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Retrograde acucise endopyelotomy: is it worth its cost?
F Sofras1, K Livadas, G Alivizatos
12nd Dept of Urology, University of Athens Medical School, Sismanoglio Hospital, Athens, Greece. fsofras@med.uoa.gr
Journal of Endourology
|July 16, 2004
Summary
Hynes-Anderson pyeloplasty offers a significantly higher success rate for ureteropelvic junction (UPJ) obstruction compared to Acucise endopyelotomy. Acucise is only effective for mild cases with good renal function.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Pediatric Surgery
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of hydronephrosis.
- Treatment options include open pyeloplasty and minimally invasive endoscopic techniques.
- Identifying optimal candidates for each procedure is crucial for successful outcomes.
Purpose of the Study:
- To compare the efficacy of Acucise endopyelotomy versus open Hynes-Anderson pyeloplasty for UPJ obstruction.
- To identify patient characteristics that predict successful outcomes with Acucise endopyelotomy.
Main Methods:
- A prospective trial involving 40 patients with UPJ obstruction.
- 22 patients underwent Acucise endopyelotomy; 18 underwent Hynes-Anderson pyeloplasty.
- Renal scans and imaging (IVU, ultrasound) assessed obstruction and dilation pre- and post-operatively.
Main Results:
- Hynes-Anderson pyeloplasty achieved a 94.5% cure rate.
- Acucise endopyelotomy had a 32% cure rate, with 22% partial improvement and 45% failure.
- Success with Acucise correlated with good renal function and mild pelvicaliceal dilation.
Conclusions:
- Hynes-Anderson pyeloplasty is superior for most UPJ obstruction cases.
- Acucise endopyelotomy is a viable option only for select patients with mild UPJ obstruction and preserved renal function.
- Severe dilation warrants consideration of open pyeloplasty.