ENDOPYELOTOMY : Retrograde Ureteroscopic Approach - 08/09/11
Resumen |
Ureteropelvic junction (UPJ) obstruction implies a functional impedance of urinary flow at the anatomic junction of the renal pelvis and the ureter (Figure 1). A variety of obstructive processes may lead to UPJ obstruction and disruption of ureteral peristalsis. Primary causes include primary intrinsic narrowing owing to defects in the ureteral musculature, extrinsic compression by crossing vessels or fibrous bands, and abnormal high insertion of the ureter into the renal pelvis. Secondary causes of ureteral obstruction result in fibrosis following renal calculus disease, renal infection, iatrogenic injury, and renal trauma.21, 22, 23, 24
Historically, open pyeloplasty has been the mainstay of operative correction of UPJ obstruction. With the advent of endourologic techniques and technology, several minimally invasive procedures are being applied to UPJ obstruction: antegrade nephroscopic endopyelotomy, retrograde ureteroscopic endopyelotomy, balloon dilation with a cutting wire (Acucise), and laparoscopic pyeloplasty. It has been suggested that laparoscopic pyeloplasty is more effective than antegrade percutaneous endopyelotomy and Acucise endopyelotomy; however, this study did not include retrograde ureteroscopic endopyelotomy in the evaluation.11
The retrograde technique of endopyelotomy has evolved with the rapid improvements in ureteroscopic instrumentation.7, 13 Initial studies suggested a high rate of ureteral stricture formation,13, 20 which has been attributed to thermal injury from transmission of the electrocautery current.22 Current use of an insulated ureteroresectoscope with a fixed right-angle electrode has alleviated this problem.22, 24 In comparison with the antegrade approach, the retrograde approach eliminates the risks associated with percutaneous access to an upper or middle pole calyx (hydrothorax, pneumothorax) and the need for external nephrostomy tube drainage. Expanded experience with retrograde ureteroscopic endopyelotomy has made this approach an important part of the minimally invasive armamentarium for endoscopic management of UPJ obstruction.
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| Address reprint requests to Raju Thomas, MD, Department of Urology, Tulane University Medical Center, 1430 Tulane Avenue-SL 42, New Orleans, LA 70112 |
Vol 25 - N° 2
P. 305-310 - mai 1998 Regresar al número
Artículo precedente
- RETROGRADE BALLOON CAUTERY INCISION OF URETEROPELVIC JUNCTION OBSTRUCTION
- Peter Aslan, Glenn M. Preminger
- ANTEGRADE ENDOPYELOTOMY
- Joseph W. Segura
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