Oshinsky G S, Jarrett T W, Smith A D
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
J Endourol. 1996 Apr;10(2):147-51. doi: 10.1089/end.1996.10.147.
Endopyelotomy is currently advocated for management of the obstructed ureteropelvic junction (UPJ). Healing of the stented UPJ occurs by secondary intention. Regardless of the method employed, success rates approach 85%. In order to increase the rate of success, we have devised a method of performing endopyelotomy in conjunction with endoscopic suturing of the incised UPJ. Two methods were developed to allow for the placement of a single absorbable monofilament suture. In the first method, endopyelotomy is carried out in the standard antegrade manner, and endoscopic suturing is performed with the use of a second retroperitoneal access sheath at the UPJ. In the second method, endoscopic placement of the suture is carried out through the standard renal access sheath, with suturing performed via the nephroscope. We have performed endoscopic pyeloplasty in eight patients. With a mean follow-up of 12 months, the procedure was successful in seven of these patients. Endoscopic suturing of the UPJ is technically demanding, but once sufficient expertise is gained, it may be utilized for immediate tissue coaptation, possibly decreasing urinary extravasation and, it is hoped, maximizing the caliber of the UPJ.
目前，肾盂内切开术被提倡用于治疗梗阻性肾盂输尿管连接部（UPJ）。置入支架的UPJ通过二期愈合。无论采用何种方法，成功率都接近85%。为了提高成功率，我们设计了一种在肾盂内切开术的同时对切开的UPJ进行内镜缝合的方法。开发了两种方法来放置单根可吸收单丝缝线。第一种方法，以标准的顺行方式进行肾盂内切开术，并在UPJ处使用第二个腹膜后穿刺鞘进行内镜缝合。第二种方法，通过标准的肾穿刺鞘进行缝线的内镜置入，并通过肾镜进行缝合。我们对8例患者进行了内镜肾盂成形术。平均随访12个月，其中7例患者手术成功。对UPJ进行内镜缝合技术要求较高，但一旦获得足够的专业技能，它可用于即时组织对合，可能减少尿液外渗，并有望使UPJ口径最大化。
