Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
Urologia. 2021 Feb;88(1):34-40. doi: 10.1177/0391560320904259. Epub 2020 Feb 12.
To evaluate the factors affecting the effectiveness, safety, and success of retrograde holmium:yttrium-aluminum-garnet laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction in adults.
Adult patients who underwent retrograde holmium:yttrium-aluminum-garnet laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction between January 2012 and June 2016 at our clinic were retrospectively analyzed. Success was defined as the relief of symptoms and the resolution of obstruction, as assessed via radiography. Factors affecting success were analyzed, such as the clinical characteristics, procedural outcomes, complications, and the type of ureteroscopy used in the procedure.
Procedural success was achieved in 29 (74.4%) out of 39 patients, with a mean age of 38.3 ± 12.3 years during a median follow-up duration of 44 (33-65) months. Failure occurred at a median of 4.5 (3-22) months. It was detected that the presence of primary obstruction, ipsilateral kidney function being >30% of normal, and the length of obstruction being <1 cm positively affected procedural success ( = 0.009, = 0.011, and = 0.019, respectively). In the postoperative period, two Grade I and four Grade II complications were observed according to the Clavien-Dindo classification. There was a difference only in the operation time between semirigid (24) and flexible ureteroscopes (15), with the operation time being shorter with the use of a semirigid ureteroscope than with the use of a flexible uteroscope ( < 0.001).
Retrograde holmium:yttrium-aluminum-garnet laser endopyelotomy is a minimally invasive method that can be used effectively and safely as the primary treatment of patients with ureteropelvic obstruction, when long-term results are also taken into consideration. The decision of performing laser endopyelotomy should be made after a detailed evaluation of the characteristics of the patient as well as of the obstruction.
评估逆行钬：钇-铝-石榴石激光内切开术作为成人肾盂输尿管连接部梗阻的主要治疗方法的有效性、安全性和成功率的影响因素。
回顾性分析 2012 年 1 月至 2016 年 6 月在我科接受逆行钬：钇-铝-石榴石激光内切开术作为成人肾盂输尿管连接部梗阻的主要治疗的成年患者。成功定义为症状缓解和梗阻解除，通过影像学评估。分析影响成功率的因素，如临床特征、程序结果、并发症以及手术中使用的输尿管镜类型。
39 例患者中，29 例（74.4%）手术成功，平均年龄 38.3±12.3 岁，中位随访时间为 44（33-65）个月。失败发生在中位时间为 4.5（3-22）个月。研究发现，原发性梗阻的存在、同侧肾脏功能>30%正常和梗阻长度<1cm 对手术成功率有积极影响（=0.009、=0.011 和=0.019）。术后根据 Clavien-Dindo 分类，观察到 2 例 I 级和 4 例 II 级并发症。只有半刚性（24）和软性输尿管镜（15）之间的手术时间有差异，与使用软性输尿管镜相比，使用半刚性输尿管镜的手术时间更短（ < 0.001）。
逆行钬：钇-铝-石榴石激光内切开术是一种微创方法，当考虑到长期结果时，可有效且安全地作为肾盂输尿管连接部梗阻患者的主要治疗方法。在进行激光内切开术之前，应根据患者的特征以及梗阻的特征进行详细评估。
