The management of secondary pelvi-ureteric junction obstruction - a comparison of pyeloplasty and endopyelotomy

BJU Int. 2014 Jan;113(1):108-12. doi: 10.1111/bju.12454.

Abstract

Objective: To review our experience in the management of secondary pelvi-ureteric junction obstruction (PUJO) comparing endopyelotomy with pyeloplasty.

Patients and methods: We retrospectively analysed our database of 58 patients having undergone operative management of PUJO after failed primary management, including 41 with failed pyeloplasty and 17 failed endopyelotomy. Outcomes included mercapto-acetyltriglycine (MAG3) drainage capacity, symptomatic control and need for further intervention. Success was defined as freedom from failure in all three.

Results: Patients undergoing secondary pyeloplasty had better outcomes than endopyelotomy for symptomatic success (87.5% vs 74%), resolution of obstruction on MAG3 renography (96% vs 74%), and no need for further intervention (96% vs 71%). Overall success was 87.5% for pyeloplasty compared with 44% after secondary endopyelotomy.

Conclusion: Outcomes of pyelopasty for secondary PUJO were superior when compared with endopyelotomy.

Keywords: endopyelotomy; pyeloplasty; secondary pelvi-ureteric junction obstruction.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Drainage*
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Diseases / complications
  • Kidney Diseases / physiopathology
  • Kidney Diseases / surgery*
  • Kidney Pelvis / physiopathology
  • Kidney Pelvis / surgery*
  • Laparoscopy*
  • Male
  • Middle Aged
  • Radioisotope Renography
  • Reoperation
  • Retrospective Studies
  • Treatment Failure
  • Treatment Outcome
  • Ureteral Obstruction / complications
  • Ureteral Obstruction / physiopathology
  • Ureteral Obstruction / surgery*
  • Urologic Surgical Procedures / adverse effects
  • Urologic Surgical Procedures / methods*