Long-term outcome of endopyelotomy for the treatment of ureteropelvic junction obstruction: how long should patients be followed up?

Purpose: To evaluate the long-term success rate of endopyelotomy for the treatment of ureteropelvic junction (UPJ) obstruction.

Patients And Methods: Between January 1995 and December 2003, 85 endopyelotomies (10 percutaneous, 75 retrograde) were performed in 77 patients with a mean age of 35.2 +/- 13.9 years. The mean number of procedures per patient was 1.14, with 69 patients undergoing a single procedure. Endopyelotomies were performed using either a cold knife (N = 26), Ho:YAG laser (N = 47), or hook electrode (N = 12). Treatment success was defined as symptomatic relief with radiographic resolution or stabilization of renal function, as judged by an excretory urogram or diuretic renogram. Kaplan-Meier analysis was used to determine the long-term probability of success.

Results: With a median follow-up of 37.3 months (range 3-98 months), the overall success rate was 67.5%, and the median time to failure was 7.7 months (range 1-50 months). Kaplan-Meier estimates of success were 87.8% at 6 months, 76.9% at 12 months, 72.2% at 18 months, 68.7% at 24 months, 64.8% at 36 months, and 61.6% at 60 months. The success rate was not significantly affected by the etiology, surgical approach, or incisional method. Similarly, the degree of preoperative hydronephrosis or renal function did not affect the success rate.

Conclusions: The success rate of endopyelotomy decreases as the follow-up increases. Although most failures were detected within 1 year of the procedure, it appears that follow-up of at least 36 months is required for patients who have undergone endopyelotomy for UPJ obstruction.