Practice trends in contemporary management of adult ureteropelvic junction obstruction

Objectives. To determine current practice patterns in the surgical treatment of ureteropelvic junction obstruction in the United States and Canada. Methods. An e-mail survey was sent to 56 academic endourologists regarding the number of procedures performed in the previous year for ureteropelvic junction obstruction, factors considered in the choice of procedure, and whether community urologists in their area were performing laparoscopic pyeloplasty or endopyelotomy. Results. The response rate was 66% (37 of 56). More respondents were performing endopyelotomy (91%) than laparoscopic pyeloplasty (51%), and nearly one half were performing open pyeloplasty. The mean number of procedures performed by respondents in the previous year was 9.5 endopyelotomies, 4 laparoscopic pyeloplasties, and 2.5 open pyeloplasties. A number of factors had an impact on the practitioners' choice of procedure, including the presence of a crossing vessel and massive hydronephrosis, secondary ureteropelvic junction obstruction, the surgeon's training, procedure cost, operative time, expected success rate, degree of invasiveness, and patient preference. Nearly one fifth of respondents said they would choose laparoscopic pyeloplasty as first-line therapy regardless of anatomic considerations. Seventy-eight percent stated that community urologists in their area were performing endopyelotomy routinely or occasionally compared with only 3% who stated community urologists in their area were performing laparoscopic pyeloplasty. Conclusions. Laparoscopic pyeloplasty is still in its early stages. Although laparoscopic pyeloplasty has a greater success rate, endopyelotomy continues to be more commonly performed in academic centers. Laparoscopic pyeloplasty has not yet made significant inroads into community practice. Several factors, especially the surgeons' training, have an impact on the choice of procedure. Open pyeloplasty is still performed by a significant number of academic endourologists.