Question Title: UPJ Obstruction: Accucise vs. Pyeloplasty

About 6 months ago, I had a kidney infection. I went to my Doctor for antibiotics. Since I had a history of them, she sent me for an IVP. My test results showed: UPJ Obstruction, Hydronephrosis, severe pelvocaliectasis, and moderate cortical atrophy. I am 46 yrs. old, I had my first kidney infection at 18. I was referred to a Urologist. He told me he was going to do an Open Pyeloplasty, and that depending on what my kidney looked like, if the function was less than 20%, he was taking it out, but he wouldn't know until he got in there. When I found out the incision was 8 inches and there would be a tube coming out my back, I freaked. I went for a second opinion. That Doctor told me about Accucise Endopyelotomy. Since it is done laparoscopically, there would be no incision. Of course I jumped at that. I had a follow-up IVP done 4 months later. Before my Doctor's visit I posted my results on Apr. 06 and was replied to by "KR". He said it appeared I showed evidence of partial obstruction. I went for my follow-up visit, with my IVP results, and my Doctor said everything looked great, see you in 6 months for another IVP. My concern is that in the last month I have had two episodes of pain, and now I have blood in my urine (for the second time). My doctor is not concerned as long as it goes away. I only need to call him if it doesn't. I just want to know if this is something I I have to learn to live with or what? I am really worried that eventually I will need the pyeloplasty and that I should have just done it the first time. The differences in opinions between the two Doctors worries me. Do you have any opinions on accucise endopyelotomy vs. open pyeloplasty? P.S. My sister's 3 year old just had a pyeloplasy done last week for UPJ Obstruction. It's scary. Thanks so much, Linda

Dear Linda,
Endopylotomy(accucise) has become a time-tested alternative to open pyeloplasty in the treatment of UPJ obstruction success rates between 75-89%. Early skepticism concerned the durability of the results, but an 8 year follow-up shows few long term failures. This procedure involves an incision made through a diseased portion of the ureter and then mucosa and smooth muscle heal over a stent provided that there is continuity in the region and adequate blood supply. The chief advantage of endopylotomy is the avoidance of open surgery and nondisruption of the ureteral blood supply.
I would encourage my patients to try endopylotomy before open surgery. Yes it is possible for the stricture of the ureter (UPJ) to return and cause your pain and bleeding, but even after open surgery, this can be the case. You made need a follow-up renal scan (DTPA) to determine if an obstruction is present. Talk to your urologist to see if this is necessary. If not, avoid consumption of large amounts of diuretic beverages (coffee, tea, caffeine) and this may limit your periodic discomfort.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword:UPJ

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