title: Outcomes of endopyelotomy for pelviureteric junction obstruction in the paediatric population: A systematic review.
abstract: BACKGROUND
  Dismembered pyeloplasty is the gold standard treatment for pelviureteric obstruction (PUJO) although endourological techniques are also employed. Outcomes and success rates for paediatric endopyelotomy are variably reported.
  
  
  OBJECTIVE
  The study aimed to systematically analyse published literature to give an overall success rate for endopyelotomy in children.
  
  
  METHODS
  Medline and Embase databases were searched using relevant key terms to identify reports of paediatric endoplyelotomy. Literature reviews, case reports, series of <3 children and adult studies (age >20 years) were excluded. Primary and secondary procedures were considered separately. The procedure was considered successful if [a] the author reported success AND [b] there was no immediate conversion to open pyeloplasty OR a subsequent procedure to the PUJ 3 or more weeks after endopyelotomy.
  
  
  RESULTS
  One hundred and fourteen studies were assessed, 15 were included in the final review. Overall, 220 endopyelotomies were performed in 216 patients; 128 had primary PUJO, 92 underwent secondary endopyelotomy. Median success rate was 71% (range 46-100) in the primary group and 75% (25-100) in the secondary group. Previously undetected crossing vessels were found at subsequent open pyeloplasty in 12 failures (11 primary = 31% of failed primary endopyelotomies). Complications were reported in 14.8% of primary and 14.1% of secondary procedures.
  
  
  CONCLUSIONS
  This study is limited by the data given in the individual series: varied criteria used for patient selection and outcome as well as inconsistent pre and post operative imaging data precluded a meta-analysis. Designating procedures as failures if there were subsequent procedures to the PUJ lowered success rates from author-given figures for some studies. Complications rates after endopyelotomy are higher than those for open and minimally invasive pyeloplasty. Success rates for endoplyelotomy do not compare favourably with pyeloplasty and crossing vessels should be excluded before considering the procedure.
authors.affiliation: Department of Surgery, Alder Hey Children's Hospital, Liverpool, UK. Electronic address: harriet.corbett@alderhey.nhs.uk.
authors.forename: Harriet J
authors.initials: HJ
authors.lastname: Corbett
authors.affiliation: Department of Surgery, Alder Hey Children's Hospital, Liverpool, UK.
authors.forename: Dhanya
authors.initials: D
authors.lastname: Mullassery
mesh_terms: D002648:Child; D006801:Humans; D006869:Hydronephrosis / Q000151:congenital* / Q000601:surgery; D007682:Kidney Pelvis / Q000601:surgery*; D021782:Multicystic Dysplastic Kidney / Q000601:surgery*; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: Endopyelotomy; Paediatric; Pelviureteric junction; Pyeloplasty