Retrograde acucise endopyelotomy: is it worth its cost?
OBJECTIVE
To identify patients with ureteropelvic junction (UPJ) obstruction who will benefit from endoscopic Acucise incision of the stenosis and to compare the open Hynes-Anderson pyeloplasty with this minimally invasive technique.


METHODS
In a prospective trial, 22 patients with primary and secondary UPJ obstruction were treated by Acucise endopyelotomy, and 18 patients were treated by Hynes-Anderson pyeloplasty. Preoperative and postoperative renal scans were used to determine the degree of obstruction and intravenous urography, ultrasound scanning, or both to assess the degree of dilation.


RESULTS
There was a vast difference in the cure rate of the two groups: Hynes-Anderson pyeloplasty cured 94.5% of the patients, while in the Acucise group, the cure rate was only 32%. There was some improvement in another 22% of the patients, but the renal scan curve remained obstructed. The remaining 45% of patients failed to show any improvement.


CONCLUSIONS
Acucise endopyelotomy will improve or cure only patients with good renal function and mild dilation of the pelvicaliceal system. Patients with severe dilation should be treated by Hynes-Anderson pyeloplasty.
Sofras
F
F
2nd Dept of Urology, University of Athens Medical School, Sismanoglio Hospital, Athens, Greece. fsofras@med.uoa.gr
Livadas
K
K
Alivizatos
G
G
Deliveliotis
Ch
Ch
Albanis
S
S
Melekos
M
M
Christoforidis
K
K
D000293:Adolescent; D000328:Adult; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014517:Ureteral Obstruction / Q000601:surgery*; D018666:Ureteroscopy / Q000191:economics* / Q000379:methods*