[Endopyelotomy with the ureteral cutting balloon device for ureteropelvic junction obstruction].

BACKGROUND

This study investigated the feasibility of retrograde endopyelotomy with the Acucise ureteral cutting balloon device in the management of ureteropelvic junction (UPJ) obstruction.

METHODS

Six patients (male: 3, female: 3, age: 6-18) with UPJ obstruction and abdominal pain as the chief complaint, were treated by the Acucise ureteral cutting balloon device (flexible ureteral catheter, 7 Fr) under epidural or general anesthesia (for the 6-year-old girl only). After cutting the stenotic area electrically and posteriolaterally using a 3 cm cutting wire and dilation by the balloon to a maximum of 24 Fr for 10 seconds, a 6/10 Fr (for children) or 7/14 Fr (for adults) endopyelotomy ureteral catheter was left in situ for 8 weeks after the operation. After removing the ureteral catheter transurethrally, the results, including the patency of the UPJ, of this procedure were evaluated by intravenous pyelography and the disappearance of the chief complaint, abdominal pain, 12 weeks after removing the ureteral catheter.

RESULTS

Mean operative time was 47 (25-90) minutes and the hospital stay after the operation was 5.3 (3-14, median: 4) days. There was no transfusion or emergent open operation for uncontrolled bleeding in this series. The results 20 months after the operation: improvement of hydronephrosis was shown in 4 patients (66.7%) on intravenous pyelography and abdominal pain disappeared in all patients.

CONCLUSION

UPJ obstruction may be easily and safely treated by retrograde endopyelotomy with the Acucise ureteral cutting balloon device. The principal potential advantage of this procedure is reduced morbidity compared to that with antegrade or retrograde endopyelotomy by endoscopy.