Laser retrograde endopyelotomy for the treatment of Ureteropelvic junction obstruction : initial experience at Hopital General Idrissa Pouye of Dakar

Abstract

Introduction: Ureteropelvic junction (UPJ) obstruction is an obstructive congenital malformation characterized by a dilation of the pelvis and the callyx upstream of an obstacle located between the renal pelvis and the proximal ureter. Endopyelotomy consists of an endoscopic longitudinal incision of UPJ. It is a minimally invasive technique that can be used as an alternative to open surgery and laparoscopy. The objective was to study the feasibility and efficacy of retrograde endopyelotomy in the treatment of UPJ obstruction at the Department of Urology of Hôpital Général Idrissa Pouye in Dakar.

Methods: We conducted a descriptive study of the first patients treated by endopyelotomy for UPJ obstruction between January 2015 and December 2017 at the Department of Urology of Hôpital Général Idrissa Pouye in Grand Yoff, Dakar. We collected data on clinical aspects and diagnoses and therapeutic outcomes based on patient complaints and CT scans. We computed descriptive statistics with a statistical significance considered for p<5%.

Results: Eight patients underwent endopyelotomy, of which five on the right side and three on the left side. Mean age was 45.38 years (SD: 8.62; Range: 35 to 60 years). Four patients were male and four were female. All patients complained of flank pain and the diagnosis was confirmed by a CT scan. Seven patients were hospitalised for two days and one patient for one day. The post-operative period was uneventful for all patients. Four patients were successfully treated, while three patients had a failure. One patient died from a cause not related to the surgery, prior to the post operative evaluation. Among the patients with a failure, two subsequently underwent a pyeloplasty by open surgery.

Conclusion: Retrograde endopyelotomy under ureteroscopy is a good alternative for open pyeloplasty and its associated surgical wound and complications. It allows a good visualisation of UPJ and the treatment of associated urinary stones. The procedure is achievable in our context and its results will be improved by an appropriate learning curve.