A Comparison of Minimally Invasive Surgical Techniques for Ureteropelvic Junction Obstructions: Endopyelotomy, Acucise Endopyelotomy, and Laparoscopic Pyeloplasty

Dong Youp Han; Kwang Sung Park; Ill Young Seo; Joung Sik Rim

doi:10.4111/kju.2008.49.7.592

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Han, Park, Seo, and Rim: A Comparison of Minimally Invasive Surgical Techniques for Ureteropelvic Junction Obstructions: Endopyelotomy, Acucise Endopyelotomy, and Laparoscopic Pyeloplasty

Original Article

Korean J Urol 2008;49(7):592-597.

Published online: 19 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.7.592

A Comparison of Minimally Invasive Surgical Techniques for Ureteropelvic Junction Obstructions: Endopyelotomy, Acucise Endopyelotomy, and Laparoscopic Pyeloplasty

Dong Youp Han, Kwang Sung Park¹, Ill Young Seo, Joung Sik Rim

From the Department of Urology, Wonkwang University School of Medicine, Iksan, Korea

¹Chonnam National University Medical School, Gwangju, Korea

Received 7 January 20085 June 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to compare the efficacy and outcomes of endopyelotomy, Acucise endopyelotomy, and laparoscopic pyeloplasty for patients with ureteropelvic junction obstructions.

Materials and Methods

We studied 45 patients with ureteropelvic junction obstructions who underwent minimally invasive surgeries between January 2001 and April 2007. Patients were divided into three groups according to operative procedure: group I, endopyelotomy (n=17); group II, Acucise endopyelotomy (n=12; and group III, laparoscopic pyeloplasty (n=16).

Results

The mean patient ages in the three groups were 42.7±17.2 years, 48.8±14.1 years, and 49.5±13.6 years for groups I, II, and III, respectively. The mean stricture lengths were 0.99±0.25cm, 0.93±0.10cm, and 1.03±0.38 cm for groups I, II, and III, respectively, and were not significantly different among the groups (p＞0.05). The mean operating time for group II (55.7±25.3 minutes) was shorter than that for group I (131.7±30.5 minutes) and group III (165.2±23.7 minutes) (p＜0.05). The length of hospital stay for group II (4.7±1.6 days) was shorter than that for group I (6.6±1.8 days) and group III (7.4±0.6 days) (p＜0.05). Rates of symptomatic improvement were 58.8%, 66.7%, and 93.8% for groups I, II, and III, respectively. Rates of radiologic improvement were 58.8%, 66.7%, and 93.8% for groups I, II, and III, respectively. There was no significant correlation between success rate and either stricture length or degree of hydronephrosis.

Conclusions

Laparoscopic pyeloplasty had the highest success rate among the minimally invasive surgeries for patients with ureteropelvic junction obstructions. However, when the stricture length is less than 1cm in length, Acucise endopyelotomy may be considered as the first treatment because the associated operating time and hospital stay are short.

Keywords: Ureteroscopy, Acucise, Endopyelotomy, Laparoscopy

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Table 1.

Comparison of preoperative parameters among the three groups

	Group I (n=17)	Group II (n=12)	Group III (n=16)	p-value
Sex				0.947
Male/Female (%)	9 (52.9)/8 (47.1)	6 (50)/6 (50)	9 (56.3)/7 (43.8)
Age (years)	42.7±17.2	48.8±14.1	49.5±13.6	0.383
Left/Right (%)	10 (58.8)/7 (41.8)	5 (42)/7 (58.3)	10 (62.5)/6 (37.5)	0.418
BMI (kg/m²)	23.0±2.8	23.4±2.9	22.8±4.2	0.837
Etiology (%)				0.313
Primary/Secondary	11 (64.7)/6 (35.3)	9 (75)/3 (25)	14 (87.5)/2 (12.5)
Length (cm)	0.99±0.25	0.93±0.10	1.03±0.38	0.661
Symptom (%)
Pain	11 (64.7)	7 (58.3)	14 (87.5)
Hematuria	4 (23.5)	3 (25)	2 (12.5)
UTI	2 (11.8)	2 (1.1)	0 (0)
Serum creatinine (mg/dl)	1.2±0.6	1.2±0.6	1.1±0.3	0.536
Hydronephrosis (%)				0.968
Grade I-II/III-IV	7 (41.2)/10 (58.8)	5 (41.7)/7 (58.3)	6 (37.5)/10 (62.5)
F/U period (months)	16.5±4.8	13.4±3.5	14.3±2.9	0.259

