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Endopyelotomy for secondary ureteropelvic junction obstruction in children
L R Kavoussi1, S Meretyk, S M Dierks
1Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.
Insights
Percutaneous endopyelotomy is a safe and effective treatment for secondary ureteropelvic junction obstruction in children. This minimally invasive procedure successfully relieved obstruction in all four pediatric patients studied.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Endourology
Background:
- Ureteropelvic junction (UPJ) obstruction is a common congenital anomaly in children.
- Open dismembered pyeloplasty is the traditional surgical treatment for UPJ obstruction.
- Limited data exist on the efficacy of percutaneous endopyelotomy for secondary UPJ obstruction in pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous endopyelotomy in children with secondary UPJ obstruction.
- To assess the outcomes of percutaneous endopyelotomy following failed open pyeloplasty in pediatric patients.
Main Methods:
- Retrospective case series of 4 pediatric patients (6.5 weeks to 5.5 years old) with secondary UPJ obstruction.
- Preoperative diagnosis confirmed by nephrostogram, diuretic renogram, and/or ultrasonography.
- Percutaneous endopyelotomy performed as a minimally invasive treatment.
Main Results:
- Successful relief of UPJ obstruction in all 4 patients.
- Two patients required secondary endoscopic procedures for persistent obstruction or ureterovesical stricture.
- All patients remained asymptomatic with a patent UPJ at 1.5 to 3 years of follow-up.
Conclusions:
- Percutaneous endopyelotomy is a safe and effective treatment option for secondary UPJ obstruction in children.
- This minimally invasive approach offers a viable alternative after failed open pyeloplasty.
- Long-term follow-up demonstrates sustained patency and symptom resolution.
Abstract:
Percutaneous endopyelotomy has been shown to be successful in treating ureteropelvic junction obstruction in adults. Little data have been published regarding this procedure in children. We describe 4 patients 6.5 weeks to 5.5 years old who underwent percutaneous endopyelotomy to treat ureteropelvic junction obstruction following failed open dismembered pyeloplasty. Preoperative obstruction was demonstrated by a nephrostogram, diuretic renogram and/or ultrasonography. Percutaneous endopyelotomy was successful in relieving the obstruction in all 4 patients, although 2 required secondary endoscopic procedures. One patient had persistent obstruction 40 days after endopyelotomy at the ureteropelvic junction and, subsequently, required percutaneous resection of a persistent flap of obstructing tissue. In another patient a ureterovesical stricture was noted at the time of stent removal, which was treated by endoscopic incision. All patients have been followed from 1.5 to 3 years postoperatively. Followup diuretic renograms, ultrasound and/or excretory urography demonstrated a patent ureteropelvic junction in all patients and all have remained asymptomatic. Endopyelotomy appears to be safe and effective in treating secondary ureteropelvic junction obstruction in children.