[Endopyeloureterotomy via transpelvic extraureteral approach]

Endopyelotomy has been established as a valuable procedure to relieve the obstruction of ureteropelvic junction or upper ureteral stenosis. However, in a case with a long stenotic segment and in a case with high insertion type of ureteropelvic junction obstruction, we had often poor results by the conventional technique. To resolve these problems, we developed a new technique of endopyeloureterotomy via transpelvic extraureteral approach. We made an auxiliary incision in renal pelvis or dilated ureter involved with stricture to pass a 22 Fr. urethrotome equipped with a cold knife into the retroperitoneal space. Then we incised a stenotic segment by the knife through the urethrotome until the normal caliber of ureteric lumen was found. A 10-16 Fr. stent was left in place in the incised segment for 3 weeks. We treated 38 patients with ureteropelvic junction stenosis or upper ureteral stenosis by this procedure between August 1988 and June 1990. A total of 39 procedures were performed on 39 ureteropelvic junctions or upper ureters. Original disease were congenital anomalies in 23 patients, strictures secondary to urinary calculi in 12 and postoperative strictures in 4. The length of incision was 2 to 6 cm with the average being 3.2 cm. Postoperative follow-up period ranged 4 to 32 months with the average being 19 months. Obstructive changes disappeared or improved in 37 procedures (95%). In two procedures we failed. Thus this new technique of endopyeloureterotomy might be an useful procedure to relieve ureteropelvic junction stenosis or upper ureteral stenosis with a long stenotic segment or high insertion type of ureteropelvic junction stenosis.