[Endopyelotomy. A definitive alternative to pyeloplasty?]

Endopyelotomy is a minimally invasive surgical alternative to the classic open surgery in the treatment of stenosis of the pyelo-ureteral attachment with similar success rates. This paper presents the results from 38 endopyelotomies performed between February 1989 and December 1993 in equal number of patients, 36 of them using percutaneous approach, 29 through the medium calix and 7 through the lower calix. Acucise's catheter was used in both cases. With the total of 38 endopyelotomies performed the complications and results obtained are presented as well as the results assessed by clinical, radiological and renographic criteria. The overall rate of success for endopyelotomy was 77.8%. When only improvement of urographic signs was evaluated, the success rate was lower (66.7%). In 4 clinically asymptomatic patients who showed no radiological improvement, a good response to diuretic therapy was seen in the renogram which was shown to be a basic test in the diagnosis, evaluation of results and follow-up of these patients. It is concluded that currently, endopyelotomy represents a choice technique in the treatment of stenosis of the pyelo-ureteral attachment with a low rate of intraoperative complications (3.4%). Also, it must be established that failure of this minimally invasive technique does not condition any added surgical difficulties to perform pyeloplasty.