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Open surgical exploration after failed endopyelotomy: a 12-year perspective
M Gupta1, O L Tuncay, A D Smith
1Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
The Journal of Urology
|May 1, 1997
Summary
High-grade hydronephrosis and poor renal function significantly increase endopyelotomy failure risk. Crossing vessels play a minor role in the failure of this kidney stone treatment.
Area of Science:
- Urology
- Nephrology
- Surgical Outcomes
Background:
- Endopyelotomy is a common procedure for ureteropelvic junction obstruction.
- Factors influencing endopyelotomy success are not fully understood.
- Previous studies suggested high-grade hydronephrosis and crossing vessels as key factors.
Purpose of the Study:
- To retrospectively analyze factors affecting endopyelotomy outcomes.
- To determine the significance of renal function, hydronephrosis, and crossing vessels in endopyelotomy failure.
- To evaluate the role of surgeon experience and ureteral stents.
Main Methods:
- Retrospective analysis of 401 percutaneous antegrade endopyelotomies.
- Evaluation of patient data including renal function and hydronephrosis grade.
- Analysis of surgical exploration findings for failed cases.
Main Results:
- High-grade hydronephrosis (50% success) and poor renal function (54% success) were associated with significantly lower success rates compared to moderate hydronephrosis (96%) or good renal function (92%).
- Severe extrinsic fibrosis and intrinsic fibrotic stenosis were common findings in failed cases.
- Obstructing crossing vessels were identified in only 4% of explored patients, suggesting a limited role.
Conclusions:
- High-grade hydronephrosis and poor initial renal function are significant predictors of endopyelotomy failure.
- The role of crossing vessels in endopyelotomy failure appears less significant than previously believed.
- These findings can help refine patient selection and surgical planning for endopyelotomy.