SECONDARY URETEROPELVIC JUNCTION OBSTRUCTION: ENDOPYELOTOMY A BETTER OPTION

Abstract

Objective: To evaluate the outcome of percutaneous antegrade endopyelot -omy as a primary intervention for Secondary Ureteropelvic junction (UPJ) ob-struction.
Methodology: This study was conducted from 20th January 2011 to 19th
January 2012 at Institute of Kidney diseases, Hayatabad, Peshawar. A sample
of 31 cases having evidence of secondary ureteropelvic obstruction were list-ed for the study of which 21 cases as males and the rest females. Ultrasound,
intravenous urogram and DTPA Scanwere carried out. Patients with severe
hydronephrosis, renal function <30%, anterior crossing vessel and UPJ>2 cm
stenosed segment were not included in the study. Stenosed segment was
incised posterior-laterally until periureteral and peripelvic fat was visualized.
At completion of 8 weeks postoperatively the ureteric stents were removed
as day cases and the patients were evaluated at follow-up of 3 months and
every subsequent 6 months in the out-patient department with data relevant
collected on a predesigned proforma.
Results: Demographically the findings were observed and mean age at both
sexes was similar. The mean split GFR on the affected side was 36.5 mg/ml.
The average time taken to completion of the procedure was 63 min. Hospital
stay averaged 3.8 days (ranging form 2–6 days). Success rate was 81% (25 of
31) at 10.25 months. Failure was noted clinically in 6 cases with presentation
variably at completion of first to the third month postoperatively.
Conclusion: Percutaneous antegrade endopyelotomy has significant advan-tages in term of reduced hospital stay, shorter operative time, early postoper -ative recovery, minimal morbidity and decreased postoperative analgesic re-quirements. It is successful in selected patient who have good renal functions,
no crossing vessels, mild to moderate hydronephrosis and dependent ureters.