Antegrade transpelvic endopyelotomy: Long term follow- up

OBJECTIVES: endopyelotomy has long been performed in the therapy of ureteropelvic junction obstruction (UPJ) but it is reported that the initial good results are not lasting. The aims of our procedure are lo carry out the operation in lull visualization allowing the operation to be performed on patients with anomalous vessels, on pediatric patients as well as adults and to obtain reliable results in terms of quality and duration. We have been performing this technique since 1989 so we are able to evaluate the long term follow-up results. MATERIALS AND METHODS:From 1989 to 1995, 46 patients (26 men, 20 women),age range (5 - 62) underwent antegrade transpelvic endopyelotomy. The technique proceeds in the following manner: - Percutaneous access to the renal pelvis via lower calix - Incision of the pelvis with straight cold blade - Access to the peripelvic space - 3 cm. incision of the ureter with hooked blade A double-J ureteral stent was positioned before the operation and removed after 3 weeks and a nephrostomic catheter was positioned for 3 days. RESULTS:follow-up was from 2 to 6 years. 38 patients ( 81%) had good results in terms of patency and a reduction of the hydronephrosis. 5 patients ( 11%) reported only a slight improvement of their symptoms. All patients underwent intravenous pyelography and sequential renal scintigraphy before the operation, at 6 months and 1 year post-operative, then every year thereafter. 2 patients underwent open surgery: 1 man with UPJ obstruction after 6 months, 1 woman because of the total detachment of the ureter from the renal pelvis during the operation. CONCLUSION: in our experience, the results do not change in the long term.Unsuccessful results are immediate. We believe that the results depend on the technique adopted.