Laser Endo-Pyelotomy

Endoscopic opening of pelvi-ureteric junction stricture.

Endoscopic technique of incising a short stricture with a laser. A stent remains 6 weeks post operatively

Stricturing or narrowing of the ureter causing significant hydronephrosis.
Leading to chronic infection.
End-result is loss of renal function.
An end-to-end anastomosis can be considered in the mid ureter.
A Reimplantation into the bladder with lower ureteric strictures.
A pelvi-ureteric junction repair in higher ureteric strictures.
A trans uretero-ureteric anastomosis joining one ureter to the other where long defects are present.
Renal Auto Transplantation where ureter is completely damaged or.
An ileal ureteric substitution where to whole ureter is damaged.

Patients will receive a general anesthesia.
Prophylactic antibiotics is given.
The correct ureteric system is identified and marked while you are awake.
This will be mostly an endoscopic procedure.
A cystoscopy will be done with placement of ureteric guidewires.
The affected ureter is entered with ureteroscopy. Laser is used to cut through the short stricture until peri-ureteric fat is observed.
This is not an advisable procedure where the stricture overlies vascular structures.
A ureteric stent is placed.
An indwelling catheter is placed.

You may be in hospital for 3 days.
Your drain will be removed when there is no urine draining.
Your catheter will be removed the following day.
As soon as you are comfortable with no signs of pain and emptying your bladder sufficiently, you will be discharged.
A follow-up appointment will be scheduled for 6 weeks to remove your ureteric stent under local anesthesia with a Flexible Cystoscope.
A review with a CT IVP will be scheduled 6 weeks after this to check on the end result of the ureter.
Any pain or signs of fever require an urgent review.
DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

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Wes Laser Endo-Pyelotomy