Endopyelotomy – a Minimally Invasive Surgical Option for Pelvi-ureteric Junction Obstruction: a Study Of 34 Cases

Abstract

We performed antegrade endopyelotomy in 34 cases in the last 2½ years. In all cases standardized antegrade percutaneous method was used. A single guide wire and a cold knife were used to perform the endopyelotomy. Nephrostomy tube was retained for 48 hours and the repair stented for 6 weeks. Patients were followed up at 3 months, 6 months and 1 year post-operatively for subjective improvement and objectively by DTPA scans/IVU and ultrasound. The population included 2 bilateral cases, one horseshoe kidney and 3 children. The patient's age ranged from 9-59 years, average 32 years. There were 21 males and 13 females. 28 renal units were primary and 8 were secondary pelviureteric junction (PUJ) obstruction. Follow up period was 3-28 months. Most cases had significant symptomatic and functional recovery postoperatively. Five cases presented with urinary tract infection, which regressed after treatment. At 3 rd month postoperatively the DTPA/IVU scan was equivocal in 7 cases. In these, a RGP was done which in every case showed a patent PUJ. In 5 cases that were still symptomatic, 6-8 weeks of further stenting produced symptom regression. Two cases failed and needed revision, one by open pyeloplasty and the other by endopyelotomy. Our success rate overall in these cases followed upto 1 year post operatively is 91.6%. We conclude that endopyelotomy is successful across a wide spectrum of cases. MJAFI 2003, 59 : 320-323Key Words : Endopyelotomy; Pelvi-ureteric junction Endopyelotomy is a minimally invasive option for the management of these cases. The principle was laid down as late back as 1940 in the operation of "Intubated Ureterotomy" devised by Davis. The procedure needs a small incision about 1.5-2 cm. The operative time is short, usually about 40-50 minutes. Consequently, it is associated with less morbidity. The procedure can be performed either by the antegrade nephroscopic approach or by the retrograde ureteroscopic approach. We present our experience in endopyelotomy done with a single guide wire, using the antegrade method and analyse our results for the 34 cases we performed in the last 2½ years. Material and MethodsIn the last two years we have operated on 34 cases. In these, 36 operations were done with two cases being bilateral. Preoperative evaluation of all patients included an IVU, ultrasound of the kidney, ureter, bladder region and DTPA scan in addition to routine investigations for fitness for a major operative procedure. In all cases the procedure was done in a standardized manner using the antegrade percutaneous method. First, the anatomy of the PUJ was delineated by means of a retrograde pyelogram. Thereafter, a guide wire was passed retrograde through the obstructed segment. Access for the pelvi-calyceal system was established through the mid or the upper calyx. The previously