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Antegrade Endopyelotomy

  • Chapter
Advanced Endourology

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

The popularity of minimally invasive surgical techniques, such as endopyelotomy, has increased markedly among urologists in recent years. Antegrade endopyelotomy has become a well-established alternative to open operative pyeloplasty for management of both primary and secondary ureteropelvic junction obstruction (UPJO). Endopyelotomy results in significantly less morbidity, and should this technique fail, subsequent open pyeloplasty is still technically feasible. Although several variations of the technique have been described, the goal in all cases is to develop a full thickness incision though the obstructing proximal ureter that extends out to the peripyeloureteral fat and heals over an internal stent. Antegrade endopyelotomy is particularly valuable in the setting of upper tract stones that can then be managed simultaneously. Contraindications to antegrade endoscopic incision of the UPJ include a long stricture, sepsis, a large redundant renal pelvis, poor renal function, and the presence of crossing lower vessel as the cause of the UPJO. The role of percutaneous endopyelotomy in children remains undefined. Although successful results have been reported in infants, the relative morbidity and long-term success of open pyeloplasty in this age group are excellent, thus limiting the relative advantage of an endoscopic approach. However, there may be a role for endopyelotomy in older children and in those patients with secondary obstruction who have failed open surgery. Postoperatively, it is generally recommended that the stent be left in place for a minimum of 6 weeks following endoscopic incision of the UPJ though successful results have been reported with much shorter stenting intervals of a few days. Complications of the procedure include bleeding that may require blood transfusion, sepsis, injury to abdominal organs, and contrast allergic reactions. Overall, endopyelotomy is a safe and effective treatment for primary and secondary UPJO for most patients.

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Authors and Affiliations

  1. Department of Urology, Long Island Jewish Medical Center, New Hyde Park, NY

    Beng Jit Tan MD, PhD, Assaad El-Hakim MD, Benjamin R. Lee MD & Arthur D. Smith MD

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  1. Beng Jit Tan MD, PhD
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  2. Assaad El-Hakim MD
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  3. Benjamin R. Lee MD
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  4. Arthur D. Smith MD
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Editors and Affiliations

  1. The University of Wisconsin Medical School, Madison, WI

    Stephen Y. Nakada MD

  2. The University of Texas Southwestern Medical Center, Dallas, TX

    Margaret S. Pearle MD, PhD

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Tan, B.J., El-Hakim, A., Lee, B.R., Smith, A.D. (2006). Antegrade Endopyelotomy. In: Nakada, S.Y., Pearle, M.S. (eds) Advanced Endourology. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-59259-954-7_10

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