ABSTRACT
The principle of endopyelotomy is derived from the Davis intubated ureterotomy. Endopyelotomy may be considered the treatment of choice in children with uretero-pelvic junction obstruction (UPJO) secondary to failed open pyeloplasty. The difficulty and morbidity of open re-operative pyeloplasty make percutaneous endopyelotomy (PCEP) an attractive consideration, with further advantages of reduced convalescence. The high success rate of pediatric open pyeloplasty makes this an uncommon indication, and therefore endo-urological experience is a prerequisite. The majority of the literature related to children deals with the percutaneous or antegrade approach, but the development of smaller ureteroscopes will contribute to greater applicability of the retrograde approach in the future. The poor results of endopyelotomy in children with primary UPJO combined with the promising evolution of laparoscopic pyeloplasty in children suggests that endopyelotomy should not be contemplated in this situation. Finally, endopyelotomy with the cutting balloon is another retrograde option, but is presently not practical in the pre-pubertal child because of the size of the balloon (10 Fr). Simple balloon dilatation of the UPJ without incision should be avoided in view of the poor results. (See Table 51.1)
• UPJO secondary to failed open pyeloplasty. • UPJO and concomitant renal lithiasis. • UPJO in an adolescent in the absence of aberrant
crossing vessels (relative).
