Endopyelotomy in the symptomatic older child

Objective To evaluate the results of endopyelotomy in children, an establis hed method in adult practice as a treatment for pelvi-ureteric junction (PU J) obstruction. Patients and methods Endopyelotomies undertaken between 1992 and 1999 by on e surgeon in an established endourology unit were reviewed retrospectively. Children aged > 5 years presenting with pain and obstruction on isotope re nography were selected for endopyelotomy. Patients with crossing vessels de tectable on spiral computed tomography were treated by open pyeloplasty. Ac cess to the renal pelvis was provided by a uroradiologist. Endopyelotomy wa s carried out through an Amplatz sheath of (median) 26 F. After applying tr action to invaginate the PUJ an incision was made posterolaterally using el ectrocautery via an 11F paediatric resectoscope. Stenting was maintained fo r 6 weeks. In all, 13 patients (median age 10 years, range 5-14) were treat ed; two had associated calculi. Results The symptoms resolved and the obstruction was relieved in only six patients, with a median (range) follow-up of 50 (26-68) months. The seven p atients in whom endopyelotomy failed, as indicated by persistent pain, proc eeded to open pyeloplasty at a median (range) of 4 (1.3-79) months. Of thes e, two had presented with associated multiple calculi and significant hydro nephrosis tone with an associated duplex system) and three had crossing low er pole vessels at open operation. One developed a urinoma after the origin al endopyelotomy and one had a retained stent fragment removed at the time of pyeloplasty. Conclusions Endopyelotomy in the symptomatic child requires a careful preop erative evaluation. Crossing lower pole vessels warrant an open pyeloplasty .