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Endopyelotomy in the symptomatic older child
G Nicholls1, D Hrouda, M J Kellett
1Institute of Urology, The Middlesex Hospital, London, UK.
BJU International
|April 12, 2001
Summary
Endopyelotomy in children for pelvi-ureteric junction obstruction showed limited success, with only half of patients achieving symptom resolution. Careful preoperative assessment is crucial, especially for cases involving crossing lower pole vessels.
Area of Science:
- Pediatric Urology
- Endourology
- Surgical Outcomes
Background:
- Pelvi-ureteric junction (PUJ) obstruction is a common condition in children.
- Endopyelotomy is an established treatment for PUJ obstruction in adults.
- Its efficacy in pediatric patients requires further evaluation.
Purpose of the Study:
- To assess the outcomes of endopyelotomy in pediatric patients with PUJ obstruction.
- To identify factors influencing treatment success or failure.
Main Methods:
- Retrospective review of 13 pediatric patients (age > 5 years) undergoing endopyelotomy between 1992-1999.
- Exclusion of patients with crossing vessels (identified by CT) who underwent open pyeloplasty.
- Standard endopyelotomy technique with a 6-week stent placement.
Main Results:
- Successful symptom resolution and obstruction relief in 6 out of 13 patients (46%).
- Seven patients experienced treatment failure, necessitating open pyeloplasty.
- Complications included urinoma and retained stent fragment; crossing lower pole vessels were noted in 3 failed cases.
Conclusions:
- Endopyelotomy in symptomatic children has a suboptimal success rate.
- Thorough preoperative evaluation is essential.
- Open pyeloplasty is recommended for pediatric patients with crossing lower pole vessels.