Ureteroscopic endopyelotomy at a single setting

Purpose: Endopyelotomy has become the initial treatment of choice for ureteropelvic junction obstruction. Debate persists regarding the preferred approach (percutaneous or ureteroscopic) and the need for preoperative stenting. We review our experience with ureteroscopic endopyelotomy without preoperative stenting. Materials and Methods: We treated 21 patients a mean of 37 years old who had ureteropelvic junction obstruction with ureteroscopy and without preoperative stenting. Endoluminal ultrasound was performed in all cases for imaging the periureteral anatomy. A minimum of I year of followup is available in all cases. Success was defined as pain-free status with resolution of obstruction on diuretic renal scintigraphy. Results: Success was achieved in 17 of 21 patients (81%). Complications included stent irritation, postoperative urinary tract infection and stent displacement requiring repositioning in I case each. Crossing vessels in 57% of the patients affected success (67 versus 100% in those with and without crossing vessels, respectively). No patient had significant hemorrhage. Conclusions: Ureteroscopic endopyelotomy without preoperative stenting is effective and safe for ureteropelvic junction obstruction.