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Percutaneous endopyelotomy in infants and young children after failed open pyeloplasty
G J Faerber1, M L Ritchey, D A Bloom
1Department of Surgery, University of Michigan School of Medicine, Ann Arbor, USA.
Insights
Percutaneous endopyelotomy is a safe and effective treatment for secondary ureteropelvic junction obstruction in children after open pyeloplasty. This minimally invasive approach offers a viable alternative to repeat open surgery.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
Background:
- Secondary ureteropelvic junction (UPJ) obstruction can occur after initial open pyeloplasty.
- Repeat open pyeloplasty may be associated with significant morbidity in pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous antegrade endopyelotomy for secondary UPJ obstruction in infants and young children.
- To assess percutaneous endopyelotomy as a minimally invasive alternative to repeat open pyeloplasty.
Main Methods:
- A cohort of 5 children (3 boys, 2 girls) with persistent UPJ obstruction post-open pyeloplasty underwent the procedure.
- Percutaneous antegrade cold knife endopyelotomy was performed using an 18F nephrostomy tract.
Main Results:
- The procedure was technically successful in all 5 children with minimal complications.
- At a mean follow-up of 2.5 years, 4 out of 5 children showed successful outcomes.
- Success was defined by symptom resolution, normal pressure-perfusion studies, and improved diuretic renal scintigraphy.
Conclusions:
- Percutaneous antegrade endopyelotomy is a safe and effective treatment for pediatric secondary UPJ obstruction.
- This minimally invasive technique provides a valuable alternative to repeat open pyeloplasty, potentially reducing patient morbidity.
Purpose:
We assessed the efficacy and safety of percutaneous endopyelotomy in infants and young children with secondary ureteropelvic junction obstruction after previous open pyeloplasty.
Materials And Methods:
Three boys and 2 girls with persistent ureteropelvic junction obstruction after open pyeloplasty underwent percutaneous antegrade cold knife endopyelotomy via an 18F nephrostomy tract.
Results:
Percutaneous endopyelotomy was successfully performed in all 5 children with minimal complications. At a mean followup of 2.5 years endopyelotomy was successful in 4 of the 5 children based on the absence of symptoms, normal pressure-perfusion studies and normal or improved diuretic renal scintigraphy studies. One child in whom endopyelotomy failed underwent successful ureterocalicostomy.
Conclusions:
Percutaneous antegrade endopyelotomy is a safe and efficacious method of treating secondary ureteropelvic junction obstruction in children. This method offers a minimally invasive alternative to conventional repeat open pyeloplasty.