[Retrograde cold knife endo-pyelotomy in ureteropelvic junction stenosis]

Between September 1998 and July 2000 we performed a new procedure of ureteropelvic junction (UPJ) stenosis treatment: retrograde endopyelotomy (REP). So, 17 patients (7 males and 10 females) between 23 and 56 years old with hydronephrosis (IInd grade--3 cases, IIIrd grade--12 cases and IVth grade--2 cases) were evaluated with an unitary protocol: gray-scale and duplex Doppler (resistive index--RI measurement), IVP, ureteropyelography and renal scintigraphy in selected cases. The hydronephrosis was primitive in 12 cases and secondary in 5 cases (after previous open surgery). We excluded from our series of patients cases with aberrant vessels (polar inferior), associated renal stones, important hydronephrosis and young patients. Video assisted endoincision was realized at 6 and 3 o'clock position on the left side and at 6 and 9 o'clock position on the right side with Wolf semirigid ureteroscopes, Storz special knife/scissor. Double J indwelling catheter (8 Fr.) was removed after 6 weeks. The evaluation has been made at 3.6, 9 and 12 months demonstrating normal pyelocaliceal system in 10 cases (58.8%), a significative reduction of hydronephrosis grade in 3 cases (17.6%), mean RI = 0.63, with the presence in 15 cases (88.2%) of RI under 0.70. Stable good results were found in 14 cases (82.3%). After the failure of this technique (stenosis in 2 cases) the REP was practiced again. We didn't find intraoperative complications. Our conclusions despite the relative short follow-up period are very much in favor of this modality of treatment, minimally invasive, being an efficient technique in the modern therapy of hydronephrosis.