Patient selection before endopyelotomy: can it improve the outcome?

Objective To compare endopyelotomy and primary reconstructive procedures in patients with pelvi-ureteric junction (PUJ) obstruction and with risk fact ors for endopyelotomy failure. Patients and methods Nineteen patients (eight female and 11 male, mean age 34.5 years, range 15-82) underwent endoluminal ultrasonography (US) before treatment for PUJ obstruction; the US findings were used to direct the trea tment. Patients with unavoidable crossing vessels, massive hydronephrosis a nd crossing vessels associated with previous failed endopyelotomy were sele cted for reconstructive surgery. The clinical results of these patients (gr oup 1) were compared with 12 consecutive patients who had undergone endopye lotomy before the use of endoluminal ultrasonography (group 2). Results Imaging detected 17 crossing vessels in 13 of the 19 patients. Six patients underwent primary reconstructive surgery and 13 underwent endopyel otomy. The endoluminal US findings changed treatment in some way in nine pa tients. Endopyelotomy was successful in 12 of the 13 patients and reconstru ctive surgery successful in five of six patients. The success after endopye lotomy improved from eight in 12 patients in group 2 to 12 of 13 in group 1 (P = 0.16, NS). Conclusions Endoluminal US can be used to select patients in whom endopyelo tomy is likely to fail. Using primary reconstructive procedures in these pa tients might improve the overall outcome, but these preliminary findings ne ed to be confirmed in a larger study.