Endopyelotomy with the Acucise catheter.

OBJECTIVES Determine the efficiency of the Acucise catheter in the treatment of ureteropelvic junction (UPJ) obstruction. MATERIALS AND METHODS Between May 1997 and April 1999, 30 patients with primary or secondary ureteropelvic junction obstruction were treated using Acucise endopyelotomy catheter. The diagnosis was based on intravenous urography and diuretic renography. None of the patients underwent imaging studies for identification of blood vessels at the UPJ region. Twenty-one patients presented mild pyelocalyceal dilation and 9 had severe pyelocalyceal dilation. As for etiology, primary stricture was found in 24 patients and secondary stricture in 6. Three patients had UPJ obstruction associated with homolateral renal lithiasis. Retrograde Acucise endopyelotomy was performed in 27 patients; the antegrade access was used in 3 patients that had associated renal calculi. Incision of the stricture was performed laterally in all patients under fluoroscopic guidance. A 7F double-J catheter was placed immediately following the procedure, and removed after 6 weeks. Antegrade pyelotomy required a hospital stay of 3 days and retrograde pyelotomy required 1 day. RESULTS Postoperative intravenous urography and diuretic renography demonstrated good results in 26 patients (86.6%). CONCLUSIONS Acucise endopyelotomy represents a minimally invasive therapeutic option and can be used both in adults and in children 8 years old and above. Patients with UPJ obstruction and severe pyelocalyceal dilation had poorer results than those with mild pyelocalyceal dilation.