Holmium-laser endopyelotomy

Graham M. Watson M.D.; Sunil Shroff; Robert Thomas; Michael Kellett

doi:10.1117/12.175026

2 May 1994 Holmium-laser endopyelotomy

Graham M. Watson M.D., Sunil Shroff, Robert Thomas, Michael Kellett

Proceedings Volume 2129, Lasers in Urology; (1994) https://doi.org/10.1117/12.175026
Event: OE/LASE '94, 1994, Los Angeles, CA, United States

Abstract

The conventional treatment of the obstructive pelviureteric junction (PUJ) is open surgical repair via a loin incision and a pyeloplasty. A funnel-shaped PUJ is constructed by means of sewing in a flap of pelvis into the proximal ureter or a spatulated anastomosis is performed. Wickham suggested that an incision of the PUJ combined with stenting could be performed by means of a percutaneous approach and would replicate a Davis intubated pyeloplasty. Davis had shown that simply incising a narrow PUJ or ureteric stricture followed by stenting for 6-8 weeks would result in the regeneration of muscle and epithelium around the stent to form an unobstructed new structure. The percutaneous approach had a lower success rate than conventional open surgery. Approximately 30% of cases relapsed. These failures could however also be treated by a second incision and stenting. A less invasive modification of the percutaneous approach is to perform the entire procedure via a ureteroscope. This has been performed using large caliber ureteroscopes and electrical incision. We report here the use of a holmium laser to incise the ureter in combination with a miniaturised ureteroscope. It has been shown that large caliber ureteroscopy carries a high complication rate with strictures and perforations. Miniaturised ureteroscopy is safer and easier.

Citation Download Citation

Graham M. Watson M.D., Sunil Shroff, Robert Thomas, and Michael Kellett "Holmium-laser endopyelotomy", Proc. SPIE 2129, Lasers in Urology, (2 May 1994); https://doi.org/10.1117/12.175026

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