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Comparison of percutaneous endopyelotomy with open pyeloplasty for pediatric ureteropelvic junction obstruction
1Department of Urology, West Virginia University, Morgantown, USA.
Insights
Percutaneous endopyelotomy is effective for primary ureteropelvic junction obstruction in children, similar to open pyeloplasty. However, this minimally invasive approach incurs higher costs and operative times.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urologic Oncology
Background:
- Ureteropelvic junction obstruction (UPJO) is a common cause of hydronephrosis in children.
- Percutaneous endopyelotomy (EP) is established for adult UPJO and secondary pediatric UPJO.
- Limited data exists on EP as a primary treatment for pediatric UPJO.
Purpose of the Study:
- To evaluate the efficacy of percutaneous endopyelotomy (EP) as a primary treatment for ureteropelvic junction obstruction (UPJO) in children.
- To compare EP outcomes with traditional open pyeloplasty in pediatric patients.
Main Methods:
- A comparative study of 8 pediatric patients undergoing primary EP versus 20 undergoing open pyeloplasty for UPJO.
- Preoperative diagnosis confirmed via ultrasound, IVP, or renal scan.
- Postoperative follow-up of 1.5 to 3 years, assessing success through imaging and clinical findings.
Main Results:
- Overall success rates were comparable: 88% for EP and 93% for open pyeloplasty.
- One failure occurred in each treatment group.
- Hospital stays were similar, but EP involved longer operative times and higher hospital costs.
Conclusions:
- Percutaneous endopyelotomy (EP) is an effective option for primary ureteropelvic junction obstruction (UPJO) in pediatric patients.
- While successful, EP is associated with increased costs compared to open pyeloplasty.
Purpose:
Percutaneous endopyelotomy has been shown to be effective in the management of ureteropelvic junction obstruction in adults and secondary ureteropelvic junction obstruction in children. There are little published data regarding endopyelotomy as a primary treatment in children.
Materials And Methods:
During 3 years we performed 8 endopyelotomies and 20 open pyeloplasties for primary ureteropelvic junction obstruction and compared the results. Preoperative ureteropelvic junction obstruction was detected by renal ultrasound, excretory urogram (IVP) or renal scan. All patients were followed 1.5 to 3 years postoperatively. The success of the procedure was determined by excretory urogram, renal scan or the absence of clinical findings, with 1 failure in each group.
Results:
The overall success rates for endopyelotomy and open pyeloplasty were 88% and 93%, respectively. Hospital stays were essentially equal between the groups but operative time and hospital costs were higher for endopyelotomy.
Conclusions:
Endopyelotomy may be performed effectively for primary ureteropelvic junction obstruction in children but with increased costs.