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Antegrade endopyelotomy for pelvi-ureteric junction obstruction in children
N Rodrigues Netto1, O Ikari, S C Esteves
1Division of Urology, University of Campinas Medical Center, São Paulo, Brazil.
Insights
Percutaneous endopyelotomy is a safe and effective treatment for pediatric primary pelvi-ureteric junction obstruction. However, results for secondary obstruction were suboptimal, warranting further investigation.
Area of Science:
- Urology
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Pelvi-ureteric junction (PUJ) obstruction is a common cause of congenital hydronephrosis in children.
- Percutaneous endopyelotomy offers a minimally invasive approach to treat PUJ obstruction.
Purpose of the Study:
- To compare the efficacy and safety of percutaneous endopyelotomy for PUJ obstruction in children versus adults.
- To evaluate outcomes based on primary versus secondary obstruction in both age groups.
Main Methods:
- A retrospective review of 9 children and 61 adults undergoing cold-knife percutaneous endopyelotomy for PUJ obstruction.
- Comparison of success rates, morbidity, and follow-up data between pediatric and adult cohorts.
Main Results:
- Overall success rates for endopyelotomy were comparable between children (78%) and adults (82%), with no statistical difference (P=0.58).
- Success in primary PUJ obstruction was high in both groups (children: 83%, adults: 83%).
- Morbidity was low in both children (11%) and adults (3.2%).
Conclusions:
- Percutaneous endopyelotomy is a safe and effective option for primary PUJ obstruction in children.
- Results for secondary PUJ obstruction were less favorable in children.
- Larger studies are needed to define the role of endopyelotomy in pediatric PUJ obstruction, considering alternatives like open pyeloplasty.
Objective:
To compare the results of repairing pelvi-ureteric junction (PUJ) obstruction by percutaneous endopyelotomy in children with a similar series carried out in adults.
Patients And Methods:
Nine children with primary (six) or secondary (three) PUJ obstruction were treated using a one-stage cold-knife percutaneous endopyelotomy. The success and morbidity rates were compared with a series of 61 adults with primary (46) or secondary (15) PUJ obstruction treated similarly.
Results:
In children, endopyelotomy was successful in five of six with primary and two of three with secondary PUJ obstruction, with a mean follow-up of 30 months (range 18-56). In the adults, endopyelotomy was successful in 38 of 46 (83%) with primary and 12 of 15 with secondary PUJ obstruction, an overall success rate of 82%, with a mean follow-up of 42 months (range 9-86). There was no statistical difference in the success rates with primary and secondary endopyelotomy between adults and children (P = 0.58). Failures were associated with high-grade hydronephrosis, a stenotic segment > 1.5 cm long and technical problems. Morbidity occurred in one of nine children and 3.2% of the adults.
Conclusion:
This early experience suggests that percutaneous endopyelotomy can be performed safely and successfully in children with primary PUJ obstruction. However, in secondary stenosis, the results were less than optimal. Larger series should be analysed to form definitive conclusions on the role of endopyelotomy for the treatment of PUJ obstruction in children, given the high rate of success of open pyeloplasty and its minimal morbidity.