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Endopyelotomy in poorly functioning kidney: is it worthwhile?

R Kapoor1, W Zaman, A Kumar

  • 1Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. rkapoor@sgpgi.ac.in

Journal of Endourology
|November 8, 2001
PubMed
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Endopyelotomy offers symptom improvement for ureteropelvic junction obstruction, even in poorly functioning kidneys. However, significant GFR improvement is less common in these cases.

Area of Science:

  • Urology
  • Minimally Invasive Surgery

Background:

  • Ureteropelvic junction (UPJ) obstruction is a common cause of kidney dysfunction.
  • Endopyelotomy is a minimally invasive surgical option for UPJ obstruction.
  • The efficacy of endopyelotomy in kidneys with poor function remains debated.

Purpose of the Study:

  • To evaluate the success of endopyelotomy in patients with poorly functioning kidneys due to primary UPJ obstruction.
  • To compare outcomes based on different levels of renal function.

Main Methods:

  • Retrospective review of 34 endopyelotomies in poorly functioning kidneys (GFR <25 mL/min).
  • Patients were divided into two groups based on GFR: <15 mL/min (Group I) and 15-25 mL/min (Group II).
  • Antegrade endopyelotomy was performed using a twin guidewire rail technique with a cold knife, followed by stenting and clinical/radiological follow-up.

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Main Results:

  • Success rates for endopyelotomy were 62% in Group I (GFR <15 mL/min) and 90% in Group II (GFR 15-25 mL/min).
  • All patients opted for endopyelotomy to avoid open surgery.
  • Symptomatic improvement was observed in a majority of patients.

Conclusions:

  • Endopyelotomy can be a viable option for symptomatic relief in patients with UPJ obstruction and poor renal function.
  • While symptoms may improve, significant stabilization or improvement in glomerular filtration rate (GFR) is less consistently achieved in severely compromised kidneys.