Endopyelotomy and endoureterotomy with the acucise ureteral cutting balloon device: preliminary experience

Endoureterotomy and endopyelotomy usually involve an endoscopic antegrade approach. In an effort to simplify this technique, we designed an 8-mm balloon catheter with a 100-microns electrocautery cutting wire (Acucise) for retrograde incision of the ureter under fluoroscopic control. Twenty-eight patients with ureteral or ureteropelvic junction obstruction of 3.5 cm or less underwent Acucise endoureterotomy or endopyelotomy. The average operating time was 100 minutes, and the average hospital stay was 2.6 days. Follow-up was obtained with a subjective symptom score, intravenous urography, diuretic renal scan, a Whitaker test, or various combinations thereof. All patients had a minimum of 3 months of follow-up (mean 3.8 months; range 3-9 months). Overall, of the 21 patients who had symptoms of upper tract urinary obstruction, 14 (67%) had complete resolution, and another 4 (19%) had partial resolution, of their symptoms. Postoperative studies demonstrated normal upper tracts in 71% and improvement in another 14% of the patients. In our experience, the Acucise ureteral cutting balloon device provides an effective and efficient means for performing a retrograde endoureterotomy or endopyelotomy.