ENDOPYELOTOMY AND PYELOPLASTY - FACE-TO-FACE

46 symptomatic adult patients with documented ureteropelvic junction o bstruction were treated with pyeloplasty (n = 23) or endopyelotomy (n = 23). Basic characteristics in both the groups were comparable. The t echnical aspects, complications and outcome, in the form of improvemen t in function and drainage patterns, were compared in both the groups. Endopyelotomy enjoyed the significant advantages of a shorter operati ng time and hospital stay, and obviously better cosmetic acceptance. T he major complications in the endopyelotomy groups were related to ext ernal drainage and secondary infection in the form of fever, secondary hemorrhage and slippage of tubes in 44, 9 and 13% of cases, respectiv ely. Complications associated with pyeloplasty were prolonged urinary leak, wound infection and urinary tract infection in 12, 17 and 22% of cases, respectively. Using Tc-99-DTPA diuretic scan, an improvement o f more than 10% in split renal function could not be documented for an y case from either group. In none of the patients did the function det eriorate either. Of all evaluable cases, only 1 in the pyeloplasty gro up showed a persistent obstructive pattern. The rest all demonstrated adequate drainage across the ureteropelvic junction. Overall in 12 cas es (8 pyeloplasty, 4 endopyelotomy) drainage could not be determined p ostoperatively due to poor radionuclide uptake. A nephrostogram and/or pressure flow study, however, demonstrated a nonobstructive pattern i n all these patients. It is concluded that endopyelotomy scores over p yeloplasty with a shorter operating time and hospital stay. The compli cation rate and outcome following surgery, however, are comparable in both the groups. Using external drainage following endopyelotomy, earl y resumption of work, however, could not be obtained.