Effectiveness of Antegrade Endopyelotomy for treating Ureteropelvic Junction Obstruction in Children

Significant advances in the endourology and utilization of minimally invasive procedures have resulted in the improvement of the management of cases with ureteropelvic junction obstruction (UPJO). However, the effectiveness and successfulness of this technique have not been evaluated in children. Hence, the present study assessed the efficacy and safety of antegrade endopyelotomy in children.
We retrospectively reviewed a case series study from 2001 to 2012 consisting of 58 patients, aged two days to seven years, who were diagnosed with UPJO and treated with antegrade endopyelotomy. The study endpoint was to assess the necessity for scheduling repeated endopyelotomy, performing open pyeloplasty as well as recording any damage to parenchyma and length of hospital stay.
Antegrade endopyelotomy was successfully performed in 53 out of 58 studied children (91.3%) without any complications or necessity for further interventions. However, repeated endopyelotomy was scheduled for five cases, and open pyeloplasty was conducted in two cases because of the large size of pelvis and delay in urine drainage. DMSA scanning before and after antegrade endopyelotomy for all patients revealed no parenchymal damage. The mean hospital stay was also 2.5 days. DTPA was performed in all patients to evaluate the success of endopyelotomy before and after the operation.
Antegrade endopyelotomy is a safe and efficacious method for treating UPJO in children. It, therefore, provides a minimally invasive alternative to conventional open pyeloplasty.