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[Complications of "Acucise" balloon endopyelotomy]
Jochen Walz1, Catherine Lecamus, Eric Lechevallier
1Service d'Urologie et de Transplantation Rénale, Hôpital Salvator, 249, Bd. de Sainte Marguerite, BP, 51, 13274 Marseille.
Insights
Acucise balloon endopyelotomy for ureteropelvic junction stenosis is effective, but careful patient selection is crucial. Hemorrhagic complications, often linked to lower pole vessels, require meticulous technique and indications.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Endourology
Background:
- Ureteropelvic junction (UPJ) stenosis is a common condition requiring surgical intervention.
- Endopyelotomy using Acucise balloon is a minimally invasive treatment option for UPJ stenosis.
- Understanding the specific complications associated with Acucise balloon endopyelotomy is essential for optimizing patient outcomes.
Purpose of the Study:
- To investigate the specific complications encountered during Acucise balloon endopyelotomy for UPJ stenosis.
- To evaluate the safety and efficacy of Acucise balloon endopyelotomy in a cohort of patients.
- To identify factors that may contribute to complications and treatment failure.
Main Methods:
- A retrospective review of 50 consecutive patients treated with Acucise balloon endopyelotomy for UPJ stenosis between January 1994 and February 1999.
- Data collected included patient demographics, stenosis characteristics, intraoperative events, perioperative complications, and long-term outcomes.
- Preoperative CT angiography was utilized to diagnose polar pedicles in select cases.
Main Results:
- The overall success rate was 74% with a mean follow-up of 47 months.
- Intraoperative technical incidents occurred in 12% of cases (e.g., balloon rupture).
- Perioperative hemorrhagic complications occurred in 14% of cases, particularly in patients with polar pedicles, requiring radiological embolization or lumbotomy in some instances. Urinary tract infections and stent discomfort were also noted.
Conclusions:
- Acucise balloon endopyelotomy is a simple and effective treatment for UPJ stenosis.
- Careful patient selection and meticulous surgical technique are paramount to minimize the risk of hemorrhagic complications, especially those related to lower pole vessels.
- Despite complications, the overall success rate remains favorable, though failure may be associated with lower pole pedicles.
Objectives:
Although the results of endopyelotomy for ureteropelvic junction (UPJ) stenosis are well known, our objective was to study the specific complications of treatment of UPJ stenoses by Acucise balloon.
Material And Methods:
The specific complications of 50 patients (40 women, 10 men) treated consecutively by Acucise balloon endopyelotomy for UPJ stenosis from January 1994 to February 1999 were reviewed. The mean age was 47 years (range: 19-84 years). Thirty-five stenoses (70%) were primary. A polar pedicle was diagnosed by preoperative CT angiography in 5 cases. The endopyelotomy technique was that described by Chandhokf except in 3 cases in which section with strict external lateral orientation was performed.
Results:
Mean operating time and mean length of hospital stay were 70 min (range: 35-180 min) and 5.4 days (range: 2-27 days), respectively. Six (12%) technical incidents were observed intraoperatively (3 cases of rupture of balloon) and 7 (14%) haemorrhagic incidents were observed perioperatively (5 polar pedicles). There were no conversions to open surgery. There were 4 (8%) major perioperative complications, all haemorrhagic, which required 2 radiological embolizations and one lumbotomy. Only these patients required transfusion (3.25 units/patient). Fourteen urinary tract infections were observed, including 2 cases of pyelonephritis (4%) and one case of septicaemia (2%). Nine patients experienced severe discomfort due to the double J stent. With a mean follow-up of 47 months, the overall success rate was 74%, not influenced by the development of a complication. Seven (58%) of the 12 patients with failure of endopyelotomy had a lower pole pedicle.
Conclusion:
Acucise endopyelotomy is a simple and effective technique. However, rigorous indications and technique are essential due to the possibility of haemorrhagic complications, often related to a lower pole vessel.