endopyelotomy

Endopyelotomy is a minimally invasive surgical procedure used primarily to treat urinary obstruction caused by strictures in the ureteropelvic junction (UPJ) or ureter. The procedure involves the insertion of a small, flexible scope called a cystoscope into the bladder, followed by the passage of a ureteroscope through the urethra and into the ureter. Once the scope reaches the site of the obstruction, a small incision is made in the ureter wall to relieve the blockage.

This technique is often preferred over traditional open surgery because it offers several advantages, including reduced recovery time, lower risk of infection, and smaller incisions. Endopyelotomy is typically performed under general anesthesia and may be done on an outpatient basis in some cases. The procedure is generally well-tolerated, with most patients experiencing minimal discomfort immediately following surgery.

Indications for endopyelotomy include symptomatic ureteral strictures, recurrent urinary infections, and hydronephrosis due to obstruction. It is particularly useful in patients who are not candidates for other less invasive treatments, such as stent placement or endoscopic dilation. The procedure is not suitable for all patients, however, and may be contraindicated in those with severe comorbidities, active urinary tract infections, or certain anatomical abnormalities.

Postoperative care involves monitoring for signs of infection, bleeding, or complications such as ureteral perforation. Patients are typically advised to avoid strenuous activity for a few days and may require a short course of antibiotics to prevent infection. Follow-up imaging, such as a CT scan or ultrasound, is often recommended to assess the long-term outcome and ensure the obstruction has been effectively relieved.

While endopyelotomy is generally effective, success rates can vary depending on the underlying cause of the stricture and individual patient factors. Long-term outcomes may require additional procedures in some cases, particularly if the stricture recurs. As with any surgical intervention, the benefits and risks should be carefully weighed with a healthcare provider before proceeding.