Ureteroscopic endopyelotomy in the treatment of patients with ureteropelvic junction obstruction.
OBJECTIVE
To investigate the effectiveness and morbidity of ureteroscopic endopyelotomy in adults with ureteropelvic junction (UPJ) obstruction.


METHODS
Twenty-two patients (13 women, 9 men) with a mean age of 44 years (range 18 to 86) underwent retrograde ureteroscopic endopyelotomy in the treatment of primary (n = 18) or secondary (n = 4) UPJ obstruction. All procedures were performed using a 6F to 8.5F semirigid ureteroscope with either a 3F electrocautery probe (n = 16) or a 365-microm holmium laser fiber (n = 6). Postoperatively, a tapered 14/7F endoureterotomy stent (n = 11) or standard 7F to 8F double pigtail stent (n = 11) was left in place for 6 to 7 weeks. Radiographic follow-up was obtained using intravenous urography or renal scintigraphy.


RESULTS
With a median follow-up of 20.5 months, the success rate was 82% (18 of 22 patients). Follow-up of at least 6 and 12 months was available in 21 (95%) and 17 (77%) of 22 patients, respectively. The mean operative duration was 63 minutes, and all but 1 patient was hospitalized for less than 24 hours. No bleeding complications or other serious morbidity were encountered. No difference in treatment outcome was found on the basis of the size of the stent placed postoperatively, the incision type (cautery versus laser), or the etiology of the obstruction.


CONCLUSIONS
Ureteroscopic endopyelotomy is an effective, minimally invasive treatment option for patients with primary or secondary UPJ obstruction.
Gerber
G S
GS
Department of Surgery, University of Chicago Pritzker School of Medicine, Illinois 60637, USA.
Kim
J C
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011859:Radiography; D015607:Stents; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*