Endopyelotomy outcome as a function of high versus dependent ureteral insertion

Objectives, To determine whether a high versus a dependent ureteral inserti on significantly affects the outcome of endopyelotomy for management of ure teropelvic junction (UPJ) obstruction. Methods. Sixty patients with UPJ obstruction were treated with. an endopyel otomy by way of either an antegrade percutaneous approach (n = 36) or a ret rograde hot-wire balloon incision (n = 24). In these 60 patients, the urete ral insertion was high on the renal pelvis in 19 (32%), dependent in 25 (42 %), and indeterminate in 16 (26%). Intravenous urography was performed 4 to 6 weeks after stent removal (8 to 12 weeks after endopyelotomy) and then a t 6 to 12-month intervals. Success of the procedure was defined as resoluti on of symptoms and decrease in hydronephrosis compared with pre-endopyeloto my studies. Results. With a follow-up range of 2 to 41 months (mean 10.3), the overall success rate was 80%, This rate was independent of whether the procedure wa s performed in an antegrade or retrograde fashion. A successful result was achieved in 15 (78.9%) of those with a high insertion, 19 (76%) of those wi th a dependent insertion, and 14 (87.5%) of those with an equivocal inserti on; these differences were not statistically significant (P = 0.72). Conclusions. The type of ureteral insertion (ie, high versus dependent) had no significant impact on the outcome of endopyelotomy by way of either a p ercutaneous or retrograde approach. As such, these anatomic variations need not play a role in a decision-making, algorithm for contemporary managemen t of UPJ obstruction. (C) 1999, Elsevier Science Inc.