title: Percutaneous Endopyelotomy over High Pressure Balloon for Recurrent Ureteropelvic Junction Obstruction in Children.
abstract: OBJECTIVE
  We analyzed results of percutaneous endopyelotomy for treatment of recurrent ureteropelvic junction obstruction in children with failed primary pyeloplasty.
  
  
  METHODS
  We retrospectively studied all patients treated at our department for recurrent ureteropelvic junction obstruction between 2009 and 2013. All procedures were performed using a 12Fr miniperc approach with the patient in the supine position. A high pressure balloon was inflated at the ureteropelvic junction obstruction. To improve the exposure of the cutting area, the ureteropelvic junction was introduced into the renal pelvis by pushing the high pressure balloon. Modified percutaneous endopyelotomy was done with monopolar electrocautery over it to avoid damaging nearby structures. Medical data and imaging studies before and after the first surgery and percutaneous endopyelotomy were reviewed.
  
  
  RESULTS
  Seven boys and 2 girls (mean ± SD age 5.8 ± 4.9 years) with recurrent ureteropelvic junction obstruction were treated at our hospital between July 2009 and July 2013. Three patients had a solitary kidney. Three children had previously undergone 2 procedures. Mean ± SD operative time was 61.0 ± 17.9 minutes, postoperative hospital stay was 3.8 ± 1.9 days and followup after modified percutaneous endopyelotomy was 39.3 ± 25.2 months. All patients were rendered symptom-free. Postoperative ultrasound and renogram revealed that modified percutaneous endopyelotomy was successful in 7 renal units. In 2 patients hydronephrosis improvement was not significant. Three patients suffered postoperative complications, consisting of hematuria, obstruction of Double-J® stent and paralytic ileus in 1 each.
  
  
  CONCLUSIONS
  Modified percutaneous endopyelotomy is a fairly effective technique to treat recurrent ureteropelvic junction obstruction after failed pyeloplasty in children. However, in some cases potentially serious complications can occur.
authors.affiliation: Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Parente
authors.affiliation: Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Angulo
authors.affiliation: Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Burgos
authors.affiliation: Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain.
authors.forename: R M
authors.initials: RM
authors.lastname: Romero
authors.affiliation: Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Rivas
authors.affiliation: Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Ortiz
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000151:congenital* / Q000601:surgery; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D021782:Multicystic Dysplastic Kidney / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods
keywords: child; endoscopy; kidney pelvis; ureteral obstruction