Secondary endoscopic pyelotomy in children with failed pyeloplasty - Abstract

Pediatric Urology Center, University Children's Hospitals EKZ Amsterdam/WKZ Utrecht, the Netherlands.

To assess the results of secondary endopyelotomies (SEP) that were performed in our center in children who had earlier failed pyeloplasty.

Eleven secondary endopyelotomies were done between 2005 and 2010 in 10 patients (5 boys and 5 girls, mean age 6.8 years), with a follow-up time of >6 months. The primary procedure was an open/laparoscopic pyeloplasty (n = 10) or a ureterocalicostomy (n = 1). In all cases, endopyelotomy was done by means of a monopolar electrocautery hook using the standard pediatric resectoscope. In 10 patients, SEP was done percutaneously, and in 1 patient it was done in a retrograde fashion. The mean operation time was 69 minutes.

After a mean follow-up of 20 months, 70% of patients were free of complaints (n = 7), which was defined as a resolution of complaints, resolution of hydronephrosis, and improvement of renal wash-out curve and function. In 4 renal units, reintervention had to be considered; in one of these, a re-pyeloplasty has already been performed. The mean postoperative hospital stay was 2.8 days. No intraoperative complications occurred. In 1 patient, postoperative leakage around the nephrostomy drain occurred but resolved spontaneously.

SEP is a fairly safe method to treat recurrent ureteropelvic junction-stenosis after failed pyeloplasty in children. However, because it seems to be less affective than the open redo pyeloplasty, it cannot be considered as a gold standard procedure and as such should be thoroughly discussed with the patient and parents.

Written by:
Veenboer PW, Chrzan R, Dik P, Klijn AJ, de Jong TP.   Are you the author?

Reference: Urology. 2011 Jan 20. Epub ahead of print.
doi: 10.1016/j.urology.2010.10.021

PubMed Abstract
PMID: 21256576 Pediatric Urology Section

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