Percutaneous Antegrade Endopyelotomy-Factors Influencing the Success Rates

Chang, Kwang Sik; Kim, Joon Chul; Hwang, Tae Kon

Abstract

PURPOSE: Endopyelotomy is a minimally invasive surgical alternative to the classic open surgery in the treatment of ureteropelvic junction obstruction with similar success rates. We analyzed factors influencing success rates after endopyelotomy based on clinical data. MATERIALS AND METHOD: Between 1989 and 1997, we performed percutaneous antegrade endopyelotomy in 53 cases of ureteropelvic junction obstructions. Among these patients, 47 patients have been followed with range from 3 to 70 months(mean 18.1 months). Of the 47 patients, 36 had primary UPJ obstruction and 11 had secondary UPJ obstruction. A rigid urethrotome(cold knife) was employed in 31 cases, a electrotome(hot knife) in 10 and a balloon dilator in 6. A stent(14/7Fr endopyelotomy stent or 6Fr double-J stent) was placed for 4 to 12 weeks after the procedure. Coexisting stones or infundibular strictures were managed simultaneously.
RESULTS
Overall success rate(measured by symptom-free status and improved uroradiographic findings) was 80.9%(86.1% in primary and 63.6% in secondary cases). Success rates related to the method of incision were as follows; 87.1% with a cold knife, 80% with a electric knife and 50% with a balloon dilator only. 14/7Fr endopyelotomy stent was used in 21 patients with a successful outcome in 19(90.5%), while 25 received 6Fr double stent with a successful outcome in 18(72%). Success rates according to the duration of stenting were as follows; 86.7% in the 8-week group, 78.6% in the 6-week group and 66.7% in the 4-week group.
CONCLUSIONS
Our experience indicates that endopyelotomy can be selected as the initial procedure of choice for the selected patients with UPJ obstruction. The small number of patients in each parameter did not reach statistical significance. However, there was a trend for better results in patients with primary UPJ obstruction and with the use of 14/7Fr endopyelotomy stent.