Persistent hydronephrosis after pyeloplasty: Is it a true obstruction? The role of endourology
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Abstract
Introduction: Anderson-Hynes pyeloplasty remains the gold standard in the treatment of ureteropelvic junction obstruction. The diagnostic criteria for defining the failure of pyeloplasty are not well-defined or even arbitrary. Likewise, the ideal treatment of persistent hydronephrosis after pyeloplasty is not well established. We tested an innovative endourological procedure, which simultaneously allows a diagnostic definition of failure and treatment when necessary.
Materials and methods: The endourological procedure was applied prospectively to 13 cases from 2006 to 2015. The mean hydronephrosis was 3 cm and all the patients showed an obstructive pattern at scintigraphie. Of these, only 2 patients had symptoms. The procedure consisted in the endoscopic calibration of the pyeloureteral junction. In case of confirmed persistent stenosis, the procedure continued with the high pressure dilation of the junction. The calibration/dilation procedure was carried out with a balloon catheter, previously used for high pressure dilation in the obstructive megaureter. In all patients, a ureteral stent was positioned for 6 - 8 weeks.
The patients were then followed up using ultrasound and renoscintigraphie.
Results: According to the endoscopic balloon procedure, anastomosic stenosis was confirmed in 3 cases, treated with high pressure dilation during the same procedure. In 10 cases no stenosis was found and we followed-up these patients with periodic ultrasound and scintigraphie.
Conclusion: The calibration/dilation of the pyeloureteral junction represents in our opinion a useful diagnostic and therapeutic tool that allows to limit the repetition of open surgery only to symptomatic cases and those non-responders to endoscopic treatment.
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Salem YH, Majd M, Rushton HG, Belman AB. Outcome analysis of pediatric pyeloplasty as a function of patient age, presentation and differential renal function. J Urol. 1995; 154: 1889-1893. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7563377
Braga LH, Lorenzo AJ, Bägli DJ, Keays M, Farhat WA, et al. Risk factors for recurrent ureteropelvic junction obstruction after open pyeloplasty in a large pediatric cohort. J Urol. 2008; 180:1684-1688. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18708226
Caione P, Lais A, Nappo SG. One-Port Retroperitoneoscopic Assisted Pyeloplasty Versus Open Dismembered Pyeloplasty in Young Children: Preliminary Experience. J Urol. 2010; 184:2109-2115. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20851429
Torino G, Collura G, Mele E, Garganese MC, Capozza N. Severe primary obstructive megaureter in the first year of life: preliminary experience with endoscopic balloon dilation. J Endourol. 2012; 26: 325-329. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22050492
Thomas JC, DeMarco RT, Donohoe JM, Adams MC, Pope JC, et al. Management of the failed pyelopasty: a contemporary review. J Urol. 2005; 174: 2363-2366. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16280844
Lim DJ, Walker RD. Management of the failed pyeloplasty. J Urol. 1996; 156:738-740. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8683772
Persky L, McDouglas WS, Kedia K. Management of initial pyeloplasty failure. J Urol. 1981; 125:695.
Rohrmann D, Snyder HM, Duckett JW, Canning DA, Zderic SA. The operative management of recurrent ureteropelvic junction obstruction. J Urol. 1997; 158:1257-1259. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9258188
Baniel J, Livne PM, Savir A, Gillon G, Servadio C. Dismembered pyeloplasty in children with and without stents. Eur Urol. 1996; 30: 400-402. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8931977
Smith KE, Holmes N, Lieb JI, Mandell J, Baskin LS, et al. Stended versus nonstended pediatric pyeloplasty: a modern series and review of the literature. J Urol. 2002; 168:1127-1130. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12187251
Nicholls G, Hrouda D, Kellett MJ, Duffy PG. Endopyelotomy in the symptomatic older child. BJU International. 2001; 87: 525-527. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11298049
Figureenshau RS, Clayman RV. Endourologic options for management of ureteropelvic junction obstruction in the pediatric patient. Urol Clin North Am. 1998; 25:199-209. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9633575
Kinn AC. Ureteropelvic junction obstruction: long-term followup of adults with and without surgical treatment. J Urol 2000; 164: 652-656. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10953119
Parente A, Angulo JM, Romero RM, Rivas S, Burgos L, et al. Managment of ureteropelvic junction obstruction with high-pressure ballon dilatation: long-term outcome in 50 children under 18 months of age. Urol. 2013; 82: 1138-1143. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23992967