Jabbour M E, Goldfischer E R, Klima W J, Stravodimos K G, Smith A D
Department of Urology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York, USA.
J Urol. 1998 Sep;160(3 Pt 1):690-2; discussion 692-3. doi: 10.1016/S0022-5347(01)62757-5.
Endopyelotomy has been proposed as a technique to treat ureteropelvic junction obstruction after failed open pyeloplasty. However, to our knowledge no long-term results of this treatment have been reported. We report the long-term followup of a cohort of patients in whom pyeloplasty failed and who subsequently were treated with endopyelotomy.
From January 1985 to February 1996, 72 patients in whom open surgical pyeloplasty failed were treated with percutaneous endopyelotomy. Mean patient age was 35 years (range 5 to 82). The interval between pyeloplasty and subsequent failure ranged from 2 months to 30 years (mean 57 months). The major presenting symptoms were pain in 82% of cases, fever and urinary tract infections in 37.5%, stone formation in 25% and gross hematuria in 21%.
Antegrade endopyelotomy using a hooked knife was performed in all patients with no unusual difficulty and minimal complications. A total of 63 patients (87.5%) had long lasting clinical and radiographic treatment success after a mean followup of 88.5 months. Of the 9 endopyelotomy failures (12.5%) 7 (77.8%) were detected immediately after stent removal at 6 weeks, 1 (11.1%) at 6 months and 1 (11.1%) at 10 months postoperatively (mean failure interval 3.3 months). The failures were corrected with repeat endopyelotomy in 1 patient, pyeloplasty in 3, ileal interposition in 1 and nephrectomy in 4.
Endopyelotomy is the treatment of choice for recurrent ureteropelvic junction obstruction after failed pyeloplasty, with a high and sustained long-term success rate and no reported new failures after 1-year followup. Furthermore, endopyelotomy is technically easier with less morbidity than repeat open pyeloplasty.
肾盂内切开术已被提议作为一种在开放性肾盂成形术失败后治疗输尿管肾盂连接部梗阻的技术。然而，据我们所知，尚未有该治疗方法的长期结果报道。我们报告了一组肾盂成形术失败后接受肾盂内切开术治疗患者的长期随访情况。
1985年1月至1996年2月，72例开放性手术肾盂成形术失败的患者接受了经皮肾盂内切开术。患者平均年龄为35岁（范围5至82岁）。肾盂成形术与随后失败之间的间隔时间为2个月至30年（平均57个月）。主要表现症状为：82%的病例有疼痛，37.5%有发热和尿路感染，25%有结石形成，21%有肉眼血尿。
所有患者均采用钩形刀进行顺行肾盂内切开术，操作无异常困难，并发症极少。平均随访88.5个月后，共有63例患者（87.5%）获得了持久的临床和影像学治疗成功。在9例肾盂内切开术失败的患者中（12.5%），7例（77.8%）在术后6周支架取出后立即被发现，1例（11.1%）在术后6个月被发现，1例（11.1%）在术后10个月被发现（平均失败间隔3.3个月）。1例患者通过重复肾盂内切开术纠正失败，3例进行肾盂成形术，1例进行回肠代输尿管术，4例进行肾切除术。
肾盂内切开术是肾盂成形术失败后复发性输尿管肾盂连接部梗阻的首选治疗方法，长期成功率高且持久，1年随访后无新的失败病例报道。此外，肾盂内切开术在技术上更简单，发病率低于重复开放性肾盂成形术。
