Percutaneous pyeloplasty: an alternative to open surgery.

This paper describes the management of five patients with pelviureteric junctional obstruction who were treated by a one-stage percutaneous procedure. In two patients, renal calculi were removed simultaneously. The obstructing strictured area was divided internally by means of a modified endoscopic urethrotomy knife, which was passed through a percutaneous nephrostomy track. The defect was bridged by natural regeneration around a soft splint over six weeks. Four patients achieved a successful result with a shortened hospital stay, minimal morbidity, improved radiological drainage and the avoidance of open surgery. One patient, who had undergone three previous open plastic operations, was still symptomatic, in spite of successful anatomical correction. At exploration, open surgical repair was impossible and a nephrectomy was performed. This new technique appears applicable to selected primary and secondary pelviureteric junctional obstructions in which the obstructing segment is in an anatomically dependent situation.