title: The role of percutaneous endopyelotomy for ureteropelvic junction obstruction.
abstract: BACKGROUND
  Over the last 20 years, the surgical management of ureteropelvic junction obstruction (UPJO) has been revolutionised by the development of endourological instrumentation and several minimally invasive procedures including: antegrade or retrograde endopyelotomy, retrograde balloon dilatation, and laparoscopic pyeloplasty. Currently, in our department, we offer percutaneous antegrade endopyelotomy (PAE) as primary treatment of UPJO in adults, believing it offers less morbidity, better cosmetic results, and quicker operating time compared with open pyeloplasty.
  
  
  METHODS
  We performed a retrospective audit of our results for the 14 patients who underwent percutaneous antegrade endopyelotomy between January 2000 and May 2004.
  
  
  RESULTS
  Mean operative time was 53 min (range, 30-80 min), mean in-patient stay was 3.8 days (range, 2-7 days), and there were no major postoperative complications for this series with mean follow-up of 31.8 months (range, 12-52 months). Eleven out of the 14 patients (79%) showed radiological improvement on their 3-month MAG 3 (mercaptoacetyl-triglycyl) renogram, and 13 out of the 14 (93%) patients reported significant reduction or resolution of pain, compared with their preoperative state.
  
  
  CONCLUSIONS
  The majority of urologists still offer open pyeloplasty as primary treatment for UPJO with laparoscopic pyeloplasty currently an evolving procedure in the UK. Our series reports comparable success rates for PAE compared to other series. Despite these results, we feel that the future role of percutaneous endopyelotomy will be as a salvage procedure following failed open or laparoscopic surgery. However, in patients with concurrent stone disease or requiring antegrade ureteric access, percutaneous endopyelotomy would be suitable as a primary treatment option.
authors.affiliation: Department of Urology, University Hospital of North Staffordshire, Newcastle-under-Lyme, Staffordshire, UK. nickrukin@hotmail.com
authors.forename: N J
authors.initials: NJ
authors.lastname: Rukin
authors.forename: D A
authors.initials: DA
authors.lastname: Ashdown
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.forename: S
authors.initials: S
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000601:surgery*