Endourologic techniques for ureteropelvic junction obstruction therapy. Comparative animal study.
OBJECTIVE
The aim of this work is to compare 3 endourologic techniques for treating a ureteropelvic junction (UPJ) obstruction. To accomplish this, we performed a study in a porcine animal specimen, in which we compared laparoscopic pyeloplasty that emerges as the future gold standard technique, with 2 endopyelotomy techniques.


METHODS
Twenty-four healthy large white female pigs were randomly divided in 3 groups-group I (laparoscopic pyeloplasty), group II (endopyelotomy-Acucise, Applied Medical, Rancho Margarita, CA), and group III (endoballoon rupture endopyelotomy). Percutaneous and endoluminal ultrasonographic and fluoroscopic studies were analyzed during the different phases of the study. The study was divided in 3 phases. First one included premodel documentation of normal urinary tract and laparoscopic UPJ obstruction induction. During second phase at 6 weeks later, diagnosis and endourologic treatment were carried out. Fifteen weeks after obstruction treatment, follow-up imaging studies and postmortem evaluation of all animals were performed.


RESULTS
After the sonographic and fluoroscopic assessment, we determined the percentage of success rate for each technique-with an 87.5% for groups I and II and 75% for group III. Significant statistical differences were found between the 2 pyelotomy groups and the pyeloplasty group regarding the duration of the intervention. Significant statistical differences are evident in the evolution of the UPJ's diameter between groups I and III.


CONCLUSIONS
Laparoscopic pyeloplasty is the technique that produces fewer side effects in the reconstructed area, as well as a wider dilation of the UPJ. Nevertheless, as we show in this study, we found similar results between endopyelotomy in selected patients than pyeloplasty, and it is simpler and less invasive than the latter.
Soria
Federico
F
Endoscopy Department, Minimally Invasive Surgery Centre-Jesus Uson, Caceres, Spain. fsoria@ccmi.es
Delgado
M Immaculada
MI
Rioja
Luis A
LA
Blas
Miguel
M
Arocena
Juan
J
Duran
Esther
E
Uson
Jesus
J
D000818:Animals; D002404:Catheterization / Q000379:methods; D004195:Disease Models, Animal; D019160:Endosonography / Q000379:methods*; D005260:Female; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009403:Nephrostomy, Percutaneous / Q000379:methods; D011897:Random Allocation; D012680:Sensitivity and Specificity; D013552:Swine; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D018666:Ureteroscopy / Q000379:methods*