Ureteropelvic Junction Complete Obstruction After Failed Pyeloplasty: Endoscopic Combined Recanalization with the “Cut to the Light” Technique

Abstract

Aim of the Study:

The success rate of Anderson and Hynes dismembered pyeloplasty is more than 90% according to different published series. ¹ Failed pyeloplasty management options include open/laparoscopic surgery or an endoscopic approach. ² A case of a secondary ureteropelvic junction complete obstruction treated with a combined endoscopic approach is presented.

Materials and Methods:

A 58-year-old man with a nephrostomy tube was referred after recent failed dismembered open pyeloplasty, having previously undergone two other ipsilateral stone removal procedures (open pyelolithotomy and percutaneous nephrolithotomy). Evaluation with a simultaneous retrograde and anterograde pyelogram showed a 1 cm gap between upper ureter and pyelocaliceal system with an intrarenal pelvis.

Results:

With the patient in Valdivia–Galdakao position, a thulium laser ³ (settings 1 J/10 Hz, fiber size 275 μm) combined “cut to the light” technique was used uneventfully, followed by a pneumatic dilatation with a 8 mm balloon and positioning of a Double-J stent. The patient was discharged the following day without the nephrostomy tube.

Conclusions:

Total endoscopic approach in failed open pyeloplasty is a safe and less invasive technique that can be tried before a more invasive surgical reconstructive procedure, especially in a plurioperated kidney with an intrarenal pelvis, where the chance of surgical success is low.

No competing financial interests exist.

Runtime of video: 5 mins

This video was presented at the World Congress of Endourology in Cape Town, South Africa, in November 2016.