Current Indications for Endopyelotomy

Results of endopyelotomy fall somewhat short of contemporary open pyeloplasty (67-95% versus 95100%). As most endopyelotomy series using different techniques achieve approximately the same results, it appears likely that selection criteria play a major role. Risk factors have been identified: the presence of vessels crossing directly the ureteropelvic junction stands out as a major prognostic factor of outcome; the degree of hydronephrosis, the type of obstruction and renal function also play a role, although of lesser importance. Long avascular strictures and major alteration of renal function clearly contraindicate the procedure. In our view, the presence of a crossing vessel should be ascertained preoperatively as it significantly influences the outcome. Modern diagnostic techniques such as spiral-computed tomography, color Doppler and endoluminal ultrasonography have replaced the more invasive procedures such as angiography. With careful attention to operative details, endopyelotomy produces outstanding results with minimal morbidity. The present development of retrograde techniques avoiding the morbidity of a percutaneous access and achieving comparable success are promising. We believe that with better definition of the indications one will further improve the outcome and match open pyeloplasty in well selected patients: in the absence of vessels crossing the UPJ and of massively dilated renal pelvis, a 95% success rate can be expected.