Urology Department Faculty of Medicine, Tanta University, Egypt.
Ther Adv Urol. 2009 Dec;1(5):227-34. doi: 10.1177/1756287210362070.
This study was designed to review the long-term results and complications of the two techniques of retrograde endopyelotomy; ureteroscopic holmium laser endopyelotomy versus Acucise endopyelotomy. The results were then compared with the laparoscopic pyeloplasty results from a recent publication.
: The study was conducted retrospectively from January 2004 to July 2007. Seventy-two patients with ureteropelvic junction obstruction (UPJO) underwent retrograde endopyelotomy using either ureteroscopic laser endoincision (42 patients) or fluoroscopic guided hot-wire balloon (Acucise) endoincision (30 patients). Preoperative radiological assessment included intravenous pyelogram (IVP), helical computerized tomography and diuretic renography. The follow-up period ranged from 12 to 42 months. Subjective success was guided by the change in the preoperative flank pain while objective success on radiological evaluation was documented by either nonobstructed curve of diuretic renogram and/or T1/2 less than 10 min.
The mean patient age was 42.6 ± 7.5 years for the laser group and 39.2 ± 15.1 years for the Acucise group (p = 0.24). The operative time was 66.8 ± 22.2 min in the laser group and 59.8 ± 20.3 min in the Acucise group (p = 0.84). By objective standards (renal scan), a total of 56 (77.8%) cases were successful (nonobstructed curve). This number included 34 cases in the laser group (80.9%) and 22 cases in the Acucise group (73.3%) (p = 0.2). Overall 16 failure cases were evident clinically within 1 year of the procedure (eight cases in each group). Most of the failure cases (13/16) presented with clinical obstructive symptoms during the early follow-up period (within 3 months postoperatively) and were then confirmed radiologically (six cases in the laser group and seven cases in the Acucise group) while only three patients had failures at 6, 9 and 11 months postoperatively. There was no statistically significant difference as regards intra-operative complications between the two groups (p = 0.4). Intra-operative bleeding was seen in three cases in the Acucise group while postoperatively it was reported in one case.
The retrograde endopyelotomy approach is safe and effective for the treatment of patients with UPJO. Both ureteroscopic laser and the hot-wire balloon (Acucise) techniques have an important role in the management of UPJO, especially in secondary cases, and they provide comparable long-term objective and subjective outcomes. Laparoscopic pyeloplasty provides far better results but with higher costs, and requires well-equipped centers and involves a long learning curve.
本研究旨在回顾两种逆行经皮肾镜肾盂成形术（输尿管镜钬激光经皮肾镜肾盂切开术与 Acucise 经皮肾镜肾盂切开术）的长期结果和并发症。然后将结果与最近发表的腹腔镜肾盂成形术的结果进行比较。
本研究于 2004 年 1 月至 2007 年 7 月进行回顾性研究。72 例肾盂输尿管连接部梗阻（UPJO）患者接受逆行经皮肾镜肾盂切开术，其中 42 例采用输尿管镜激光内切开术，30 例采用透视引导热丝球囊（Acucise）内切开术。术前影像学评估包括静脉肾盂造影（IVP）、螺旋计算机断层扫描和利尿剂肾图。随访时间为 12 至 42 个月。主观疗效依据术前腰痛变化判断，客观疗效依据利尿剂肾图无梗阻曲线和/或 T1/2＜10min 确定。
激光组患者平均年龄为 42.6±7.5 岁，Acucise 组为 39.2±15.1 岁（p=0.24）。激光组手术时间为 66.8±22.2min，Acucise 组为 59.8±20.3min（p=0.84）。根据客观标准（肾扫描），共有 56 例（77.8%）成功（无梗阻曲线）。其中激光组 34 例（80.9%），Acucise 组 22 例（73.3%）（p=0.2）。术后 1 年内，临床共有 16 例（每组 8 例）失败。大多数（13/16）失败病例在术后早期（术后 3 个月内）出现临床梗阻症状，随后在影像学上证实（激光组 6 例，Acucise 组 7 例），仅 3 例在术后 6、9 和 11 个月出现失败。两组术中并发症无统计学差异（p=0.4）。Acucise 组术中出血 3 例，术后出血 1 例。
逆行经皮肾镜肾盂切开术是治疗 UPJO 的安全有效的方法。输尿管镜激光和热丝球囊（Acucise）技术在 UPJO 的治疗中都有重要作用，尤其是在继发性病例中，可提供类似的长期客观和主观疗效。腹腔镜肾盂成形术的效果更好，但成本更高，需要配备齐全的中心，且涉及较长的学习曲线。
