Outcome of secondary open surgical procedure in patients who failed primary endopyelotomy

Endopyelotomy is an effective method for treating pelviureteric junction (PUJ) obstruction; however, up to 28% of patients fail endoscopic treatment and require a secondary open surgical procedure. Six patients underwent secondary open surgical procedures following failed endopyelotomy for primary PUJ obstruction at this institution. One patient had impaired renal function in the affected kidney prior to endopyelotomy and postoperative evaluation indicated further deterioration; nephrectomy was performed for chronic obstruction and pain. The remaining 5 patients underwent secondary open pyeloplasty. In 4 patients the operation was difficult and lengthy because of extensive periureteric fibrosis. Difficult dissection was associated with a repeat endoscopic attempt to repair the PUJ obstruction, urinoma formation or stent occlusion requiring intervention. A mean follow-up of 1.7 years demonstrated no radiographic or clinical evidence of recurrent obstruction in the 5 patients undergoing secondary open pyeloplasty; all 6 patients are currently asymptomatic.