OVERVIEW

Endopyelotomy is an endoscopic surgery for the enlargement of the junction of the renal pelvis with the ureter, which facilitates the transport of urine from the kidney to the bladder.

The reasons for making an endopyelotomy are as follows:

  • Ureteropelvic junction (UPJ) obstruction (congenital condition)
  • UPJ obstruction (acquired by renal stones or previous surgeries)
  • Recurrence of UPJ obstruction after another treatment such as open or laparoscopic pyeloplasty.

Benefits of doing a laser endopyelotomy

The purpose of performing endopyelotomy is to restore the normal anatomy of the urinary tract to facilitate the transport of urine from the kidney to the bladder and thus avoid permanent and irreversible damage to the kidney. In other words, endopyelotomy can save the obstructed kidney from possible chronic kidney failure.

Laser endopyelotomy is a surgery that offers rapid recovery and little postoperative pain, since it is performed through endoscopy (no incisions are made).

The obstruction is cut by the Holmium laser, this gives a great precision to the procedure and decreases the risk of bleeding.

Risks and Complications

Possible complications that can arise when performing a laser endopyelotomy are the same that can occur in general with any surgical procedure and are hemorrhage, damage to nearby organs, reactions to anesthesia, etc. However, these complications occur infrequently and most of the time they can be resolved during the same surgery.

Another risk of laser endopyelotomy is the recurrence of the obstruction UPJ this occurs in less than 10% of the patients, when this happens, another surgery like open or laparoscopic pyeloplasty are indicated.

Alternatives to laser endopyelotomy

The aim of the laser endopyelotomy is to relief the obstruction that is found in the union of the renal pelvis and ureter, this can also be achieved by an open or laparoscopic pyeloplasty. Patients who are waiting for any of these corrective procedures may carry a JJ catheter, which allows the urine to drain until the surgery is performed.

To expect from the laser endopyelotomy

Day of surgery:

You will arrive at the hospital the same day of surgery on an empty stomach.

The surgery takes approximately 2 to 3 hours; however, the time is variable.

Anesthesia for this procedure is a spinal block (on the back) and sedation so you won’t feel pain and you’ll be relaxed during your procedure.

Pain after laser endopyelotomy is minimal and can be effectively controlled with intravenous analgesics.

Food: you can eat in the afternoon after the surgery, there are no dietary restrictions, however, a balanced diet is recommended.

Physical activity: you can walk the same day after surgery. It is normal to feel a little tired after any surgery, that problem resolves spontaneously a few weeks after laser endopyelotomy.

Hospital stay: most patients undergoing laser endopyelotomy remain hospitalized for 2 to 3 days.

Wounds: this procedure does not leave scars on the skin because is done by endoscopy through the urethra.

Catheter: a JJ stent is inserted into the ureter after performing a laser endopyelotomy that remains after surgery for 6 weeks to facilitate uniform healing of the urinary tract; this catheter is not visible because it is inside the body; however, some patients perceive a slight discomfort such as burning during urination, mild back pain, hematuria (blood in the urine) and urgency (frequent urination). The extraction of this catheter is done through endoscopy and can be done as an outpatient procedure in an office.