| Abstrakt: |
Introduction and Objectives. The ureteropelvic junction (UPJ) dysfunction, having as consequence hydronephrosis, was traditionally treated surgically by pyeloplasty, the rate of success being 71-98%. Failure was followed by one of the following interventions: repeating pyeloplasty, replacement with ileum, ureterocalicostomy, renal autotransplantation and, lastly, nephrectomy. We evaluate the role of endopyelotomy in the management of ureteropelvic junction obstruction. Materials and Methods. In a period of 27 years (1987-2014), we performed a total of 833 endopyelotomies. In our study (1987-2002), we retrospectively identified 303 patients who underwent endopyelotomy for ureteropelvic junction obstruction, who came for regular check-ups. Patient demographics, operative information, complications and success rates were reviewed for 187 patients, who could be properly assessed, with a mean age of 51 years and mean follow-up of 44 months. Treatment success was defined as the absence of symptom recurrence and improved radiographic features on ultrasound, intravenous pyelography at most recent follow-up. Results. endopyelotomy data were analyzed in 187 patients. The success rate was 83.9%. Treatment failure occurred in 30 (16%) patients. There were 20 (10.69%) cases of ureteral hypoplasia with less favorable results. Four patients (2.13%) with renal-ureteral duplication had surgical failure at 6 to 12 months reevaluation. Four patients (2.13%) were found with renal ptosis and two patients (1.06%) with horseshoe kidney in which endopyelotomy failed. Conclusions. Antegrade endopyelotomy is a minimally aggressive surgical intervention in both children adults and the elderly. The endoscopic percutaneous approach of ureteropelvic junction allows solving of associated disorders, such as renal lithiasis. Laparoscopic and robotic assisted pyeloplasty are emerging as the gold standard of treatment for ureteropelvic junction obstruction, endopyelotomy it is the treatment of choice for failed open or laparoscopic pyeloplasty and concomitant renal calculi. [ABSTRACT FROM AUTHOR] |
