Pediatric endopyelotomy: the Washington University experience

Area of Science:

• Urology
• Pediatric Surgery
• Minimally Invasive Procedures

Background:

• Ureteropelvic junction obstruction (UPJO) is a common cause of hydronephrosis in children.
• Endopyelotomy is an accepted minimally invasive treatment for adult UPJO, but its role in pediatric UPJO is debated.
• This study evaluates the efficacy of antegrade endopyelotomy in pediatric patients with UPJO.

Purpose of the Study:

• To assess the outcomes of antegrade endopyelotomy for primary treatment of pediatric ureteropelvic junction obstruction.
• To evaluate the effectiveness of antegrade endopyelotomy as a secondary treatment following failed open pyeloplasty in pediatric patients.

Main Methods:

• Seventeen pediatric patients (3 months to 17 years) underwent antegrade endopyelotomy.
• Eight patients received endopyelotomy as primary treatment for UPJO.
• Nine patients underwent secondary endopyelotomy after failed open pyeloplasty, with a mean interval of 12 weeks.

Main Results:

• Primary endopyelotomy was successful in 62% (5/8) of pediatric patients at a mean follow-up of 38 months.
• Secondary endopyelotomy after failed open pyeloplasty was successful in all 9 patients at a mean follow-up of 59 months.
• Failures in the primary group occurred at 6 weeks and 3 months postoperatively.

Conclusions:

• Antegrade endopyelotomy may be a suitable option for select pediatric patients with primary ureteropelvic junction obstruction.
• Endopyelotomy is a safe and effective treatment for pediatric UPJO when open pyeloplasty has failed.
• Further research may clarify the role of endopyelotomy in the primary management of pediatric UPJO.