ENDOPYELOTOMY FOR HORSESHOE AND ECTOPIC KIDNEYS

Purpose: We report our experience with endopyelotomy for horseshoe and ectopic kidneys in the largest series to date to our knowledge, and d iscuss the technical modifications adopted to perform successfully per cutaneous antegrade endopyelotomy. Materials and Methods: From Septemb er 1987 to April 1996, 4 patients with horseshoe and 5 with ectopic ki dney underwent percutaneous antegrade endopyelotomy for symptomatic ur eteropelvic junction obstruction. The percutaneous puncture was made m ore posteromedial and the ureteropelvic junction was incised lateral. A retrograde percutaneous access tract was created under laparoscopic guidance in pelvic kidneys. Results: The operative procedure was perfo rmed uneventfully in all patients with no major bleeding, pleural effu sion or visceral perforation. The stents were removed at 6 weeks, and an excretory urogram was performed at 2 weeks, 6 months and yearly the reafter. In 2 patients (22%) with severe hydronephrosis, poor renal fu nction and a long ureteral stricture surgical treatment failed immedia tely. The remaining 7 patients (78%) had long lasting clinical and rad iographic success with a mean followup of 62 months. Conclusions: Perc utaneous antegrade endopyelotomy, with a few technical modifications, is a safe and effective treatment for ureteropelvic junction obstructi on associated with horseshoe and ectopic kidneys.