This protocol applies to patients with ureteropelvic junction obstruction who have already undergone surgical correction but have not achieved adequate drainage or resolution of obstruction. It defines the structured next-line approach when the initial intervention falls short of expected outcomes.
The preceding intervention — pyeloplasty (open, laparoscopic, or robot-assisted dismembered Anderson-Hynes, Culp, or Foley Y-V approach), or endopyelotomy in the absence of a crossing vessel — did not achieve:
This protocol describes the step taken after this failure.
Patients who reach this protocol continue to present with one or more of the following indicators of clinically significant obstruction:
When initial surgical repair of the ureteropelvic junction has not succeeded, further surgical revision of the junction is the principal strategy. The full protocol specifies which operative approach is indicated and under what conditions each is appropriate.
DOI: 10.1016/j.eursup.2012.01.004
Some indications for surgery include <40% differential function of the hydronephrotic kidney on MAG3 scanning, a >20-mm anterior-posterior diameter of the renal pelvis on ultrasonographic scan, pain, and infection.
The indications for surgical intervention include (1) pain and infection, (2) asymptomatic obstruction with a differential function <35–40% and an APD >19 mm, (3) failure of conservative management resulting in >10% deterioration of renal function, and (4) grade 3 or 4 dilation as defined by the SFU.
Of recurrent UPJO and/or strictures, 2–5% will need to be treated with further surgery, be it redo pyeloplasty, endopyelotomy, or ureterocalicostomy.
This option may also be used in failed pyeloplasty.
This option may be useful in recurrent UPJO.
View source ↗