BERKELEY, CA (UroToday Inc.) - Ureterocalicostomy is a well-established treatment for patients with complicated ureteropelvic junction obstruction (UPJ). Classically, the procedure has been applied mainly to patients with primary UPJ obstruction associated with an intrarenal pelvis or in whom open pyeloplasty has failed. A significant number of patients with UPJ obstructions are now being treated with endourologic procedures such as endopyelotomy via an antegrade or retrograde approach. Although these treatments are minimally invasive and offer the patient a shorter recovery time, the success rates do not approach those of open or laparoscopic pyeloplasty. A growing group of patients with a failed prior intervention for UPJ obstruction now exists.

A recent review of this problem by B. R. Matlaga and D. G. Assimos from Wake Forest University and the Cleveland Clinic was published in the January, 2005 issue of Urology. It examines the application of the technique and its results from a contemporary series of 11 patients treated with ureterocalicostomy over a 13-year period. The indications for the procedure included primary UPJ obstruction associated with an intrarenal pelvis in 4 patients, failed cutting balloon incision of the UPJ in 2 patients, obliterated UPJ after percutaneous nephrolithotomy in 1 patient, and failed antegrade endopyelotomy in 1 patient. Mean age of the patients was 38 years, and mean follow-up was 10.1 months.

Preoperative evaluation of all patients included intravenous urography (IVU), retrograde pyelography, or antegrade pyelography in those patients presenting with nephrostomy tubes. All patients underwent open reconstruction via a flank approach with an 11th or 12th rib partial resection. In all patients, a lower pole partial nephrectomy was performed, with 9 of these cases being performed without renal artery clamping. All anastamoses were completed over an internal JJ stent using an interrupted 4-0 or 5-0 absorbable sutures. The renal capsule was not closed over the lower pole parenchyma. Passive peri-anastamotic drains were used in all patients. Operative time averaged 292 minutes, estimated blood loss was 372.5 ml, and mean hospital stay was 5.1 days.

Analysis by IVU or nuclear renography revealed that relief of obstruction was evident in all patients. Differential renal function of the operated kidney also increased from a mean pre-operative value of 54.6% to 60.1% post-operatively. In conclusion, the spectrum of indications for ureterocalicostomy may have changed coincident with the increasing use of endourologic interventions, but excellent results can still be achieved in properly selected patients. The procedure should be considered in all cases where the ability to achieve a tension-free anastomosis of viable proximal ureter to the renal pelvis is questionable.

Urology. 2005 Jan; 65(1):42-4