Document Detail


Open surgical exploration after failed endopyelotomy: a 12-year perspective.
MedLine Citation:
PMID:  9112488     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Factors that have a role in endopyelotomy failure have not been fully elucidated but are believed to include high grade hydronephrosis and the presence of crossing vessels at the ureteropelvic junction. MATERIALS AND METHODS: We retrospectively analyzed the importance of renal function, hydronephrosis, ureteral stents, surgeon experience and crossing vessels in determining the outcome of endopyelotomy. RESULTS: Of 401 percutaneous antegrade endopyelotomies performed at our medical center during the last 12 years 60 failed and 54 of these patients underwent surgical exploration. Patients with high grade hydronephrosis and poor initial renal function were much less likely to have successful endopyelotomy than those with moderate hydronephrosis or good renal function (success rates 50 versus 96 and 54 versus 92%, respectively, p <0.001). The most common findings at exploration included severe extrinsic fibrosis and intrinsic fibrotic stenosis. Obstructing crossing vessels were present in 13 patients explored, suggesting a possible role in causing failure in only 4% of all endopyelotomy patients. CONCLUSIONS: Patients with high grade hydronephrosis and poor initial renal function are much more likely to experience endopyelotomy failure. Crossing vessels appear to have a less significant role in endopyelotomy failure than has been previously suggested.
Authors:
M Gupta; O L Tuncay; A D Smith
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  The Journal of urology     Volume:  157     ISSN:  0022-5347     ISO Abbreviation:  J. Urol.     Publication Date:  1997 May 
Date Detail:
Created Date:  1998-10-06     Completed Date:  1998-10-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1613-8; discussion 1618-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Endoscopy
Female
Humans
Infant
Kidney Pelvis / surgery*
Male
Middle Aged
Retrospective Studies
Treatment Failure
Ureteral Obstruction / surgery*
Comments/Corrections
Comment In:
J Urol. 1997 May;157(5):1620-1   [PMID:  9112489 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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