Open Surgical Exploration After Failed Endopyelotomy: A 12-year Perspective

Abstract

Patients with high grade hydronephrosis and poor initial renal function are much more likely to experience endopyelotomy failure. Crossing vessels appear to have a less significant role in endopyelotomy failure than has been previously suggested.

Robot-assisted pyeloplasty: outcomes for primary and secondary repairs, a single institution experience

“…As for patient outcomes, (23). Open repair for secondary obstruction demonstrates greater success with rates reported as high as 95% (24). As for laparoscopic pyeloplasty for secondary UPJ obstruction after failed endopyelotomy, Sundaram reported an overall success rate of 83% with higher complication rate and longer operative time (25).…”

Accessory or additional renal arteries show no relevant effects on the width of the upper urinary tract: a 64-slice multidetector CT study in 1072 patients with 2132 kidneys

“…Despite numerous examinations that place the frequency of extrinsic UPJ obstruction between 15% and 70% of all obstructions [5,8,[13][14][15][16][22][23][24][25][26], the question as to whether they could actually cause hydronephrosis or are found merely by coincidence in patients with an intrinsic UPJ obstruction remains unanswered [7,12,27]. This was because, for these studies, usually designed retrospectively, only patients with a manifest UPJ obstruction were included and not patients without UPJ obstruction for comparison.…”

“…The primary surgical therapy of choice is endoscopic endopyelotomy [12]. The success rate of 89-90% [12,13] is thought to be noticeably poorer in patients with crossing vessels [12,13]; however, this is not undisputed [14,15]. Be that as it may, to prevent bleeding complications it is necessary to be familiar with the vascular situation around the UPJ prior to the procedure [3,[16][17][18].…”

Laparoscopic pyeloplasty: the standard of care for ureteropelvic junction obstruction

“…11,[13][14][15]18,24,[26][27][28][29] Furthermore, anatomic variants, such as pelvic, horseshoe and solitary kidney, are contraindications to endopyelotomy. Conversely, laparoscopic pyeloplasty can be effectively employed in any of these variants.…”

“…The significance of crossing vessels, which occur in 38% to 44% of patients with UPJO, 25,29 is the subject of ongoing debate. The 5-year mean success rate of antegrade endopyelotomy is only 42% in the presence of a crossing vessel.…”