Laser endopielotomy in the treatment of UPJ obstruction
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Wiesław Duda, Jan Kawecki, Michał Białożyt

Oddział Urologii, Szpital im. prof. E. Michałowskiego w Katowicach

summary

Introduction.

Hydronephrosis as a result of subpelvic ureter stenosis is a congenital defect. The obstruction can be of functional or mechanical character. It usually results in blocking urinary outflow, and after some time, hydronephrosis, when not treated, can impair renal functions. There are several methods of surgical treatment of this disorder, including laparoscopic and endoscopic techniques. Endoscopy consists in cutting the obstructed ureter and healing according to Davies’ rules.

Objective.

The aim of our study is the method of cutting the obstructed part of ureter with the holmium laser.

Material and method.

From September 2002 to December 2007, 223 patients were treated due to congenital hydronephrosis caused by subpelvic ureter obstruction with the holmium laser cutting through endoscopy. 206 patients had the procedure done by retrograde method (URS). The group consisted of 134 women (mean age 43.08) and 72 men (mean age 41.2 years). The obstruction on the right side (128) occurred more often than on the left (78), it was of primary type in 153 patients and in 53 the corrective operations had been done by various methods before. 17 patients had the cutting of ureter obstruction done by percutaneous method (PCN). The information taken both before and after the treatment included interview data, pain reports, urinary tract infections. The kidnyes were examined with USG and urography, retrograde

pyelography was done in each patient and scinthigraphy in some of them. Treatment result assessment consisted of the comparison of examination data taken before and after the procedure. In cases of recovery and USG and X-ray results improvement, the treatment result was assumed to be good, in cases of no improvement to be bad. Observation time was 52 months. Total number of 223 patients had 249 endopyelotomies, the improvement was achieved in 21 patients after the second treatment stage and in 5 patients after the third.

Results.

201 patients called for control examinations and they were included into analysis. In the PCN group 11 patients (78.6) had good treatment results, while 3 patients (21.4%) had bad results. In the URS group (187) patients (149 – 80.1%) had good treatment results, while 38 had bad results (19.9%). Summing up, good results were achieved in a group of 160 patients (79.6%), a failure was noted in 41 (20.30%). At the control examinations in the PCN group, minor complications were observed, such as hematuria in 3 patients (17.6%), temperature over 38oC in 5 patients (29.4%), temporary pains in the low back area in 8 (47%), long-term pains 3 (17.6%) and extravasation of the urine in 1 (5.9%). In the URS group the following complications were observed: hematuria in 111 patients (53.88%), temperature in 23 (11.16%), persistent low back pains in 12 patients (5.82%) and urosepsa requiring other procedures in 5 patients (2.42%), hematuria requiring other procedures in 6 patients (2.9%) and necessity to perform open surgeries in 19 patients (9.22%). In 9 patients (4.36%) insufficiency of pyeloureteral junction requires constant placement of D-J catheter.

Conclusions.

The advantages and disadvantages of using holmium laser as a knife and endoscopy as an access method were summed up. Relatively short and minimally invasive procedure reaching the satisfactory percentage of recoveries is used rarely due to expensive ednoscopic equipment and experience of medical team in endurology. To achieve the best results, patients must be selected for the procedure very cautiously.