Abstract
To evaluate the efficacy of endopyeloureterotomy via a transpelvic extraureteral approach for the treatment of ureteropelvic junction obstruction or upper ureteric stenosis, we analysed the results of 85 patients treated with this procedure between Aug. 1988 and June 1993.
Eighty-five patients underwent 87 procedures. Each patient has been followed-up more than 6 months postoperatively. Of 87 procedures, 71 were performed in patients with ureteropelvic junction obstruction and 16 were in patients with stenosis of the upper third ureter. Primary disease was 59 and secondary disease was 28. Twenty-one procedures were performed in patients with the stenotic segment over 2cm.
The operative procedure was performed by first incising with a 22 Fr. urethrotome (ACMI Co.); the dilated renal pelvic or ureteral wall posterolaterally as long as 1-1.5cm junction from the stenotic segment toward ureteropelvic junction, then bringing the urethrotome out retroperitoneally through the incision and finally incising the stenotic segment with the cold knife under direct vision. A 12-16 Fr. PTCS tube (Sumitomo Behkuraito Co.) was left in place for 3 weeks as a stent.
Mean operative time was 101min and average length of incised segment was 3.7cm. Complication included pneumothorax (1 case), pseudo ureter (1 case) and renal arterial anexryma (1 case).
Followed-up period ranged from 6 to 64 months with the average being 26 moths. Of 87 procedures, 80 (92%) achieved a disappearance or improvement of the obstructive change and 7 failed. The success rate was 95% in the cases with the congenital disease and 86% in those with the secondary disease. It was 92% in the cases with ureteropelvic junction obstruction and 94% in the upper ureteric stenosis. It was also 91% in the cases with >2cm length of stenotic segment.
These results indicate as follows; (1) this procedure is available for the upper ureteric stenosis as well as ureteropelvic junction obstruction. (2) it is feasible for treatment of the case with a long (>2cm) stenotic segment.
