ENDOPYELOTOMY WITH THE ACUCISE CUTTING BALLOON DEVICE - EARLY CLINICAL-EXPERIENCE

Objectives: To evaluate the efficacy of the Acucise balloon cutting de vice in the treatment of ureteropelvic junction (UPJ) stenosis. Method s: Forty-four patients with primary (21) or secondary (23) UPJ stenosi s underwent Acucise endopyelotomy between July 1992 and February 1995. Results: The average operating time was 53 min and the average hospit al stay was 6 +/- 4 days. The follow-up schedule included a symptom qu estionnaire, intravenous urography and diuretic renal scan. Of the 44 patients, 38 have been followed for a minimum of 3 months postoperativ ely (mean: 12 months, range: 3-39 months). Overall success was achieve d in 29 (76%). The procedure was successful in 16 out of 19 cases (84% ) with secondary strictures. When the technique was used for the treat ment of primary UPJ strictures, the success rate was only 68% (13 out 19). The presence of a large periureteric urinoma was identified as th e cause of failure in 2 cases of primary strictures. Conclusion: We re commend the use of the Acucise device as the first-line therapy for tr eatment of secondary UPJ stenosis (except in the presence of large enc losed stones). We do not approve the use of the Acucise device for tre atment of primary UPJ strictures. In primary hydronephrosis, the negat ive role of periureteric extravasation probably explains the low succe ss rate of 68% (as opposed to 85% for a large series of percutaneous e ndopyelotomies).