Abstract：Objective:To assess the efficacy of percutaneous antigrade endopyelotomy for the treatment of secondary ureteropelvic junction obstruction(UPJO).Methods:Between March 2008 and December 2011. 23 patients with clinical and radiographic evidence of secondary UPJO underwent percutaneous endopyelotomy and/or balloon catheter dilation. Secondary UPJO was defined as anastomotic structure after pyeloplasty or as de novo formation after renal or ureteral surgery. Success of the procedure was defined as both radiographic and symptomatic resolution of obstruction.Results:With a mean patient follow-up of 23 patients, previous open or laparoscopic pyeloplasties had failed in 12. 11 patients classified as patrogenic from precious renal surgeries (6 cases) and ureteric surgeries (5 case). 9 patients were considered to have coexistent stone disease, and 7 patients had flank pain before operations. With a mean patient of follow-up 23 months (range 6 to 48 ), the overall success rate was 87%(20/23). Operative intervention for 3 of 23 patients with failure included open pyeloplasty (1), nehprectomy (1) and indwelling ureteral stenting (1).Conclusions:Percutaneous endopyelotomy is highly effective in treating secondary UPJO.
[1]Niver BE, Agalliu I, Bareket R, et al. Analysis of robotic-assisted laparoscopic pyleloplasty for primary versus secondary repair in 119 consecutive cases. Urology, 2012, 79(3):689-694. [2]Knudsen BE, Cook AJ, Watterson JD, et al. Percutaneous antegrade endopyelotomy: long-term results from one institution. Urology, 2004, 63(2):230-234. [3]Patel T, Kellner CP, Katsumi H, et al. Efficacy of endopyelotomy in patients with secondary ureteropelvic junction obstruction. J Endourol, 2011, 25(4):587-591. [4]Soria F, Rioja LA, Blas M, et al. Evaluation of the duration of ureteral stenting following endopyelotomy: Animal study. Int J Urol, 2006, 13(10):1333-1338. [5]Ost MC, Kaye JD, Guttman MJ, et al. Laparoscopic pyeloplasty versus antegrade endopyelotomy: comparison in 100 patients and a new algorithm for the minimally invasive treatment of ureteropelvic junction obstruction. Urology, 2005,66(5 Suppl):47-51. [6]康绍叁,高伟兴,张立国,等. 经皮肾镜内切开术联合碎石术治疗UPJO并肾结石25例报告. 临床泌尿外科杂志,2012,27(3):174-175. [7]el-Nahas AR, Shoma AM, Eraky I. Prospective, randomized comparison of ureteroscopic endopyelotomy using holmium∶YAG laser and balloon catheter. J Urol, 2006, 175(2):614-618.
