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

Percutaneous Antegrade Endopyelotomy-Factors Influencing the Success Rates / 대한비뇨기과학회지

PURPOSE: Endopyelotomy is a minimally invasive surgical alternative to the classic open surgery in the treatment of ureteropelvic junction obstruction with similar success rates. We analyzed factors influencing success rates after endopyelotomy based on clinical data. MATERIALS AND METHOD: Between 1989 and 1997, we performed percutaneous antegrade endopyelotomy in 53 cases of ureteropelvic junction obstructions. Among these patients, 47 patients have been followed with range from 3 to 70 months(mean 18.1 months). Of the 47 patients, 36 had primary UPJ obstruction and 11 had secondary UPJ obstruction. A rigid urethrotome(cold knife) was employed in 31 cases, a electrotome(hot knife) in 10 and a balloon dilator in 6. A stent(14/7Fr endopyelotomy stent or 6Fr double-J stent) was placed for 4 to 12 weeks after the procedure. Coexisting stones or infundibular strictures were managed simultaneously. RESULTS: Overall success rate(measured by symptom-free status and improved uroradiographic findings) was 80.9%(86.1% in primary and 63.6% in secondary cases). Success rates related to the method of incision were as follows; 87.1% with a cold knife, 80% with a electric knife and 50% with a balloon dilator only. 14/7Fr endopyelotomy stent was used in 21 patients with a successful outcome in 19(90.5%), while 25 received 6Fr double stent with a successful outcome in 18(72%). Success rates according to the duration of stenting were as follows; 86.7% in the 8-week group, 78.6% in the 6-week group and 66.7% in the 4-week group. CONCLUSIONS: Our experience indicates that endopyelotomy can be selected as the initial procedure of choice for the selected patients with UPJ obstruction. The small number of patients in each parameter did not reach statistical significance. However, there was a trend for better results in patients with primary UPJ obstruction and with the use of 14/7Fr endopyelotomy stent.

Endoscopic surgery for management in stricture of ureteropelvic junction, ureter or caliceal neck / 대한비뇨기과학회지

Recently. the endopyelotomy has been used as a first choice of treatment in selected cases of ureteropelvic or ureteral strictures. 24 consecutive cages of endourologic-tomy procedure including 12 cases of endopyelotomy. 8 cases of endoureterotomy and 4 cases of endocalicotomy were performed from Nov. '89 to May '91. The causes of stricture were previous operation (7 cases), congenital (6 cases). tuberculosis (5 cases) and others. They were all followed more than 3 months. The overall success rete was 83.3%. The success means improvement of clinical symptoms and radiographic findings. The complications were upward migration of stent (1 case), granuloma (1 case) and re-stricture (2 cases). Especially in 1 cases of caliceal stricture the success rate was 100% with no complication. Our experience indicates that endourologic-tomy procedure has relatively good success rate, low morbidity, Low complication and a shorter recovery time. Especially endocalicotomy is one of the best method to treat caliceal stricture.

Advances in percutaneous nephrostomy

Management of urologic patients is being gradually but dramatically altered with new advances in technical innovation and refinements of interventional uroradiology. The broadening of indications for percutaneous nephrostomy became possible only after it was learned that it is a safe and effective means of establishing access to the renal collecting system. Percutaneous stone extraction (Nephrolithotomy) and Endopyelotomy are now well established procedures. These techniques have clear advantages over the surgical treatment for the same conditions and will increase the quality of patient care and reduce health care cost.

Endopyelotomy as a Treatment for Ureteropelvic Junction Obstruction: 3 Cases / 대한비뇨기과학회지

As the development of the percutaneous renal surgery, Ureteropelvic junction obstruction can be treated with endourologic technique instead of open surgery. Precutaneous endopyelotomy has been used mainly for the treatment of secondary ureteropelvic junction obstruction. But it was also successful for treatment of primary ureteropelvic junction obstruction. Recently, we performed endopyelotomy for 3 cases of ureteropelvic junction obstruction a 39 years-old male who had renal pelvic stones combined with ureteropelvic junction, a 32 years-old male with ureteropelvic junction obstruction and a 23 years-old male who had horseshoe kidney combined with ureteropelvic junction obstruction and good results were obtained.

Endoscopic Surgery for Ureteropelvic Junction Obstruction / 대한비뇨기과학회지

Percutaneous Endopyelotomy is a natural outgrowth of technique developed for percutaneous ureteral and renal stone removal. In it`s comparison to the Davis ureterotomy technique, a rationale for this procedure and explanation for it`s success is provided. Endopyelotomy, which we performed experimentally to prevent recurrent stone formation, has now matured into a viable procedure under the certain guideline. This procedure has become our first choice for secondary ureteropelvic junction obstruction but primary cases were not experienced. Although classical pyeloplasty must be main surgical means to UPJ obstruction, technical and equipmental advanced could be enabled us to perform 8 endopyelotomy. We incised UPJ obstruction in 8 cases with direct vision nephroscope inserted through a percutaneous nephrostomy tract and ureteroscope. In 6 patients, renal calculi were removed endourologically during same and separate session. There were no immediate complication and nephrostogram showed adequate drainage in all cases.