Endopyelotomy and Pyeloplasty: Face to Face

Retroperitoneoscopic Treatment of Ureteropelvic Junction Obstruction

“…A clear disadvantage of the retroperitoneoscopic approach is the smaller operative field compared to the transperiMinimally invasive treatment of ureteropelvic junc tion obstruction was initially reported in 1983 [1,9], Per cutaneous or retrograde endopyelotomy provide the ad vantages of significantly reduced hospitalization and re covery while yielding success rates upwards of 80% [3,10]. However, while retrograde and antegrade endopye lotomy offer similar success rates, incision of the uretero pelvic junction with a ureteroscope is technically more difficult than using the percutaneous technique [4], Recently, Banerjee et al [2] reported on a comparative study between percutaneous endopyelotomy and open pyeloplasty, concluding that there were no significant dif ferences in terms of efficacy and overall morbidity, but only for what concerns hospital stay and cosmetic results. As for hospital stay, Karlin et al [3] compared the postop erative course in patients treated by either open pyelo plasty or endopyelotomy.…”

“…During the last few years, there have been significant advances in the management of ureteropelvic junction obstruction; minimally invasive techniques offered signif icantly reduced morbidity to the patients with success rates comparable to open pyeloplasty [1][2][3], The endourological techniques include antegrade percutaneous endopyelotomy and retrograde approach to the ureteropelvic junction [4], Fluoroscopically controlled balloon incision of the ureteropelvic junction has been proposed, too [3], However, endoscopic techniques are not indicated in patients with large redundant renal pelvis or with large crossing lower pole renal vessels [5], as the overall success rate is lower than with open surgery. In an effort to match the success rate of open pyeloplasty and to eliminate the need for a large skin incision, Schuessler et al [6] obtained moderate to significant improvement in 4 out of 5 pa tients submitted to laparoscopic transperitoneal dismem bered pyeloplasty.…”

Objective evaluation of the outcome of endopyelotomy using Whitaker's test and diuretic renography

“…Symptoms are often atypical and intermittent. Persistent or recurrent bacteriuria may also make the suspicion of failure strong, but bacteriuria may be detected during early follow-up especially in cases with prolonged external drainage, despite a successful outcome [14]. Improvements on IVU, although subjective, rule out persistent obstruction.…”

“…and if drainage into the bladder has not been documented simultaneously [9,10]. WT following endopyelotomy may also not be recommended routinely as it requires the maintenance of prolonged external drainage, with the attendant risks of infection and tube-related complications [14]. The morbidity related to prolonged external drainage can be reduced significantly by decreasing the duration of splinting.…”

Endopyelotomy in Poorly Functioning Kidney: Is It Worthwhile?

“…Endopyelotomy was performed using a cold knife by a twin guidewire rail technique. 21 The UPJ was incised posterolaterally and splinted with either a 12F or a 14F polyethylene tube along with a nephrostomy tube for 4 to 6 weeks (until 1995) or an endopyelotomy stent (7F/14F) for 2 to 6 weeks (after 1995).…”