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Management of secondary pelviureteric junction obstruction.

Rogers A, Hasan T - Indian J Urol (2013)

Bottom Line: Pelviureteric junction obstruction (PUJO) of the kidney can lead to a number of different clinical manifestations, which often require surgical intervention.Although the success of pyeloplasty and endopyelotomy are good, there are still a number of patients who fail primary treatment and develop secondary PUJO.These treatment failures can be a challenging cohort to manage.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Freeman Hospital, Heaton, Newcastle upon Tyne, NE7 7DN, UK.

ABSTRACT
Pelviureteric junction obstruction (PUJO) of the kidney can lead to a number of different clinical manifestations, which often require surgical intervention. Although the success of pyeloplasty and endopyelotomy are good, there are still a number of patients who fail primary treatment and develop secondary PUJO. These treatment failures can be a challenging cohort to manage. This article aims to provide a comprehensive overview on the surgical options available to the urologist for managing secondary PUJO as well as providing some guidance on assessing factors that will influence management decisions.

No MeSH data available.


Related in: MedlinePlus

Utilisation of accusize endopyelotomy in the treatment of secondary pelviureteric junction obstruction. The patient had an open pyeloplasty 10 years previously. The markers signifying the proximal and distal extent of the cutting balloon can be clearly seen
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Figure 2: Utilisation of accusize endopyelotomy in the treatment of secondary pelviureteric junction obstruction. The patient had an open pyeloplasty 10 years previously. The markers signifying the proximal and distal extent of the cutting balloon can be clearly seen

Mentions: Managing failed pyeloplasty can be challenging as previous surgery can result in fibrosis, distorted anatomy and a need for considerable mobilization if open or laparoscopic/robotic surgery is performed. Therefore, an endourological approach can reduce morbidity and provide a shorter hospital stay and quicker post-operative recovery. Many centers appear to utilize endopyelotomy as the mainstay of treatment for the failed pyeloplasty. Endourologic management of PUJO was introduced by Ramsay et al. in 1984[17] and further popularized throughout the 1980s by urologists such as Badlani et al. who developed the term “endopyelotomy.”[18] Retrograde and antegrade approaches are used. Retrograde techniques include the wire cutting balloon (e.g. accusize endopyelotomy) and ureteroscopic laser pyelotomy, usually with the holmium or neodymium-doped yttrium aluminum garnet laser[19] [Figure 2]. Incisions for endopyelotomy should be made in the lateral aspect of the PUJ as anatomical studies have demonstrated there is less chance of encountering a crossing vessel in these region.[20] Usually an eight or 9F ureteric stent is placed afterwards. Percutaneous antegrade endopyelotomy has been well described and, in some experienced centers, results for primary PUJO has approached those of open/laparoscopic pyeloplasty.[921] The use of a percutaneous antegrade endopyelotomy in the management of secondary PUJO should certainly be considered if there are concomitant pelvi-calyceal stones, especially >2 cm, which can be managed simultaneously. Both antegrade cold knife and laser endopyelotomy techniques are described.


Management of secondary pelviureteric junction obstruction.

Rogers A, Hasan T - Indian J Urol (2013)

Utilisation of accusize endopyelotomy in the treatment of secondary pelviureteric junction obstruction. The patient had an open pyeloplasty 10 years previously. The markers signifying the proximal and distal extent of the cutting balloon can be clearly seen
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3822345&req=5

Figure 2: Utilisation of accusize endopyelotomy in the treatment of secondary pelviureteric junction obstruction. The patient had an open pyeloplasty 10 years previously. The markers signifying the proximal and distal extent of the cutting balloon can be clearly seen
Mentions: Managing failed pyeloplasty can be challenging as previous surgery can result in fibrosis, distorted anatomy and a need for considerable mobilization if open or laparoscopic/robotic surgery is performed. Therefore, an endourological approach can reduce morbidity and provide a shorter hospital stay and quicker post-operative recovery. Many centers appear to utilize endopyelotomy as the mainstay of treatment for the failed pyeloplasty. Endourologic management of PUJO was introduced by Ramsay et al. in 1984[17] and further popularized throughout the 1980s by urologists such as Badlani et al. who developed the term “endopyelotomy.”[18] Retrograde and antegrade approaches are used. Retrograde techniques include the wire cutting balloon (e.g. accusize endopyelotomy) and ureteroscopic laser pyelotomy, usually with the holmium or neodymium-doped yttrium aluminum garnet laser[19] [Figure 2]. Incisions for endopyelotomy should be made in the lateral aspect of the PUJ as anatomical studies have demonstrated there is less chance of encountering a crossing vessel in these region.[20] Usually an eight or 9F ureteric stent is placed afterwards. Percutaneous antegrade endopyelotomy has been well described and, in some experienced centers, results for primary PUJO has approached those of open/laparoscopic pyeloplasty.[921] The use of a percutaneous antegrade endopyelotomy in the management of secondary PUJO should certainly be considered if there are concomitant pelvi-calyceal stones, especially >2 cm, which can be managed simultaneously. Both antegrade cold knife and laser endopyelotomy techniques are described.

Bottom Line: Pelviureteric junction obstruction (PUJO) of the kidney can lead to a number of different clinical manifestations, which often require surgical intervention.Although the success of pyeloplasty and endopyelotomy are good, there are still a number of patients who fail primary treatment and develop secondary PUJO.These treatment failures can be a challenging cohort to manage.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Freeman Hospital, Heaton, Newcastle upon Tyne, NE7 7DN, UK.

ABSTRACT
Pelviureteric junction obstruction (PUJO) of the kidney can lead to a number of different clinical manifestations, which often require surgical intervention. Although the success of pyeloplasty and endopyelotomy are good, there are still a number of patients who fail primary treatment and develop secondary PUJO. These treatment failures can be a challenging cohort to manage. This article aims to provide a comprehensive overview on the surgical options available to the urologist for managing secondary PUJO as well as providing some guidance on assessing factors that will influence management decisions.

No MeSH data available.


Related in: MedlinePlus