Contemporary role of endopyelotomy in the management of ureteropelvic junction obstruction

Grubišić I, Tomašković I, Katušić J, Reljić A, Trnski D.

Clinical hospital centre „ Sestre milosrdnice“, Clinical department of Urology

Abstract

The succes and advances in endourology have lead to a change in the management of primary UPJ obstruction over the past 20 years. The advantages of endourologic approaches include a significantly reduced hospital stay and postoperative recovery. However, the success rate does not approach that of standard open or laparoscopic pyeloplasty. When intervention is indicated, the procedure of choice has historically been open operative repair of the UPJ, usually dismembered pyeloplasty. Laparoscopy has emerged as less invasive endourologic approach in modern time.

Because of technical chalenges of laparoscopic pyeloplasty endopyelotomy remains an effective alternative first line treatment for certain patients with primary UPJ obstruction. Although success rates with most endourologic techniques have not proven to be comparable with those of open or laparoscopic pyeloplasty, it has been suggested that the success rates may be significantly improved with careful patient selection. For patients without crossing vessels, with small segment (< 2 cm) of obstruction and with lower degree of hydronephrosis endopyelotomy is a reasonable first-line treatment option with acceptable outcomes.

Endopyelotomy is treatment of choice for failed pyeloplasty and concomitant calculi.