SECONDARY URETEROPELVIC JUNCTION OBSTRUCTION: ENDOPYELOTOMY A BETTER OPTION

Objective: To evaluate the outcome of percutaneous antegrade endopyelotomy as a primary intervention for Secondary Ureteropelvic junction (UPJ) obstruction. Methodology: This study was conducted from 20th January 2011 to 19th January 2012 at Institute of Kidney diseases, Hayatabad, Peshawar. A sample of 31 cases having evidence of secondary ureteropelvic obstruction were listed for the study of which 21 cases as males and the rest females. Ultrasound, intravenous urogram and DTPA Scanwere carried out. Patients with severe hydronephrosis, renal function <30%, anterior crossing vessel and UPJ>2 cm stenosed segment were not included in the study. Stenosed segment was incised posterior-laterally until periureteral and peripelvic fat was visualized. At completion of 8 weeks postoperatively the ureteric stents were removed as day cases and the patients were evaluated at follow-up of 3 months and every subsequent 6 months in the out-patient department with data relevant collected on a predesigned proforma. Results: Demographically the findings were observed and mean age at both sexes was similar. The mean split GFR on the affected side was 36.5 mg/ml. The average time taken to completion of the procedure was 63 min. Hospital stay averaged 3.8 days (ranging form 2–6 days). Success rate was 81% (25 of 31) at 10.25 months. Failure was noted clinically in 6 cases with presentation variably at completion of first to the third month postoperatively. Conclusion: Percutaneous antegrade endopyelotomy has significant advantages in term of reduced hospital stay, shorter operative time, early postoperative recovery, minimal morbidity and decreased postoperative analgesic requirements. It is successful in selected patient who have good renal functions, no crossing vessels, mild to moderate hydronephrosis and dependent ureters.