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Proceedings Paper

Holmium-laser endopyelotomy
Author(s): Graham M. Watson M.D.; Sunil Shroff; Robert Thomas; Michael Kellett
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Paper 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.

Paper Details

Date Published: 2 May 1994
PDF: 4 pages
Proc. SPIE 2129, Lasers in Urology, (2 May 1994); doi: 10.1117/12.175026
Show Author Affiliations
Graham M. Watson M.D., Whittington Hospital and Institute of Urology (United Kingdom)
Sunil Shroff, Whittington Hospital and Institute of Urology (United Kingdom)
Robert Thomas, Whittington Hospital and Institute of Urology (United Kingdom)
Michael Kellett, Whittington Hospital and Institute of Urology (United Kingdom)

Published in SPIE Proceedings Vol. 2129:
Lasers in Urology
Graham M. Watson M.D.; Rudolf W. Steiner; Douglas E. Johnson M.D., Editor(s)

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