The Minimally Invasive Treatment Of Ureteropelvic Junction Obstruction: A Review Of Our Experience During The Last Decade

Main Category: Urology / Nephrology
Article Date: 01 Dec 2008 - 0:00 PST

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UroToday.com - This companion article to the prior large series on robotic pyeloplasty is of great importance as the authors have evaluated retrograde endopyelotomy (128 patients), laparoscopic dismembered pyeloplasty (116 patients), and robotic pyeloplasty (29 patients) with renal scans, over time.

Notable is that with 19-20 months mean follow-up in all 3 groups, the success rate is 60%, 89% and 100%.

Like Demarco and colleagues at the Mayo Clinic1, the authors noted a significant deterioration in success rates over time such that the estimated success rate for endopyelotomy and laparoscopic pyeloplasty at 10 years is only 45% and 75% - essentially identical to what Demarco reported.

The authors noted a marked shift from endopyelotomy to laparoscopic/robotic pyeloplasty in their institution, such that presently, only 20% of their UPJ patients undergo an endopyelotomy (i.e. older, no crossing vessels, low grade hydronephrosis, and a strong desire on the patient's part to avoid any incisional procedure).

While not discussed in detail, the high success rate with robotic pyeloplasty is notable; the authors do mention that the robot would likely allow more surgeons to offer their patients a laparoscopic solution to UPJ obstruction.

Finally, I applaud the authors for their having stressed the importance of annual follow-up with renal scans and as necessary, with ultrasound study to assess cortical thickness and degree of hydronephrosis.

They have provided data that are clear and can be used for comparison to other results from other institutions over time.

References:
1Demarco, D. S., Gettman, M. T., McGee, S. M., et al.: Long-term success of antegrade endopyelotomy compared with pyeloplasty at a single institution. J. Endo. 20: 707, 2006

Yanke BV, Lallas CD, Pagnani C, McGinnis DE, Bagley DH
J Urol. 2008 Oct;180(4):1397-402
doi:10.1016/j.juro.2008.06.020

Written by UroToday.com Medical Editor Ralph V. Clayman, MD

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