Ureteroscopic Treatment of Ureteropelvic Junction Obstruction

Abstract

Ureteroscopic endopyelotomy is a safe and effective treatment for most cases of ureteropelvic junction obstruction. Endoluminal ultrasonography of the obstructed ureteropelvic junction has gained a major role in defining which patient to treat and in directing endoluminal incisions to minimize the risk of injury to adjacent vessels. There is a higher failure rate when vessels are present.

Ureteropelvic Junction Obstruction Secondary to Crossing Vessels—To Transpose or Not? The Robotic Experience

“…10 There is supporting data that crossing vessels do not always lead to obstruction. Crossing vessels are reported to be present in 38% to 71% of UPJO cases [1][2][3][4][5][6][7] and more importantly in 20% of cases of normal kidneys. 8 In addition, in a study in which 39% of patients proved to have crossing vessels on digital angiography before endopyelotomy the presence of a crossing vessel with mild or severe hydronephrosis resulted in a success rate of 50% and 39%, respectively.…”

“…Despite advances in imaging and surgical techniques, controversies remain about the etiological and surgical significance of the relationship of the renal pelvis, ureter and crossing vessels. Of patients with UPJO 38% to 71% have been reported to have crossing vessels, [1][2][3][4][5][6][7] whereas these vessels were noted in only 20% of patients with a normal ureteropelvic junction. 8 On outcome analysis in a long-term endopyelotomy series the presence of crossing vessels was concurrent with a decrease in the success rate from 82% to 33%.…”

Cost‐effective laparoscopic pyeloplasty: Single center experience

“…However, the success rates of these minimally invasive endoscopic techniques (antegrade percutaneous endopyelotomy, retrograde endopyelotomy, and Accucise balloon) are approximately 10-25% lower than those of open pyeloplasty, and hemorrhagic complications are more frequent. [4][5][6][7][8][9] Moreover, these techniques cannot be applied universally to all patients, such as those with pelvic volumes of > 70 mL, renal function < 30%, or who have a crossing vessel. Furthermore, crossing vessels can be missed by radiographic imaging and discovered only during surgical exploration after the incisional procedure fails.…”

“…[1][2][3][4] However, it is associated with open surgery postoperative morbidity, pain, prolonged convalescence and a prominent skin incision. Various minimally invasive techniques for repairing obstructed UPJ, such as percutaneous antegrade and endoscopic retrograde approaches, have success rates that are 10-25% lower than those of open pyeloplasty [4][5][6][7][8][9] and are not suitable for patients with a large renal pelvis, poor renal function, high insertion of ureter, concomitant renal stones, extrinsic vessels, or for patients who have failed endourologic procedures.…”

The role of endourology in ureteropelvic junction obstruction

“…Their identification was important not only because they influenced outcome, but because they were a mean to reduce the risk of vascular complications amplified by the development of blind or semiblind retrograde techniques [4,19]. Nakada et al [9••] confirmed that the adverse influence of the crossing vessel is sufficient to justify the added expense of preoperative diagnostic studies.…”