[Rationale for the treatment of pyelo-ureteral obstruction]

On account of the reported better results of open surgical dismembered pyeloplasty over the new techniques of endopyelotomy (95-100% versus 70-80%), the Author takes into consideration the factors which might contribute to this difference in results. Among these factors, the etiology of the obstruction seems to be of importance. In fact, while dismembered pyeloplasty involve the complete removal of both the anatomical and functional causes of obstruction (stenosis, adynamic junction), endopyelotomy should only overcome the anatomic causes of obstruction, most likely being inadequate in the functional causes of obstruction due to aperistalism of the junction. Another factor involved in the lower success rate of endopyelotomy is the absence of ampullar resection which may interfere with the recovery of a normal peristalsis. A careful and updated evaluation of the etiology and pathophysiology of pyeloureteral junction is therefore mandatory for a meaningful choice of the appropriate management and for the screening of patients who will benefit the most from each type of treatment.