Endopyelotomy: Review of Results and Complications

Abstract

Percutaneous endopyelotomy augmented by balloon dilation was performed on 27 of 40 patients for the treatment of symptomatic, primary ureteropelvic junction obstruction. Percutaneous ultrasonic lithotripsy was performed simultaneously on 12 of 27 patients (44%) for associated calculi. After endopyelotomy 24 of 27 patients became asymptomatic (clinical success rate 89%). Three clinically improved patients demonstrated only radiographic stability, while radiographic improvement was documented in 21 of 27 (radiographic success rate 78%). Adjuvant percutaneous ultrasonic lithotripsy was successful from the standpoint of stone removal in all patients and no increased morbidity could be identified. Of 27 patients 3 (11%) suffered major complications and are considered failures. Reasons for failure varied and are discussed. Included is a patient who at nephrostography and stent capping became septic and subsequently died. To decrease the risk of sepsis perioperative antibiotics to include at the time of nephrostomy tube capping are recommended. Angiography was performed in 19 of 40 patients to rule out an accessory crossing vessel at the ureteropelvic junction, and such a vessel was found in 6. From analysis of presenting excretory urograms (IVPs) we conclude that a crossing vessel cannot predictably be identified on an IVP.

Ureteroscopic Endopyelotomy with the Holmium:YAG Laser

“…Endopyelotomy is a well–established technique that was first described in 1983 by Wickham and Kellet [2]. Endopyelotomy offered direct visual incision of the UPJ and success rates have ranged from 63 to 88% [3, 4, 5, 6, 7, 8, 9]. Endopyelotomy may be performed via an antegrade or retrograde approach using rigid or flexible ureteroscopes equipped with cold knife, electrocautery, accucise [10], KTP [11], neodymium(Nd):YAG [12]or Ho:YAG laser [13].…”

Antegrade percutaneous endopyelotomy

“…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.…”

Die laparoskopische Nierenbeckenplastik mit Kontinuitätstrennung nach Anderson-Hynes

“…So liegen Berichte vor, dass bei 3-11% der Patienten eine postoperative Bluttransfusion erforderlich war und dass sogar in 3% der Fälle nach Endopyelotomie eine postoperative Embolisation bzw. Nephrektomie notwendig wurde [8].…”