Endopielotomía con acucise / Acucise endopyelotomy

La técnica de la endopielotomía con Acucise® se basa sobre el principio de la dilatación e incisión simultánea de una estrechez ureteral bajo control endoscópico sin necesidad de la ureteroscopia. Este procedimiento atrajo a muchos urólogos porque es fácil de aprender y puede realizarse como procedimiento ambulatorio con una experiencia endourológica mínima. La tasa de éxito para las distintas series es de 66% a 84% y la tasa de complicaciones graves en la mayoría de las series es baja (hemorragia,0 a 4%). El dispositivo Acucise de nueva generaciónes más pequeño y por lo tanto su inserción es más fácil en ambos sexos. Aunque la endopielotomía con el dispositivo Acucise no iguala la tasa de éxito de la pieloplastia a cielo abierto, sigue siendo preferida por los urólogos como opción terapéutica alternativa en la obstrucción de la unión pieloureteral por su menor tiempo quirúrgico, menor morbilidad, hospitalización más corta y menor costo hospitalário.

Acucise® endopyelotomy technique is based on theprinciple of simultaneous dilatation and incision of aureteral narrowing under fluoroscopic guidance withoutthe need for ureteroscopy. This procedure appealed tomany urologists, as it is easy to learn, can be performedas an outpatient procedure with minimal endourologicalexperience. The success rates for various series reportsfrom 66-84% and serious complication rates for mostseries is low (bleeding-0-4%). The new generation acucisedevice is smaller and is therefore easy to insert in bothsexes. Although acucise endopyelotomy does not matchthe success rate of open pyeloplasty, it is still preferredby urologists as an alternative treatment option in ureteropelvicjunction obstruction because of its reducedoperative time, less morbidity, shorter hospitalisation anddecreased cost to the hospital.

A Comparison of Minimally Invasive Surgical Techniques for Ureteropelvic Junction Obstructions: Endopyelotomy, Acucise Endopyelotomy, and Laparoscopic Pyeloplasty / 대한비뇨기과학회지

PURPOSE: The aim of this study was to compare the efficacy and outcomes of endopyelotomy, Acucise endopyelotomy, and laparoscopic pyeloplasty for patients with ureteropelvic junction obstructions. MATERIALS AND METHODS: We studied 45 patients with ureteropelvic junction obstructions who underwent minimally invasive surgeries between January 2001 and April 2007. Patients were divided into three groups according to operative procedure: group I, endopyelotomy(n=17); group II, Acucise endopyelotomy(n=12; and group III, laparoscopic pyeloplasty(n=16). RESULTS: The mean patient ages in the three groups were 42.7+/-17.2 years, 48.8+/-14.1 years, and 49.5+/-13.6 years for groups I, II, and III, respectively. The mean stricture lengths were 0.99+/-0.25cm, 0.93+/-0.10cm, and 1.03+/-0.38 cm for groups I, II, and III, respectively, and were not significantly different among the groups(p>0.05). The mean operating time for group II(55.7+/-25.3 minutes) was shorter than that for group I(131.7+/-30.5 minutes) and group III(165.2+/-23.7 minutes)(p<0.05). The length of hospital stay for group II(4.7+/-1.6 days) was shorter than that for group I(6.6+/-1.8 days) and group III(7.4+/-0.6 days)(p<0.05). Rates of symptomatic improvement were 58.8%, 66.7%, and 93.8% for groups I, II, and III, respectively. Rates of radiologic improvement were 58.8%, 66.7%, and 93.8% for groups I, II, and III, respectively. There was no significant correlation between success rate and either stricture length or degree of hydronephrosis. CONCLUSIONS: Laparoscopic pyeloplasty had the highest success rate among the minimally invasive surgeries for patients with ureteropelvic junction obstructions. However, when the stricture length is less than 1cm in length, Acucise endopyelotomy may be considered as the first treatment because the associated operating time and hospital stay are short