[Transrenal endopyelotomy is an alternative to surgical pyeloplasty]

Over the period 1990-1992, a total of 372 patients with hydronephrosis undergo treatment in the Clinical Center of Urology at the Faculty Alexander Hospital--Sofia Twelve of them are treated after the method of Davis, and 12 patients treated by endopyelotomy are subjected to follow-up study in collaboration with the Department of Urology and Nephrology-Higher Medical Institute, Sofia. As the result of 24 operative interventions the underlying cause of the condition is eliminated, and urinary drainage successfully restored. According to literature data the contraindications for operation include: very broad kidney pelvis and long strictures of the pyeloureteral segment; in the authors' opinion the presence of aberrant blood vessels should be also considered as a contraindication because in such cases the underlying cause cannot be removed. As shown by comparative assessment of the two methods, endopyelotomy has superiorities over surgical pyeloplasty owing to the fact that it is atraumatic, readily tolerated by patients and economically beneficial in the treatment of hydronephrosis, contributing to avoid the complications of surgical pyeloplasty; the complications of endopyelotomy are uncommon and lend themselves readily to conservative management with a positive outcome.