Group I: endopyelotomy, Group II: acucise endopyelotomy, Group III: laparoscopic pyeloplasty, BMI: body mass index, UTI: urinary tract infection, F/U: follow up. Statistically significant by Pearson chi-square test

Table 2.

Comparison of perioperative and postoperative parameters among the three groups

	Group I (n=17)	Group II (n=12)	Group III (n=16)	p-value
Anesthesia				0.361
GA/SA (%)	15 (88.2)/2 (11.8)	10 (83.3)/2 (16.7)	16 (100)/0
Operation time (min)	131.7±30.5	55.7±25.3	165.2±23.7	＜0.000^†
Transfusion (%)	2 (11.8)	0 (0)	2 (12.5)	0.081
Hospital stay (days)	6.6±1.8	4.7±1.6	7.4±0.6	＜0.000^†
Early ambulation period (days)	1.0±0.3	1.1±0.7	1.2±0.8	0.418
Postoperative s-creatinine (mg/dl)	1.3±0.2	1.1±0.2	1.1±0.5	0.821
Symptom improvement (%)	10 (58.8)	8 (66.7)	15 (93.8)	0.017*
Radiologic improvement (%)	10 (58.8)	8 (66.7)	15 (93.8)	0.017*
Complication rate (%)	2 (11.8)	1 (8.3)	2 (12.5)	0.372

Group I: endopyelotomy, Group II: Acucise endopyelotomy, Group III: laparoscopic pyeloplasty, GA: general anesthesia, SA: spinal anesthesia, Postoperative s-creatinine: serum creatinine level at 1day after operation.

^* : statistically significant by Pearson chi-square test

^† : statistically significant by Kruskal-Wallis test

Table 3.

Symptom improvement rates for endopyelotomy, Acucise endopyelotomy, and laparoscopic pyeloplasty according to stricture length and degree of hydronephrosis

	Group I	Group II	Group III
	Improved/Not-improved	Improved/Not-improved	Improved/Not-improved
Striture length
＜1cm (%)	3 (60)/2 (40)	4 (80)/1 (20)	4 (100)/0 (0)
≥1cm (%)	7 (58.3)/5 (41.7)	4 (57.1)/3 (42.9)	11 (91.7)/1 (8.3)
p-value	0.949	0.889	0.551
Hydronephrosis
Grade I-II (%)	5 (71.4)/2 (28.6)	3 (60)/2 (40)	6 (100)/0 (0)
Grade III-IV (%)	5 (50)/5 (50)	5 (71.4)/2 (28.6)	9 (90)/1 (10)
p-value	0.377	0.310	0.649

Statistical analysis using by Pearson chi-square test

Table 4.

Radiologic improvement rates for endopyelotomy, Acucise endopyelotomy, and laparoscopic pyeloplasty according to stricture length and degree of hydronephrosis

	Group I	Group II	Group III
	Improved/Not-improved	Improved/Not-improved	Improved/Not-improved
Stricture length
＜1cm (%)	3 (60)/2 (40)	4 (100)/1 (20)	4 (100)/0 (0)
≥1cm (%)	7 (58.3)/5 (41.7)	4 (57.1)/3 (42.9)	11 (91.7)/1 (8.3)
p-value	0.949	0.889	0.551
Hydronephrosis
Grade I-II (%)	5 (71.4)/2 (28.6)	4 (60)/1 (40)	6 (100)/0 (0)
Grade III-IV (%)	5 (50)/5 (50)	4 (85.7)/3 (14.3)	9 (90)/1 (10)
p-value	0.377	0.889	0.649

Statistical analysis using by Pearson chi-square test

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