson SAS. Tous droits reserves.