OUTCOME OF SECONDARY OPEN SURGICAL-PROCEDURE IN PATIENTS WHO FAILED PRIMARY ENDOPYELOTOMY

Endopyelotomy is an effective method for treating pelviureteric juncti on (PUJ) obstruction; however, up to 28%of patients fail endoscopic tr eatment and require a secondary open surgical procedure. Six patients underwent secondary open surgical procedures following failed endopyel otomy for primary PUJ obstruction at this institution. One patient had impaired renal function in the affected kidney prior to endopyelotomy and postoperative evaluation indicated further deterioration; nephrec tomy was performed for chronic obstruction and pain. The remaining 5 p atients underwent secondary open pyeloplasty. In 4 patients the operat ion was difficult and lengthy because of extensive periureteric fibros is. Difficult dissection was associated with a repeat endoscopic attem pt to repair the PUJ obstruction, urinoma formation or stent occlusion requiring intervention. A mean follow-up of 1.7 years demonstrated no radiographic or clinical evidence of recurrent obstruction in the 5 p atients undergoing secondary open pyeloplasty; all 6 patients are curr ently asymptomatic.