Comparision Of Interventional Therapy And Dismembered Pyeloplasty For Recurrent Ureteropelvic Junction Obstruction

ObjectiveTo compare the clinical efficacy of interventional therapy with dismembered pyeloplasty for recurrent ureteropelvic junction obstruction.MethodsWe retrospectively analysed the records of 30 patients with recurrent ureteropelvic junction obstruction after dismembered pyeloplasty from the urology department of the First Affiliated Hospital of Zhengzhou University during January 2006 to October 2009.Of these patients,10 cases (5 males and 5 females;mean age 42.1 years) underwent interventional treatment and 20 cases (12 males and 8 females; mean age 23.3 years) underwent the secondary dismembered pyeloplasty. Interventional treatment(10 cases):Local anesthesia or general anesthesia was administered.First,the patient was placed with the lithotomy position,and the 5F guide wire and 5FH1 catheter were inserted into the ureteral orifice under the cystoscopy.Then the patient was transferred to the DSA operating room.The patient was placed with the supine position, and the ureteropelvic junction obstruction was confirmed and the tip of catheter was in the renal pelvis under fluoroscopic imaging. Two patients underwent retrograde catheter dilation, and 10.2F or 12F stent catheter was placed in all patients.The second dismembered pyeloplasty(20 cases):the patient was placed with a lateral position under general anesthesia. The subcostal incision was made, and the dilated renal pelvis was mobilized in the retroperitoneal space.The pelvis was cut 15mm away from the edge of renal sinus and the pyeloplasty was made.The pelvi-ureteric anastomosis was sutured with absorbable suture and a 5-6F D-J catheter was inserted.The operative time, average intraoperative blood loss and postoperative length of hospital stay of the 2 groups were analyzed.ResultsThe interventional group had fewer operative time(66.5±16.5min vs 188.0±26.1min,P<0.05), shorter postoperative length of hospital stay (8.4±2.4d vs 16.5±3.8d, p<0.05), but longer extubation time(78.4±14.4d vs 61.5±5.0d, P<0.05). The mean intraoperative blood loss was 7.5ml,the mean postoperative analgesic administered was 5.0 mg and the mean gastrointestinal recovery time 4.8h in the interventional group vs 252.3ml,80.0 mg and 37.4h in the open group (p<0.05). The two groups of hydronephrosis has no statistically significant(p=0.066). One patient with hematuria and one with bladder irritation sign were observed in the interventional group. Three patients with wound dehiscence and five patients with hematuria in the open group, were managed conservatively. Radiographic assessment by intravenous urography or ultraphonic showed 40% cure rate and 60% improvement rate in the interventional group and 25% cure rate,35% improvement rate and 40% invalid rate in the open group at a follow up of 3-24 months.ConclusionOur study demonstrated that the interventional treatment was an effective therapy in some select patients with recurrent ureteropelvic junction obstruction.