Management of failed primary intervention for ureteropelvic junction obstruction: 12-year, single-center experience

To compare contemporary endourologic and open surgical management of failed primary intervention for ureteropelvic junction obstruction, specifically in regard to immediate and long-term results and complications.

Since 1989, 48 patients have undergone management of failed primary intervention for ureteropelvic junction obstruction. Of these, 42 patients (21 females and 21 males; age range 16 to 68 years, mean age 34.9) underwent follow-up evaluations. These 42 patients constitute the present study group. The mode of secondary intervention was determined by individual upper tract anatomy, concurrent medical conditions, and informed patient preference. Secondary intervention included open operative repair (n = 20) or percutaneous (n = 11), ureteroscopic (n = 5), or retrograde cautery wire balloon (n = 6) endopyelotomy. Success was defined as symptomatic relief and improved calicectasis on radiographic evaluation at latest follow-up.

Follow-up ranged from 6 to 148 months (mean 47.7). Endourologic intervention was associated with a mean hospital stay of 2.3 nights and a complication rate of 13.6%. The long-term success rate of these endoscopic approaches was 59.1% overall, including a 71.4% success rate after a failed open operative procedure and a 37.5% success rate after a failed endourologic procedure. In contrast, open operative salvage was associated with a mean stay of 4.3 nights and a 15% complication rate. The success of open operative salvage was 95% overall, including 94.1% after failed endourologic intervention and 100% after failed open operative intervention.

Endourologic intervention for failed primary management of ureteropelvic junction obstruction is associated with a short hospital stay and low rate of complications. Such intervention provides acceptable success rates in the setting of prior failed open operative intervention. However, when endourologic salvage was used for prior failed endourologic intervention, the success rates were limited. This suggests that intrinsic factors such as crossing vessels or periureteral fibrosis may play a role in limiting the utility of such procedures in this setting. In contrast, open operative salvage after any prior failed intervention for ureteropelvic junction obstruction provides excellent functional results without any increase in morbidity, with, in this contemporary series, an acceptably short hospital stay. These data should help urologists and patients make well-informed treatment decisions.