MINIMALLY INVASIVE MANAGEMENT OF URETEROPELVIC JUNCTION OBSTRUCTION.

Introduction : With the introduction of smaller ureteroscopes, flexible ureteroscopy and holmium laser, antegrade endopyelotomy has been superseded by retrograde endopyelotomy. The aim of this study was to identify whether retrograde endopyelotomy was associated with higher success rates than antegrade endopyelotomy. Method : All patients with UPJO presenting between April 1994 and May 2004 were entered into a database to record patient, operative and post-operative details. All retrograde and antegrade endopyelotomy procedures were analysed and compared to determine any differences. Result : A total of 124 patients presented to our department with UPJO. Of which 60 patients had minimally invasive treatment, 18 patients had an antegrade endopyelotomy and 42 retrograde endopyelotomy. Of the antegrade group, 17 patients had complete follow up. Those patients receiving primary treatment had a success rate of 53% with a mean time to failure of 30 months (range 1-70). Seventeen% of this group had had a previous failed open pyeloplasty and these patients had a success rate of 50%. The retrograde endopyelotomy group consisted of 24 primary and 18 secondary procedures. The primary procedures had a success rate of 71% while the secondary procedures were associated with a 53% success rate. The additional use of the endoluminal ultrasound probe in the primary procedures increased the success rate from 50 to 76%, however our numbers are insufficient for statistical analysis. Conclusion : In our experience, retrograde endopyelotomy is associated with higher success rates than antegrade endopyelotomy. The additional use of the endoluminal ultrasound probe increased our success rates in those patients receiving primary treatment.