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Endopyelotomy in childhood: our experience with 37 patients
Béla Tállai1, Morshed Ali Salah, Tibor Flaskó
1Department of Urology, University of Debrecen Medical and Health Science Center, Debrecen, Hungary. btallai@freemail.hu
Insights
Endopyelotomy is a safe and effective treatment for ureteropelvic junction (UPJ) stricture in children. This study shows an 89% success rate in pediatric patients, with minimal complications.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urologic Oncology
Background:
- Ureteropelvic junction (UPJ) stricture is a common cause of congenital hydronephrosis in children.
- Endopyelotomy offers a less invasive alternative to open pyeloplasty for UPJ obstruction.
Purpose of the Study:
- To evaluate the safety and efficacy of endopyelotomy in treating pediatric patients with UPJ stricture.
- To assess the long-term outcomes and complication rates associated with this procedure in a pediatric cohort.
Main Methods:
- A retrospective review of 37 pediatric patients who underwent percutaneous antegrade endopyelotomy for UPJ stricture between 1990 and 2002.
- The procedure involved fluoroscopic guidance, cold knife incision of the UPJ, and stenting with a transrenal drain or double-J catheter.
Main Results:
- The overall success rate of endopyelotomy was 89% at 1-year follow-up.
- One patient required repeat procedure due to drain dislodgement; two patients needed open pyeloplasty or nephrectomy for complications.
- The average postoperative hospital stay was 6 days.
Conclusions:
- Endopyelotomy is a safe and effective treatment option for UPJ stricture in the pediatric population.
- Experienced surgeons can achieve high success rates, comparable to adult outcomes.
- This minimally invasive approach provides a valuable alternative for managing UPJ obstruction in children.
Purpose:
To evaluate our experience and results with endopyelotomy in the pediatric population.
Patients And Methods:
Between 1990 and 2002, we performed percutaneous antegrade endopyelotomy under general anesthesia in 37 children because of ureteropelvic junction (UPJ) stricture. The youngest patient was 4.5 years and the oldest 17 years at the time of the procedure (mean age 11.5 years). One patient had bilateral stenosis; the two sides were operated on separately. After insertion of a 4F ureteral catheter and filling the collecting system with colored contrast material, a middle calix was punctured under fluoroscopic control. The tunnel was dilated to 26F by telescopic metal dilators. After insertion of a 0.035-inch gidewire through the UPJ, all its layers were cut by a cold knife in the dorsolateral direction so that the periureteral fatty tissue could be seen. Finally, the ureteral wound was stented by a 6F to 12F transrenal drain or a double-J catheter, which was removed after 6 weeks.
Results:
Among the 37 patients, the procedure had to be repeated in 1 because the transrenal drain stenting the UPJ slid back to the renal pelvis. We had to perform open pyeloplasty or nephrectomy in two patients because of bleeding or failed procedure. The average postoperative hospital stay was 6 days. Comparison of the preoperative intravenous urograms with studies performed 1 year after endopyelotomy showed an overall success rate of 89%. All patients are without complaints at the moment.
Conclusions:
In experienced hands, endopyelotomy is a safe and effective method for the treatment of UPJ stricture, not only in the adult, but also in the pediatric, population.
