Simplified approach to percutaneous endopyelotomy

The purpose of this report was to describe a safe, simple, and rapid approa ch to percutaneous antegrade endopyelotomy. In contrast to standard percuta neous endopyelotomy techniques, in this procedure, the endopyelotomy stent is placed at the outset. The endopyelotomy incision is then made with an ac orn-tipped Bugbee electrode directly down onto the stent, in a manner analo gous to a ureteral meatotomy in the bladder. The advantage of this approach is twofold. Primary placement of the stent helps to define the appropriate site and direction for the endopyelotomy incision, allowing marsupializati on of the proximal ureter into the renal pelvis. Use of this technique also obviates the need to pass a large-caliber stent after the endopyelotomy in cision has been made, thereby avoiding a potential risk of ureteropelvic ju nction disruption. Clinical and radiographic follow-up was available in 29 (76%) of 38 patients who underwent this procedure. Success, defined as a re solution of symptoms and decrease in calicectasis, was achieved in 24 (83%) of the 29 patients. We have found primary placement of an endopyelotomy st ent and use of electrocautery as a cutting mode safely facilitates a precis e endopyelotomy incision. UROLOGY 56: 848-850, 2000. (C) 2000, Elsevier Sci ence Inc.