Uro-8. Long term results of retrograde ureteroscopic endopyelotomy for uretero-pelvic-junction obstruction.

In recent years, with refinements in endourological techniques and development of smaller ureteroscopes, laparoscopes and laser technology, the surgical options for the management of UPJO have evolved towards minimally invasive procedures, and these indications are being expanded to include children. As compared to other treatment options, the retrograde ureteroscopic endopyelotomy is less invasive, requires less OR time, allows performance of the procedure on an outpatient basis or with a very short hospital stay, and is associated with a shorter convalescence period. The charts of 144 consecutive patients that underwent retrograde ureteroscopic endopyelotomy at Tulane University between 1989 and 2002 were analyzed. These patients included 7 pediatric patients, 4 solitary kidneys, 2 horseshoe kidneys, and 1 ptotic kidney. Both electrocautery and holmium laser were used to incise the UPJO. One hundred twelve (78%) patients were treated with long-term success. Thirty-two (22%) of them required subsequent procedures to treat a recurrence of obstruction. Fourteen of those patients (9.7%) required open or laparoscopic surgical intervention, including nephrectomies for severe hydronephrosis and non-improvement in renal function in 3 (2%) cases; emergent nephrectomy for severe bleeding in 1 (0.7%) case; dismembered open surgical pyeloplasties in 8 (5.5%) cases; and spiral flap pyeloplasties in 2 (1.3%) cases. Thirteen (9%) patients required cystoscopy and balloon dilation of the ureteropelvic junction, 4 (2.7%) required repeated retrograde ureteroscopic endopyelotomy, and 1 (0.7%) required long-term indwelling ureteral stenting. Retrograde ureteroscopic endopyelotomy provides a safe and adequate first line of treatment for patients suffering from UPJO, but patients with crossing vessels, patulous redundant renal pelvis, and borderline salvageable renal function should undergo alternative treatment modalities, such as open or laparoscopic pyeloplasty or nephrectomy, rather than be subjected to endopyelotomy.

Jeffrey Bejma, MD, Freddy R. Mendez-Torres, MD, Ruben Urena, MD, Manoj Monga, MD, and Raju Thomas, MD. Tulane University School of Medicine, Department of Urology, New Orleans, LA.