title: Percutaneous endopyelotomy with electrocautery: modified techniques in the treatment of ureteropelvic junction obstruction in a child under 2 years.
abstract: OBJECTIVE
  In recent years new techniques in minimally invasive treatment of congenital stenosis of ureteropelvic junction have been developed.  We report the treatment of pyeloureteral stenosis in children by percutaneous endopyelotomy.
  
  
  METHODS
  In the work up study of a child (18 months) with abdominal palpable mass, a severe left hydronephrosis  with a renal pelvis diameter of 65 mm and severely thinned renal parenchyma was found. The diuretic renogram showed an obstructive pattern  with impaired renal function. Initially, a retrograde dilatation balloon was placed in the ureteropelvic junction under cistoscopic control.  With the patient in modified Valdivia position, percutaneous access to the renal pelvis was performed. By Seldinger technique and under fluoroscopy guide, a 5 mm laparoscopic trocar was placed in the renal pelvis. We performed a percutaneous electrical endopyelotomy of the pyeloureteral junction over the 6 mm retrograde balloon dilator passed through.  We placed an antegrade double J stent that was removed at 4 weeks uneventfully.
  
  
  RESULTS
  Good results were assessed without perioperative or postoperative complications with great improvement in renal dilatation two years  after the intervention. The renogram showed improvement in the pattern of the curve with a slight increase in differential renal function.
  
  
  CONCLUSIONS
  Percutaneous endopyelotomy in children has important issues due to the lack of appropriate material. However it is possible to  get good results as a minimally invasive technique. In fact, it could be the ideal technique in severe hydronephrosis with large renal  pelvis that prevents the surgical or endourological approach.
authors.affiliation: Pediatric Surgery Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain. parente80@hotmail.com
authors.forename: Alberto
authors.initials: A
authors.lastname: Parente
authors.forename: José María
authors.initials: JM
authors.lastname: Angulo
authors.forename: Susana
authors.initials: S
authors.lastname: Rivas
authors.forename: Rosa María
authors.initials: RM
authors.lastname: Romero
authors.forename: Carolina
authors.initials: C
authors.lastname: Corona
authors.forename: Ana
authors.initials: A
authors.lastname: Tardaguila
mesh_terms: D004564:Electrocoagulation / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests; D016896:Treatment Outcome; D014463:Ultrasonography; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*