Русский
Transurethral endopyelotomy using thulium fiber laser
DOI: https://dx.doi.org/10.18565/urology.2020.3.63-68
A.G. Martov, M.Yu. Golubev, D.V. Ergakov, P.M. Golubev, N.A. Baykov, A.S. Andronov, D.A. Abdullaev
Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, GBUZ “City clinical hospital named after D.D. Pletnev” of the Health Department c. Moscow, Moscow, Russia
Introduction. Transurethral endopyelotomy is an alternative treatment method for short stricture of ureteropelvic junction (UPJ).
Aim: to evaluate the efficiency of transurethral thulium laser endopyelotomy.
Materials and methods. A total of 94 patients with UPJ obstruction during the period from December 2016 to December 2018 were prospectively enrolled in the study. Pelvic size did not exceed 3 cm in 31 patients, and it was in the range from 3 to 4 cm and more than 4 cm in 35 and 28 cases, respectively. Depending on the treatment, all patients were divided into 2 groups. The main group included 48 patients who underwent retrograde thulium fiber laser endopyelotomy. In the control group (n = 46), patients underwent Anderson-Hynes laparoscopic pyeloplasty. In the main group, there were significantly more patients with more preserved ipsilateral kidney function, with short (less than 1 cm) and recurrent UPJ strictures and less severe hydronephrosis compared to the control group. In addition, there were no patients with crossing vessel in the main group. Postoperatively, an internal stent of 6–8 Fr was put in all patients for a period of 6–8 weeks. After stent removal, all patients underwent a follow-up examination, including an ultrasound examination and, if pelvic size was more than 3 cm, contrast-enhanced CT-urography was performed.
Results. In all patients, after stent removal, a decrease in the pelvic size was noted. The operation time in the main and control group was 24±14 minutes and 82±26 minutes, respectively. In all cases, ureteropyeloscopy was performed prior to laparoscopy to determine the exact length of stricture and to exclude narrowing of other parts of the ureter. After follow-up of 24 months, an examination in 36 patients of the main group and 29 patients of the control group was performed. There was 1 recurrence after laparoscopic pyeloplasty and 1 recurrence after endopyelotomy. In other patients of both groups, there were neither stricture, nor impaired renal function.
Conclusion. The first experience of using a thulium fiber laser for transurethral endoscopic treatment of UPJ obstruction is presented in the article. Indications for the transurethral thulium endopyelotomy are the presence of primary or secondary UPJ obstruction (with a decrease in kidney function by no more than 40%), length of up to 1 cm, absence of an additional vessel and pelvic dilatation of no more than 4 cm.
Aim: to evaluate the efficiency of transurethral thulium laser endopyelotomy.
Materials and methods. A total of 94 patients with UPJ obstruction during the period from December 2016 to December 2018 were prospectively enrolled in the study. Pelvic size did not exceed 3 cm in 31 patients, and it was in the range from 3 to 4 cm and more than 4 cm in 35 and 28 cases, respectively. Depending on the treatment, all patients were divided into 2 groups. The main group included 48 patients who underwent retrograde thulium fiber laser endopyelotomy. In the control group (n = 46), patients underwent Anderson-Hynes laparoscopic pyeloplasty. In the main group, there were significantly more patients with more preserved ipsilateral kidney function, with short (less than 1 cm) and recurrent UPJ strictures and less severe hydronephrosis compared to the control group. In addition, there were no patients with crossing vessel in the main group. Postoperatively, an internal stent of 6–8 Fr was put in all patients for a period of 6–8 weeks. After stent removal, all patients underwent a follow-up examination, including an ultrasound examination and, if pelvic size was more than 3 cm, contrast-enhanced CT-urography was performed.
Results. In all patients, after stent removal, a decrease in the pelvic size was noted. The operation time in the main and control group was 24±14 minutes and 82±26 minutes, respectively. In all cases, ureteropyeloscopy was performed prior to laparoscopy to determine the exact length of stricture and to exclude narrowing of other parts of the ureter. After follow-up of 24 months, an examination in 36 patients of the main group and 29 patients of the control group was performed. There was 1 recurrence after laparoscopic pyeloplasty and 1 recurrence after endopyelotomy. In other patients of both groups, there were neither stricture, nor impaired renal function.
Conclusion. The first experience of using a thulium fiber laser for transurethral endoscopic treatment of UPJ obstruction is presented in the article. Indications for the transurethral thulium endopyelotomy are the presence of primary or secondary UPJ obstruction (with a decrease in kidney function by no more than 40%), length of up to 1 cm, absence of an additional vessel and pelvic dilatation of no more than 4 cm.
About the Autors
Corresponding author: A.G. Martov – MD, professor, Honored Physician of the Russian Federation, Head of the Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Head of the urologic department of GBUZ “City clinical hospital named after D.D. Pletnev” of the Health Department c. Moscow, Moscow, Russia; e-mail: martovalex@mail.ru
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