J Pediatr Urol. 2021 Jun;17(3):397.e1-397.e6. doi: 10.1016/j.jpurol.2021.01.035. Epub 2021 Feb 1.
Failed pyeloplasty procedures are caused by large amounts of scarring, and peripelvic fibrosis. This finding has been associated with urinary extravasations to the operation, urosepsis or an excessive tissue reaction. The treatment options for secondary UPJO (Ureteropelvic Junction Obstruction) are the same with the options for primary procedures: in cases of very poor renal function, various pyeloplasty forms (open and laparoscopic), and ureterocalicostomy or sometimes nephrectomy may be considered in severe renal function loss. Whereas, endoscopic treatment can be considered in elective cases.
A total of 46 young patients who underwent endopyelotomy due to secondary ureteropelvic obstruction between January 2013 and September 2018 were included in the study. Patients underwent semirigid URS (Ureterorenoscopy) guided laser endopyelotomy until July 2015, and the patients had flexible URS guided laser endopyelotomy since July 2015.
The mean age of the patients was found as 17.7 ± 4.2 and 16.9 ± 5.7 years in the SURSLE (Semirigid Ureterorenoscopy Laser Endopyelotomy), and FURSLE (Flexible Ureterorenoscopy Laser Endopyelotomy) groups, respectively. Success of the procedure was confirmed in 20 (83%) patients in the SURSLE group, and 19 (86%) patients in the FURSLE group who had no obstructive symptoms based on USG, GFR and excretion curves on the renogram ordered in the 24th month. Four (16%) patients in the SURSLE group, and 3 (14%) patients in the FURSLE group were accepted as failed, their treatments were arranged for additional surgical procedures, and these patients were taken under the follow-up protocol.
This is one of the first studies comparing endopyelotomy with semirigid URS and flexible URS in patients with ureteropelvic stenosis. Long-term results with a large series of patients are not known, and our approach can be considered only as an individual method. There are different treatment options in UPJO. The use of fluoroscopy has advantages in endourologic operations. Therefore, lower radiation exposure can be a rational approach for protecting a person. Similarly, providing necessary protection also for physicians and operating room personnel is essential. In our study, shorter fluoroscopy time with SURSLE provided an advantage over FURSLE in terms of radiation exposure.
Of semirigid and flexible URS techniques that have no superiority over each other in terms of success, preferring semi-rigid URS guided laser endopyelotomy with lower ionizing radiation used, is more rational.
肾盂成形术失败的原因是大量的瘢痕和肾盂周围纤维化。这一发现与手术中的尿外渗、尿脓毒症或过度的组织反应有关。对于继发性 UPJO（肾盂输尿管连接部梗阻）的治疗选择与原发性手术相同：在肾功能非常差的情况下，各种肾盂成形术（开放和腹腔镜），以及输尿管肾盂吻合术或有时在严重肾功能丧失时考虑肾切除术。而对于择期病例，可以考虑内镜治疗。
2013 年 1 月至 2018 年 9 月，共有 46 例因继发性输尿管肾盂连接部梗阻行内镜肾盂切开术的年轻患者纳入本研究。患者接受半刚性输尿管镜检查（URS）引导激光内切开术，直至 2015 年 7 月，此后患者接受软性 URS 引导激光内切开术。
SURSLE（半刚性输尿管镜激光内切开术）组和 FURSLE（软性输尿管镜激光内切开术）组患者的平均年龄分别为 17.7±4.2 和 16.9±5.7 岁。SURSLE 组 20 例（83%）患者和 FURSLE 组 19 例（86%）患者的手术成功，根据超声、GFR 和 24 个月时肾图上的排泄曲线，这些患者没有梗阻症状。SURSLE 组 4 例（16%）和 FURSLE 组 3 例（14%）患者治疗失败，需进行额外的手术治疗，这些患者纳入随访方案。
这是第一项比较半刚性 URS 和软性 URS 在输尿管肾盂狭窄患者中行内切开术的研究之一。长期的大样本患者结果尚不清楚，我们的方法只能被视为一种个体化方法。UPJO 有不同的治疗选择。在腔内手术中，使用透视有优势。因此，为了保护个人，减少辐射暴露可能是一种合理的方法。同样，为医生和手术室人员提供必要的保护也是至关重要的。在我们的研究中，与 FURSLE 相比，SURSLE 较短的透视时间在辐射暴露方面具有优势。
在手术成功率方面，半刚性和软性 URS 技术没有优势，使用放射剂量较低的半刚性 URS 引导激光内切开术更为合理。
