Efficacy of pyeloplasty and endoscopic treatment for ureteropelvic junction obstruction
CHEN Song1,2, TANG Yuzhe2, FU Meng2, SU Boxing2, LIU Yubao2, XIAO Bo2, HU Weiguo2, LI Jianxing2
1Department of Urology, Beijing Fengtai Hospital of Integrated Traditional and Western Medicine, Beijing 100072, China; 2Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
Abstract：Objective： To compare the therapeutic effects of laparoscopic/open pyeloplasty and endoscopic treatment for the management of ureteropelvic junction obstruction （UPJO）. Methods： A retrospective cohort study was performed on the clinical data of patients with UPJO admitted to our hospital from December 2014 to February 2018. The endoscopic balloon dilation/stenosis internal incision or open/laparoscopic pyeloplasty was done. The curative efficacy was evaluated by postoperative imaging. The multivariate logistics regression analysis was carried out. Results： There were a total of 40 UPJO cases in this cohort （53 sides）, including 38 cases given the endoscopic surgery and 15 treated with open/laparoscopic pyeloplasty. The effective rate of endoscopic treatment was 44.7% （17/38）,The effective rate of open/laparoscopic pyeloplasty was 80% （12/15）, significantly higher than that of endoscopic surgery （44.7%, 17/38）. The success rate of open/laparoscopic pyeloplasty was 2.3 times that of endoscopic treatment. The success rate of retreatment decreased with the increased times of previous surgery. For cases with history of treatment failure more than three times, the success rate of retreatment was 2% of that of the cases without previous treatment history （P=0.03）. Conclusion： The success rate of open/laparoscopic pyeloplasty is significantly higher than that of endoscopic surgery, but endoscopic treatment of appropriate cases can still be used as the first-line treatment for some UPJO cases with initial treatment or open/laparoscopic pyeloplasty failure. For cases where surgical treatment has failed more than three times, open/laparoscopic pyeloplasty should be used instead of endoscopic surgery.
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