title: Endopyelotomy for secondary ureteropelvic junction obstruction in children.
abstract: Percutaneous endopyelotomy has been shown to be successful in treating ureteropelvic junction obstruction in adults. Little data have been published regarding this procedure in children. We describe 4 patients 6.5 weeks to 5.5 years old who underwent percutaneous endopyelotomy to treat ureteropelvic junction obstruction following failed open dismembered pyeloplasty. Preoperative obstruction was demonstrated by a nephrostogram, diuretic renogram and/or ultrasonography. Percutaneous endopyelotomy was successful in relieving the obstruction in all 4 patients, although 2 required secondary endoscopic procedures. One patient had persistent obstruction 40 days after endopyelotomy at the ureteropelvic junction and, subsequently, required percutaneous resection of a persistent flap of obstructing tissue. In another patient a ureterovesical stricture was noted at the time of stent removal, which was treated by endoscopic incision. All patients have been followed from 1.5 to 3 years postoperatively. Followup diuretic renograms, ultrasound and/or excretory urography demonstrated a patent ureteropelvic junction in all patients and all have remained asymptomatic. Endopyelotomy appears to be safe and effective in treating secondary ureteropelvic junction obstruction in children.
authors.affiliation: Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: L R
authors.initials: LR
authors.lastname: Kavoussi
authors.forename: S
authors.initials: S
authors.lastname: Meretyk
authors.forename: S M
authors.initials: SM
authors.lastname: Dierks
authors.forename: S W
authors.initials: SW
authors.lastname: Bigg
authors.forename: D I
authors.initials: DI
authors.lastname: Gup
authors.forename: C B
authors.initials: CB
authors.lastname: Manley
authors.forename: E
authors.initials: E
authors.lastname: Shapiro
authors.forename: R V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D002675:Child, Preschool; D004564:Electrocoagulation / Q000379:methods; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D009403:Nephrostomy, Percutaneous; D015641:Radiography, Interventional; D012086:Reoperation; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*