Endopyelotomy versus redo pyeoloplasty for management of failed pyeloplasty in children: A single center experience.
PURPOSE
We compared endopyelotomy to redo pyeloplasty for the treatment of failed pyeloplasty in children to identify factors that may have an impact on outcome and favor one procedure over the other.


METHODS
Of 43 patients with recurrent UPJO, EP was performed in 27 and RP was performed in 16. Age, gender, side, presentation of secondary UPJO, hospital stay, complications and success rates were compared. Success was defined as radiographic relief of obstruction as determined by ultrasound or diuretic renography at latest follow-up.


RESULTS
Mean (Range) patient age was 7.2 years (range 6 months to 17 years) in EP (group 1) while 7.4 (range 6 months to 17 years) in RP (group 2). EP technique consisted of retrograde cold-knife in 17 patients, retrograde holmium laser in 8 and antegrade cold-knife in 2. RP was performed in 16 patients. All the patients with failed EP had a stricture greater than 15 mm. Mean length of the narrowed ureteral segment was 17.8 mm in the failed EP group vs 10 mm in the successful group (p < 0.001). Mean Hospital stay was 1 day for the EP group and 5 days for the RP group (p < 0.001). Mean follow-up was 17 months (range 12 to 43) after EP and 21 months (12 to 51) after RP. There was no statistical significance between both groups regarding the postoperative degree of hydronephrosis, parenchymal thickness, split renal functions and renal drainage. The overall success was (86%); the success was nonsignificantly higher in RP (93.8%) vs (81.5%) in EP.


CONCLUSION
In selected children, retrograde endopyelotomy is safe and may give comparable short-term outcomes as open redo pyeloplasty for correction of secondary UPJO after failed pyeloplasty. Narrowed ureteral segment greater than 15 mm and preoperative grade 4 hydronephrosis were factors significantly associated with a poor outcome after EP.


A LEVEL-OF-EVIDENCE RATING FOR CLASSIFYING STUDY QUALITY
LEVEL III Retrospective comparative study.
['Abdrabuh|Abdrabuh M|AM|', 'Salih|Elsayed M|EM|', 'Aboelnasr|Mahmoud|M|', 'Galal|Hussein|H|', 'El-Emam|Abdelbasset|A|', 'El-Zayat|Tarek|T|']
D000293:Adolescent D002648:Child D002675:Child, Preschool D006801:Humans D007223:Infant D007668:Kidney D007902:Length of Stay D000074643:Nephrotomy D012086:Reoperation D012189:Retrospective Studies D017211:Treatment Failure D014517:Ureteral Obstruction
Child Kidney pelvis Postoperative complications Ureteral obstruction Urologic surgical procedures