Long‐term outcome of secondary endopyelotomy after failed primary intervention for ureteropelvic junction obstruction

Abstract

Objective: To evaluate the long-term outcome of secondary endopyelotomy after failed primary intervention for uretero-pelvic junction (UPJ) obstruction and to assess the effect of preoperative parameters on treatment outcome. Methods: Twenty patients (13 men, seven women; mean age 30.7 years) who underwent secondary endopyelotomy after the failure of a primary intervention for the treatment of congenital UPJ obstruction were included in this retrospective analysis. Mean interval from primary treatment to secondary endopyelotomy was 27.2 months (range 3-123 months). The diagnosis of failure of the primary treatment was based on symptoms and the results of imaging studies. Treatment success was defined as symptomatic relief with either stable or improved renal function and improved wash-out shown on diuretic renogram or excretory urography. Results: Mean follow-up was 47.2 months (range 6.2-138.8 months). Success rates were as follows: overall, 70%; after primary dismembered pyeloplasty, 66.7%; after primary endopyelotomy, 57.1%; after primary balloon dilatation, 100%. Kaplan-Meier estimates of success were 64.4% at 5 years. Six patients in whom the procedure failed at a mean of 13.8 months (range 4-33 months) were treated with open pyeloplasty (four patients), simple nephrectomy (one), and a repeat endopyelotomy (one). Grade 4 hydronephrosis and significant obstruction occurred more often in the failure group. Conclusions: Endopyelotomy is an acceptable minimally invasive secondary treatment option for UPJ obstruction. Preoperative severe hydronephrosis and the presence of a significant obstruction seem to be risk factors for the failure of a secondary endopyelotomy.

National Trends in Secondary Procedures Following Pediatric Pyeloplasty

“…12,25,26 Adults may experience better outcomes from salvage endoscopic procedures with 70% to 87.5% success in some series, which is more acceptable in a population with lower life expectancy. 27,28 Although we expected to find endoscopic treatments mostly in older adolescents, reflecting greater acceptance of secondary endopyelotomy in adults, more than half of the endoscopic attempts were performed in patients younger than 14 years.…”

Robotic-assisted laparoscopic approaches to the ureter: Pyeloplasty and ureteral reimplantation

“…For example, the documented success rate for endopyelotomy after a failed primary repair is between 60% and 70%, depending on the primary treatment modality. [3233] Laparoscopic redo-pyeloplasty has been found to have higher success rates [>85%), but remains a difficult procedure. [3435] It was has been postulated suggested that the benefits of robotic surgery would be provides advantageous significant advantages over standard laparoscopy for a minimally invasive option in these difficult salvage procedures.…”

The management of secondary pelvi‐ureteric junction obstruction – a comparison of pyeloplasty and endopyelotomy

“…Endopyelotomy success rates in our institution have previously been reported as 70% compared with 92% for transperitoneal laparoscopic pyeloplasty. Others report success rates for pyeloplasty varying between 75% and 98% . Laparoscopic and robotic pyeloplasty have been deemed to be as good as the traditional ‘gold standard’ open pyeloplasty.…”

“…Laparoscopic and robotic pyeloplasty have been deemed to be as good as the traditional ‘gold standard’ open pyeloplasty. Success rates for endopyelotomy vary hugely in the literature (41–100%) .…”