Efficacy of endopyelotomy in patients with secondary ureteropelvic junction obstruction

Background and Purpose: Few studies have focused on secondary ureteropelvic junction obstruction (UPJO) as a disease entity. This study was designed to elucidate the etiology of secondary UPJO and to assess the success rate of endopyelotomy in these cases. Patients and Methods: A retrospective review of all patients who underwent an endopyelotomy by a single surgeon from May 1997 to September 2009 was conducted. Secondary UPJO was defined anastomotic strictures after dismembered pyeloplasty or as de novo formation after renal surgery. Success of the procedure was defined as both radiographic and symptomatic resolution of obstruction. Results: Of 157 endopyelotomies performed, 41 patients were considered to have secondary UPJO. Of these 41, previous open or laparoscopic pyeloplasties had failed in 14. Twenty classified as iatrogenic from previous renal surgeries: 10 open, 8 percutaneous, and 2 ureteroscopic. Two cases of secondary UPJO were attributed to strictures that were secondary to impacted stones in the past. The remaining five patients were considered to have idiopathic secondary UPJO and had previous normal imaging studies demonstrating absence of hydronephrosis before development of UJPO. The surgical success rate was 83.5% (35/41) for endopyelotomy in these cases. Seventy-five percent (3/4) of endopyelotomies in children ≤5 years old failed. Conclusions: With proper selection, endopyelotomy for secondary UPJO in the adult population was found to be successful and should be considered before more invasive therapy. Success in the pediatric population was poor in this limited evaluation.