RESUMO
PURPOSE: We compared endopyelotomy to redo pyeloplasty for the treatment of failed pyeloplasty in children to identify factors that may have an impact on outcome and favor one procedure over the other. METHODS: Of 43 patients with recurrent UPJO, EP was performed in 27 and RP was performed in 16. Age, gender, side, presentation of secondary UPJO, hospital stay, complications and success rates were compared. Success was defined as radiographic relief of obstruction as determined by ultrasound or diuretic renography at latest follow-up. RESULTS: Mean (Range) patient age was 7.2â¯years (range 6â¯months to 17â¯years) in EP (group 1) while 7.4 (range 6â¯months to 17â¯years) in RP (group 2). EP technique consisted of retrograde cold-knife in 17 patients, retrograde holmium laser in 8 and antegrade cold-knife in 2. RP was performed in 16 patients. All the patients with failed EP had a stricture greater than 15â¯mm. Mean length of the narrowed ureteral segment was 17.8â¯mm in the failed EP group vs 10â¯mm in the successful group (pâ¯<â¯0.001). Mean Hospital stay was 1â¯day for the EP group and 5â¯days for the RP group (pâ¯<â¯0.001). Mean follow-up was 17â¯months (range 12 to 43) after EP and 21â¯months (12 to 51) after RP. There was no statistical significance between both groups regarding the postoperative degree of hydronephrosis, parenchymal thickness, split renal functions and renal drainage. The overall success was (86%); the success was nonsignificantly higher in RP (93.8%) vs (81.5%) in EP. CONCLUSION: In selected children, retrograde endopyelotomy is safe and may give comparable short-term outcomes as open redo pyeloplasty for correction of secondary UPJO after failed pyeloplasty. Narrowed ureteral segment greater than 15â¯mm and preoperative grade 4 hydronephrosis were factors significantly associated with a poor outcome after EP. A LEVEL-OF-EVIDENCE RATING FOR CLASSIFYING STUDY QUALITY: LEVEL III Retrospective comparative study.
