World J Urol DOI 10.1007/s00345-014-1405-3
TOPIC PAPER
Laser endoureterotomy and endopyelotomy: an update Esteban Emiliani · Alberto Breda
Received: 29 July 2014 / Accepted: 10 September 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose Although minimally invasive approach is one of the first-line treatment choices for ureteral strictures, there are still controversies on the ideal method to treat this entity. The objective of this update was to define the level of evidence around endoscopic treatment of ureteropelvic junction (UPJ) and ureteral strictures. Methods We reviewed the current available literature on the PubMed database from the last decade up to May 2014 on laser endoureterotomy and endopyelotomy. Results The level of evidence for the endoscopic treatment of UPJ and ureteral strictures is low. Despite this, it appears that endoureterotomy and endopyelotomy performed mainly with Ho:YAG laser achieve good success rates with minimal perioperative morbidity. Conclusions Laser endoureterotomy and endopyelotomy should be considered a reasonable treatment option in selected patients. Keywords Endoureterotomy · Endopyelotomy · Ureteropelvic junction obstruction · Ureteral stenosis · Endoscopic laser pyelotomy · Endoscopic laser ureterotomy · Minimal invasive treatment
Introduction Ureteral and ureteropelvic junction stricture is a major concern in urology since renal function may be silently affected. Such condition can be developed after surgery
with considerable incidence after ureteroscopic procedures (0.5–11 %) [1–3], also as a consequence of infectious or inflammatory diseases such as tuberculosis or endometriosis, when scaring for lithiasis passage or impacted stone, and even as an idiopathic condition [4]. Although traditional open and laparoscopic surgical repair remains the gold standard, they may lead to extended surgical times, hospital stay, postoperative morbidity and recovery time [5, 6]. Technological advances have made endoscopic laser pyelotomy (ELP) and ureterotomy (ELU) a good treatment option for selected patients with benign ureteral strictures (including pediatrics) [7, 8] providing minimally invasive approaches with hardly any perioperative morbidity and short recovery time with success rates up to 89 % [9, 10]. Holmium:yttrium–aluminum–garnet laser (Ho:YAG) is the most used laser among studies, being those series likely reproducible with similar success rates and similar and lower complication rates unlike other endourological implements [11–13]. No crucial differences in outcomes between laser types have been published. The role of ELP and ELU remains under constant evaluation with acceptable outcomes in recent series that recommend the minimally invasive technique as a reasonable treatment option in selected cases [9, 14, 15]. We analyzed the current literature in order to obtain the best strategy to treat ureteral stenosis and ureteropelvic junction obstruction (UPJO) by endoscopic means with laser technology.
Materials and methods E. Emiliani (*) · A. Breda Fundación Puigvert, Universitat Autonoma de Barcelona, Carrer Cartagena 340‑350, 08025 Barcelona, Spain e-mail: [email protected]
A systematic review of the current available literature on LEU and endopyelotomy was performed. Articles in English, Spanish, Italian and French were included
13
using PubMed database from the last decade up to May 2014. The mesh terms used were as follows: “ureteral stenosis” “ureteral stricture,” “endoureterotomy,” “laser endoureterotomy,” “retrograde laser endoureterotomy,” “laser endopyelotomy” and “ureteropelvic junction endopyelotomy,”“ureteroileal stenosis”. Case reports, short series (
TOPIC PAPER
Laser endoureterotomy and endopyelotomy: an update Esteban Emiliani · Alberto Breda
Received: 29 July 2014 / Accepted: 10 September 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose Although minimally invasive approach is one of the first-line treatment choices for ureteral strictures, there are still controversies on the ideal method to treat this entity. The objective of this update was to define the level of evidence around endoscopic treatment of ureteropelvic junction (UPJ) and ureteral strictures. Methods We reviewed the current available literature on the PubMed database from the last decade up to May 2014 on laser endoureterotomy and endopyelotomy. Results The level of evidence for the endoscopic treatment of UPJ and ureteral strictures is low. Despite this, it appears that endoureterotomy and endopyelotomy performed mainly with Ho:YAG laser achieve good success rates with minimal perioperative morbidity. Conclusions Laser endoureterotomy and endopyelotomy should be considered a reasonable treatment option in selected patients. Keywords Endoureterotomy · Endopyelotomy · Ureteropelvic junction obstruction · Ureteral stenosis · Endoscopic laser pyelotomy · Endoscopic laser ureterotomy · Minimal invasive treatment
Introduction Ureteral and ureteropelvic junction stricture is a major concern in urology since renal function may be silently affected. Such condition can be developed after surgery
with considerable incidence after ureteroscopic procedures (0.5–11 %) [1–3], also as a consequence of infectious or inflammatory diseases such as tuberculosis or endometriosis, when scaring for lithiasis passage or impacted stone, and even as an idiopathic condition [4]. Although traditional open and laparoscopic surgical repair remains the gold standard, they may lead to extended surgical times, hospital stay, postoperative morbidity and recovery time [5, 6]. Technological advances have made endoscopic laser pyelotomy (ELP) and ureterotomy (ELU) a good treatment option for selected patients with benign ureteral strictures (including pediatrics) [7, 8] providing minimally invasive approaches with hardly any perioperative morbidity and short recovery time with success rates up to 89 % [9, 10]. Holmium:yttrium–aluminum–garnet laser (Ho:YAG) is the most used laser among studies, being those series likely reproducible with similar success rates and similar and lower complication rates unlike other endourological implements [11–13]. No crucial differences in outcomes between laser types have been published. The role of ELP and ELU remains under constant evaluation with acceptable outcomes in recent series that recommend the minimally invasive technique as a reasonable treatment option in selected cases [9, 14, 15]. We analyzed the current literature in order to obtain the best strategy to treat ureteral stenosis and ureteropelvic junction obstruction (UPJO) by endoscopic means with laser technology.
Materials and methods E. Emiliani (*) · A. Breda Fundación Puigvert, Universitat Autonoma de Barcelona, Carrer Cartagena 340‑350, 08025 Barcelona, Spain e-mail: [email protected]
A systematic review of the current available literature on LEU and endopyelotomy was performed. Articles in English, Spanish, Italian and French were included
13
using PubMed database from the last decade up to May 2014. The mesh terms used were as follows: “ureteral stenosis” “ureteral stricture,” “endoureterotomy,” “laser endoureterotomy,” “retrograde laser endoureterotomy,” “laser endopyelotomy” and “ureteropelvic junction endopyelotomy,”“ureteroileal stenosis”. Case reports, short series (
