title: Definitive Management of Failure After Pyeloplasty.
abstract: BACKGROUND
  Failure after pyeloplasty is difficult to manage. We report our experience managing pyeloplasty failures.
  
  
  METHODS
  We retrospectively reviewed the case log of a single surgeon, from August 1996 to August 2014, to identify all patients undergoing a surgical procedure after failed pyeloplasty. We excluded patients without follow-up exceeding 1 year from initial postpyeloplasty procedure. Failure was defined as a need for additional definitive intervention.
  
  
  RESULTS
  Of 247 laparoscopic pyeloplasties, 68 endopyelotomies and 305 simple laparoscopic nephrectomies reviewed, 41 were performed after previous pyeloplasty and had sufficient follow-up. Laparoscopic nephrectomy was performed in nine patients. All three secondary laparoscopic pyeloplasties were successful. Of 29 secondary endopyelotomies, 10 (34%) were successful. Of the 19 failures after secondary endopyelotomy, 12 patients had tertiary pyeloplasty (5 laparoscopic and 7 open surgical), 5 (26%) underwent tertiary endopyelotomy, and 2 (11%) required nephrectomy. Our overall endopyelotomy success rate was 38% (13/34) vs 100% (11/11) for secondary or tertiary pyeloplasty (4 patients lost to follow-up). Median time to failure was 5 months for endopyelotomy. Median follow-up for patients free from intervention was 40.2 months.
  
  
  CONCLUSIONS
  Secondary pyeloplasty (including both laparoscopic and open surgical approach) is more than twice as successful as endopyelotomy after failed pyeloplasty. Secondary pyeloplasty is an excellent alternative to endopyelotomy in select patients with failure after initial pyeloplasty.
authors.affiliation: Department of Urology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Ryan
authors.initials: R
authors.lastname: Swearingen
authors.affiliation: Department of Urology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Sapan
authors.initials: S
authors.lastname: Ambani
authors.affiliation: Department of Urology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Faerber
authors.affiliation: Department of Urology, University of Michigan , Ann Arbor, Michigan.
authors.forename: David A
authors.initials: DA
authors.lastname: Bloom
authors.affiliation: Department of Urology, University of Michigan , Ann Arbor, Michigan.
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*