Hoenig D M, Shalhav A L, Elbahnasy A M, McDougall E M, Smith D, Clayman R V
Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Endourol. 1998 Apr;12(2):131-3. doi: 10.1089/end.1998.12.131.
Endopyelotomy for secondary ureteropelvic junction obstruction (UPJO) is a highly effective procedure. However, the impact of the etiology of the obstruction on the outcome of an endopyelotomy has not been defined. Herein, we review the success rates with endopyelotomy for secondary UPJO after failure of open pyeloplasty or endopyelotomy. Thirty-five adult patients with both objective and subjective follow-up were identified retrospectively who had endopyelotomy for secondary UPJO. Twenty-four patients had failed a previous open reconstruction (23) or laparoscopic Foley Y-V plasty (1). Eleven patients had failed a prior endopyelotomy. Retrograde endopyelotomy was performed using the Acucise device in 11 patients, and antegrade endopyelotomy was performed in 24 patients. Objective follow-up was obtained with diuretic renal scintigraphy (mean 14.1 months) and subjective follow-up by analog pain scales (mean 27.8 months). Objective success was defined as no obstruction on renal scintigraphy, while subjective success was used to describe a minimum of 50% resolution of symptoms. The subjective success rate of secondary endopyelotomy in the open-pyeloplasty group was 88% v 71% in the prior endopyelotomy group (P = 0.20). The objective success rate in the failed-pyeloplasty group was 71% v 55% in the prior endopyelotomy group (P = 0.40). Endopyelotomy for secondary UPJO has a good success rate. Success rates tend to be higher in patients who have failed an open pyeloplasty; however, a statistically significant difference was not seen between the two groups.
内切开术治疗继发性肾盂输尿管连接处梗阻（UPJO）是一种非常有效的手术。然而，梗阻病因对肾盂内切开术结果的影响尚未明确。在此，我们回顾了开放性肾盂成形术或肾盂内切开术失败后，内切开术治疗继发性UPJO的成功率。回顾性确定了35例接受继发性UPJO内切开术且有客观和主观随访的成年患者。24例患者之前的开放性重建手术（23例）或腹腔镜Foley Y-V成形术（1例）失败。11例患者之前的肾盂内切开术失败。11例患者使用Acucise装置进行了逆行肾盂内切开术，24例患者进行了顺行肾盂内切开术。通过利尿肾动态显像（平均14.1个月）获得客观随访，通过视觉模拟疼痛量表（平均27.8个月）获得主观随访。客观成功定义为肾动态显像无梗阻，主观成功用于描述症状至少缓解50%。开放性肾盂成形术组继发性肾盂内切开术的主观成功率为88%，而之前肾盂内切开术组为71%（P = 0.20）。肾盂成形术失败组的客观成功率为71%，而之前肾盂内切开术组为55%（P = 0.40）。继发性UPJO的肾盂内切开术成功率良好。开放性肾盂成形术失败的患者成功率往往更高；然而，两组之间未观察到统计学上的显著差异。
