Percutaneous Pyelolysis: Indications, Complications and Results

Abstract

The results of percutaneous pyelolysis in 28 patients are presented. There were 18 successful and 10 unsuccessful cases. The indications for the procedure are defined in the light of this analysis.

Retroperitoneoscopic Treatment of Ureteropelvic Junction Obstruction

“…Peers et al [14] reported on 18 endoscopic pyeloplasties performed on the pig: ureteral anastomosis was carried out in all cases using either clips or intracorporéal suturing, or a combination of intracorporéal suturing and fibrin glue tissue sealant. A clear disadvantage of the retroperitoneoscopic approach is the smaller operative field compared to the transperiMinimally invasive treatment of ureteropelvic junc tion obstruction was initially reported in 1983 [1,9], Per cutaneous or retrograde endopyelotomy provide the ad vantages of significantly reduced hospitalization and re covery while yielding success rates upwards of 80% [3,10]. However, while retrograde and antegrade endopye lotomy offer similar success rates, incision of the uretero pelvic junction with a ureteroscope is technically more difficult than using the percutaneous technique [4], Recently, Banerjee et al [2] reported on a comparative study between percutaneous endopyelotomy and open pyeloplasty, concluding that there were no significant dif ferences in terms of efficacy and overall morbidity, but only for what concerns hospital stay and cosmetic results.…”

“…During the last few years, there have been significant advances in the management of ureteropelvic junction obstruction; minimally invasive techniques offered signif icantly reduced morbidity to the patients with success rates comparable to open pyeloplasty [1][2][3], The endourological techniques include antegrade percutaneous endopyelotomy and retrograde approach to the ureteropelvic junction [4], Fluoroscopically controlled balloon incision of the ureteropelvic junction has been proposed, too [3], However, endoscopic techniques are not indicated in patients with large redundant renal pelvis or with large crossing lower pole renal vessels [5], as the overall success rate is lower than with open surgery. In an effort to match the success rate of open pyeloplasty and to eliminate the need for a large skin incision, Schuessler et al [6] obtained moderate to significant improvement in 4 out of 5 pa tients submitted to laparoscopic transperitoneal dismem bered pyeloplasty.…”

Endopyelotomy with the Acucise Cutting Balloon Device

“…One year later, Ramsay et al [4] reported a series of 28 patients who were treated with a success rate of 64%. Since then, reports of large series of endopyelotomies have been issued [5][6][7].…”

Effective Intubation for Percutaneous Pyelolysis

“…Since the original description of percutaneous pyelolysis there have been variable reports of the efficiency of this technique in effecting improved pelvic drainage [ 10,11]. These discrepancies are undoubtedly multifactorial and reflect the non-conformity of selection for surgery, the techniques of pyelolysis and intubation, and the method applied for follow-up [12], Diuretic renography is a freely available and well-proven technique for the diagnosis of pelvic outflow obstruction [7], It is also repeatable and reproducible for the follow-up of decom pressive surgery, in all except the grossest of hydrone phroses when direct pressure measurement techniques are necessary [13].…”