AIM: To analyze the results of secondary percutaneous endopyelotomy (PE) in children with failed primary pyeloplasty for the treatment of secondary ureteropelvic junction obstruction (UPJO).
METHODS: We performed a retrospective study of all patients treated in our department in the period 2009-2013 due to recurrent UPJO. All procedures were performed with a 12 Fr Miniperc in supine position. A high pressure balloon was inflated at the UPJO. In order to improve the exposure of the cutting area, the UPJ is introduced into the renal pelvis by pushing the high-pressure balloon. Modified percutaneous endopyelotomy (MPE) was done with monopolar electrocautery over it to avoid damaging nearby structures. Medical data and imaging studies previous and posterior to first surgery and PE were reviewed.
RESULTS: Between July 2009 and July 2013, 9 patients (7 boys - 2 girls) with recurrent UPJO were treated in our hospital (5.8 ± 4.9 years). Three patients had a solitary kidney. Three children had 2 previous procedures. Mean operative time was 61.0 ± 17.9 minutes. Mean hospital stay after surgery was 3.8 ± 1.9 days. Mean follow-up after MPE was 39.3 ± 25.2 months. All patients were symptom free Postoperative ultrasound and renogram showed that MPE was successful in 7 renal units. In 2 patients hydronephrosis improvement was not significant. Three patients suffered postoperative complications: hematuria, double J obstruction y paralytic ileus.
CONCLUSION: MPE is a fairly effective technique to treat recurrent UPJO after failed pyeloplasty in children. However, in some cases potentially serious complications can be observed.
Written by:
Parente A, Angulo JM, Burgos L, Romero RM, Rivas S, Ortiz R. Are you the author?
Pediatric Urology Department, Gregorio Marañon University Hospital, Madrid, Spain.
Reference: J Urol. 2015 Jan 23. pii: S0022-5347(15)00163-9.
doi: 10.1016/j.juro.2015.01.074
PubMed Abstract
PMID: 25623746