The management of secondary pelvi-ureteric junction obstruction - a comparison of pyeloplasty and endopyelotomy

Abstract

Objective: To review our experience in the management of secondary pelvi-ureteric junction obstruction (PUJO) comparing endopyelotomy with pyeloplasty.

Patients and methods: We retrospectively analysed our database of 58 patients having undergone operative management of PUJO after failed primary management, including 41 with failed pyeloplasty and 17 failed endopyelotomy. Outcomes included mercapto-acetyltriglycine (MAG3) drainage capacity, symptomatic control and need for further intervention. Success was defined as freedom from failure in all three.

Results: Patients undergoing secondary pyeloplasty had better outcomes than endopyelotomy for symptomatic success (87.5% vs 74%), resolution of obstruction on MAG3 renography (96% vs 74%), and no need for further intervention (96% vs 71%). Overall success was 87.5% for pyeloplasty compared with 44% after secondary endopyelotomy.

Conclusion: Outcomes of pyelopasty for secondary PUJO were superior when compared with endopyelotomy.

Keywords: endopyelotomy; pyeloplasty; secondary pelvi-ureteric junction obstruction.