Endopyelotomy After Failed Pyeloplasty: The Long-Term Results

Jabbour, Michel E.; Goldfischer, Evan R.; Klima, Wlodzimierz J.; Stravodimos, Konstantinos; Smith, Arthur D.

doi:10.1016/s0022-5347(01)62757-5

Cited by 57 publications

(20 citation statements)

References 26 publications

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“…Crossing vessels, for example, decreases the success rate from 82 to 33% and can be detected by spiral CT and endoluminal ultrasound respectively in 79 and 53% of UPJ obstructions [5][6][7] . Other factors can be poor renal function and redundant pelvis [8] . These could be some of the reasons related to the fact that in many institutions, the laparoscopic pyeloplasty in primary UPJ obstruction is, today, gaining more popularity than endopyelotomies.…”

Section: Discussionmentioning

confidence: 99%

Ureteroscopic Laser Endopyelotomy in Secondary UPJ Obstruction after Pyeloplasty Failure

Grazia¹,

Nicolosi²

2005

Urol Int

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Objectives: Secondary ureteropelvic junction (UPJ) obstruction after failure of open and laparoscopic repair may be challenging to resolve due to possible extensive fibrosis and the increased invasiveness of this procedure. Alternatively, ureteroscopic laser endopyelotomy may be a more acceptable procedure for patients and surgeons. We report our preliminary experience with ureteroscopic holmium laser endopyelotomy after open pyeloplasty failure and define the complications that arose and the results. Materials and Methods: We performed 6 retrograde endopyelotomies with a holmium laser for failed UPJ repairs following the Anderson-Hynes procedures. Patient follow-up was carried out every 3 months using sonography and renal scan, and again after 1 year using renal scan and urography. Results: Mean hospitalization was 2.1 days. Ureteroscopic laser endopyelotomy was successful in 4 cases (66.6%). In 2 patients, failure occurred at the third month of follow-up. Complications included 1 case of slight bleeding, which was resolved conservatively without the need for blood transfusion, and 2 cases of guidewire rupture. Conclusions: Secondary UPJ obstruction is more challenging to resolve by open or laparoscopic approach. Retrograde endopyelotomy gives a valid alternative thanks to its success rate and its better acceptance by patients. We consider retrograde laser endopyelotomy the approach to choose when faced with secondary UPJ obstruction after open or laparoscopic failures.

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Section: Discussionmentioning

confidence: 99%

Ureteroscopic Laser Endopyelotomy in Secondary UPJ Obstruction after Pyeloplasty Failure

Grazia¹,

Nicolosi²

2005

Urol Int

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“…No Whitaker test was performed. Hydronephrosis was classified as grade I (mild), II (moderate), III (severe) and IV (massive) based on IVP and ultrasound findings, as described by Jabbour et al [3]. Renal function was considered good, moderate or poor if the kidney achieved greater than 40, 25 to 40 or less than 25% of total function, respectively [3].…”

Section: Methodsmentioning

confidence: 99%

Long-Term Results of Anderson-Hynes Pyeloplasty in 180 Adults in the Era of Endourologic Procedures

Göğüş

Karamürsel²,

Tokatlı³

et al. 2004

Urol Int

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Introduction: The aim of the present study wasto evaluate the long-term results of adult open pyeloplasties performed by the Anderson-Hynes technique in the era of new endourologic procedures. Materials and Methods: The medical records of 180 adult patients who underwent Anderson-Hynes pyeloplasty with a diagnosis of ureteropelvic junction (UPJ) obstruction, were retrospectively reviewed. Pre- and postoperative results were compared with clinical, radiologic and radionuclide studies. The mean age of the patients was 33.2 (16–65) years. The minimum clinical follow-up time was 12 months and the mean time from the operation was 9.4 years (between 1 and 17 years). Results: Success was defined as resolution of symptoms and decrease in pyelocaliceal volume and calicectasis. The overall success rate was 91.1%. The success rate was between 93.1 and 100% in patients with grades I–III and 62.5% in patients with grade IV hydronephrosis and contribute to renal function less than 25%. The pyelocaliceal volume returned to normal in 39 (21.7%) patients, significantly decreased in 82 (45.5%), and the flow of contrast media from renal pelvis to ureter improved in 43 (23.9%) and did not change or increased in 16 (8.9%). The failure happened in the first 3 months in 57% of patients and in long-term follow-up in 43% of patients. Conclusion: Despite newer endoscopic techniques, Anderson-Hynes pyeloplasty, with an over 90% success rate remains the gold standard in the treatment of primary UPJ obstruction.

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“…The main advantages of antegrade endopyelotomy are its minimally invasive nature, relative ease of learning, and ability to treat successfully concomitant renal stones. Although this approach may be selected as first-line therapy, it is specifically indicated for patients who have failed previous open or laparoscopic pyeloplasty [12].…”

Section: Indications For Surgical Therapymentioning

confidence: 99%

“…The need for transfusion has been reported as less than 5% and selective embolization less than 2.5% in most series [12,21]. Other significant problems can include urinoma formation (< 2%) [23,24], urosepsis (< 4%) [20,21,25], and (very rarely) nephrectomy.…”

Section: Complicationsmentioning

confidence: 99%

Antegrade percutaneous endopyelotomy

Ko¹,

Duvdevani²,

Denstedt

2007

Curr Urol Rep

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Ureteropelvic junction obstruction (UPJO) is a well-known pathologic condition with several potential associated urologic complications. The treatment for UPJO has evolved dramatically during the past two decades with the advent of minimally invasive treatment options. This has resulted in shorter hospital stays, reduced postoperative pain, and quicker convalescence compared with the gold standard, open pyeloplasty. Antegrade (percutaneous) endopyelotomy is one of the many minimally invasive treatment options for this disorder. In this article, we review the technical aspects, outcomes, and current role of antegrade endopyelotomy in the treatment of UPJO.

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Endopyelotomy After Failed Pyeloplasty: The Long-Term Results

Cited by 57 publications

References 26 publications

Ureteroscopic Laser Endopyelotomy in Secondary UPJ Obstruction after Pyeloplasty Failure

Ureteroscopic Laser Endopyelotomy in Secondary UPJ Obstruction after Pyeloplasty Failure

Long-Term Results of Anderson-Hynes Pyeloplasty in 180 Adults in the Era of Endourologic Procedures

Antegrade percutaneous endopyelotomy

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