Endopyeloplasty versus endopyelotomy versus laparoscopic pyeloplasty for primary ureteropelvic junction obstruction

To present our intermediate-term (1-year) data on endopyeloplasty and retrospectively compare it with endopyelotomy and laparoscopic pyeloplasty in 44 patients with primary ureteropelvic junction (UPJ) obstruction. Endopyeloplasty, horizontal percutaneous suturing of a conventional longitudinal endopyelotomy incision, is a promising novel option for minimally invasive management of UPJ obstruction. We recently developed the technique and demonstrated the clinical feasibility of percutaneous endopyeloplasty.

At our two institutions, 44 consecutive, nonrandomized patients with primary UPJ obstruction underwent percutaneous endopyeloplasty (n = 15; group 1), percutaneous endopyelotomy (n = 15; group 2), or laparoscopic dismembered pyeloplasty (n = 14; group 3). The study inclusion criteria were short segment (less than 1 cm) stenosis, no prior surgery for UPJ obstruction, and no crossing vessels in groups 1 and 2. The mean patient age was 30.3, 38.6, and 38.9 years and the duration of symptoms was 5.5, 6, and 6.6 months in groups 1, 2, and 3, respectively. Postoperative success was evaluated by symptoms, intravenous urography, and/or diuretic renography.

The mean operative time was 119 minutes in group 1, 52 minutes in group 2, and 243 minutes in group 3 (P <0.001). Complications occurred in 3 patients in group 1 (fever in 2 and fluid extravasation in 1), 2 patients in group 2 (bleeding in 1 and urinoma in 1), and no patients in group 3. The duration of double-J stent placement was 2, 4, and 6 weeks in groups 1, 2, and 3, respectively. A resolution of symptoms and unobstructed drainage on intravenous urography and/or diuretic renography was noted in 100% and 100% of patients in group 1 (mean follow-up 11.6 months), 93% and 88% of patients in group 2 (mean follow-up 31.4 months), and 93% and 100% of patients in group 3 (mean follow-up 20 months).

The results of this retrospective comparison of patients with primary UPJ obstruction suggest that percutaneous endopyeloplasty may have functional superiority over percutaneous endopyelotomy. The technical simplicity and shorter operative time of endopyeloplasty are advantages compared with laparoscopic pyeloplasty. Endopyeloplasty may be associated with a shorter duration of stenting compared with the other techniques. Longer term follow-up in a larger group of patients from multiple centers and a prospective randomized comparison among these various minimally invasive approaches are necessary to validate these preliminary results.