Long-term Outcome of Endopyelotomy for the Treatment of Ureteropelvic Junction Obstruction

Doo, Chinkyung; Kang, Tae Jin; Park, Sung Chan; Hong, Bumsik; Park, Hyung Keun; Park, Taehan

Abstract

Purpose
The treatment outcome of endopyelotomy is now being re-evaluated in the era of laparoscopic pyeloplasty. This study was performed to evaluate the long-term success rate of an endopyelotomy for the treatment of an ureteropelvic junction obstruction (UPJO).
Materials and Methods
Between January 1995 and December 2003, 77 patients with an UPJO (mean age 35.2+/-13.89) underwent 85 endopyelotomies, with a percutaneous approach in 10 and a retrograde approach in the other 75 cases. The mean number of the procedure was 1.14, with 69 patients undergoing a single procedure. Endopyelotomies were performed using either a cold knife (n=26), Ho:YAG laser (n=47) or a hook electrode (n=12). Treatment success was defined as symptomatic relief, with radiographic resolution or stabilization of renal function in the excretory and/or diuretic renograms. A Kaplan-Meier curve of the long-term success was generated, and the preoperative hydronephrosis and renal function correlated with the success rate.
Results
With a median follow-up of 37.1 months (3-98), the overall success rate was 67.5%. The median time to failure was 7.7 months (1-50). The Kaplan-Meier estimates of success were 87.8, 76.9, 72.2, 68.7, 64.8 and 61.6% at 1, 12, 18, 24, 36 and 60 months, respectively. The success rate was not significantly affected by the etiology, the approach and the incisional methods. The degree of hydronephrosis and renal function showed no significant correlation with the success rate.
Conclusions
The success rates of an endopyelotomy decreased with increasing follow-up period. In our conclusion, a long-term follow-up, at least as long as 36 months, is mandatory in patients having undergone an endopyelotomy for an ureteropelvic junction obstruction, although the majority of failures were found within 1 year.