Endopyelotomy for Primary Repair of Ureteropelvic Junction Obstruction

Brannen, George E.; Bush, William H.; Lewis, Gregory P.

doi:10.1016/s0022-5347(17)42280-4

Cited by 36 publications

(7 citation statements)

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“…However, the technique did not gain popularity until 1983 when Whitfield et al [6], and Wickham and Keilet [7] described pyelolysis (endopyelotomy) in which the PUJ obstruction was approached percutaneously and incised with a cold knife under direct vision. Since then, more investigators have reported endopyelotomy in the treatment of PUJ obstruction but in relatively small groups of predominantly adult patients [9,17,18], In our group of paediatric patients, we attempted endopyelotomy in 17 cases and had relief of obstruction in 10 (58%). However, allowing for the fact that 4 of our 17 patients did not come to endopyelotomy for the rea sons already outlined, 10 of 13 children undergoing endo pyelotomy have had a successful outcome.…”

Section: Discussionmentioning

confidence: 95%

“…We have abandoned endopyelotomy in favour of an open pyeloplasty if we fail to pass a retrograde guide into the pelvis of the kidney, but others have suggested manoeuvres such as antegrade placement of guide wire via a nephrostomy tract or even retrograde manipulation with a flexible nephroscope [9,18], We have not attempted either of these manoeuvres as it has been our experience that the PUJ can be very diffi cult to identify antegradely in an infant.…”

Section: Discussionmentioning

confidence: 99%

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Endopyelotomy for Pelvi-Ureteric Junction Obstruction in Children

Najmaldin

1993

Eur Urol

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Endopyelotomy for Pelvi-Ureteric Junction Obstruction in Children

Najmaldin

1993

Eur Urol

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“…The degree of hydronephrosis and the renal function are interlinked issues for assessing the appropriateness for endopyelotomy. High grade hydronephrosis and poorly functioning kidneys are associated with poor results of about 50-60% [9,10]. We had 3 cases of severe hydronephrosis, all being primary PUJ obstructions and in all of these endopyelotomy was successful.…”

Section: Discussionmentioning

confidence: 95%

“…Crossing vessels to the lower pole are often found in normal subjects in about 71.3% of population [8]. They are also occasionally associated causally to PUJ obstruction and are also reported to lower the success rate of endopyelotomy [9,10]. Many authors have reported on the need for preoperative screening for crossing vessels using Intraluminal Ultrasound or Spiral CT with a pick up rate ranging from 53-71% on Intraluminal Ultrasound [12] versus 79% on Spiral CT [13].…”

Section: Discussionmentioning

confidence: 99%

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

Pradhan

Sood

Madhusoodanan

et al. 2003

Medical Journal Armed Forces India

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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

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“…In den letzten Jahren wurden verstärkt Endopyelotomietechniken als minimalinvasive Alternative zur Therapie der primären Nierenbeckenabgangsstenose eingeführt [2,5,6,7]. Ohne Zweifel sind diese endoskopisch durchgeführten Inzisionen mit einer geringeren perioperativen Morbidität verbunden allerdings sind die Erfolgsraten um 10-20% geringer als nach offener Nierenbeckenplastik [19,21,34].…”

Section: Diskussionunclassified

Die laparoskopische Nierenbeckenplastik mit Kontinuitätstrennung nach Anderson-Hynes

et al. 2003

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Because of the minimal invasiveness of the laparoscopic approach, we introduced the laparoscopic dismembered pyeloplasty in our treatment modalities for patients with primary UPJ obstruction. We report on our technique and the results after a median follow-up of more than 2 years. Between August 1997 and September 2002, 52 patients underwent a laparoscopic dismembered pyeloplasty at our institution. All patients had a symptomatic primary PJ obstruction. We prefer the transperitoneal route with laterocolic exposure of the kidney. After preparation and exposure of the ureter and the renal pelvis, we performed in each case the dismembered Anderson-Hynes pyeloplasty with resection of the pelvis and reanastomosis between the ureter and renal pelvis. Intracorporeal suturing and knotting techniques were used exclusively. All procedures could be performed successfully. In no case was conversion to open surgery necessary. The mean operative time was 180 min. Crossing vessels were present in 57% of patients. The mean postoperative hospital stay was 4 days. The first patient had an anastomosis insufficiency, which required laparoscopic repair. The same patient failed in the follow-up. He developed a late recurrence of the stenosis and needed an open repair. In all other patients the obstruction was resolved or significantly improved. The long-term success rate is 98% with a follow-up of 25 months. Our results with laparoscopic dismembered pyeloplasties compare favorably with those achieved by open pyeloplasties with less perioperative morbidity and discomfort. We do believe that laparoscopic dismembered pyeloplasty will be the method of choice in the treatment of UPJ obstruction.

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Endopyelotomy for Primary Repair of Ureteropelvic Junction Obstruction

Cited by 36 publications

References 14 publications

Endopyelotomy for Pelvi-Ureteric Junction Obstruction in Children

Endopyelotomy for Pelvi-Ureteric Junction Obstruction in Children

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

Die laparoskopische Nierenbeckenplastik mit Kontinuitätstrennung nach Anderson-Hynes

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