Prognostic Factors and Patient Selection

Abstract

For many years, open surgery has been the optimal therapy for ureteropelvic junction (UPJ) obstruction. Of the existing operations, dismembered pyeloplasty remains the gold standard. Percutaneous techniques were developed in the early 1980s for the treatment of nephrolithiasis. Their intrinsic advantage of minimal invasiveness were rapidly perceived and applied to the management of UPJ obstruction. In 1983, several reports of endoscopic management appeared in the literature, including percutaneous pyeloplasty, pyelolysis, endopyelotomy, and endoureteropyelotomy.* The basic principle of these procedures is a full-thickness incision of the narrow segment followed by prolonged stenting and drainage to allow regeneration of an adequate caliber ureter around the stent. This concept was first described in 1903 by the French urologist Joachin Albarran (ur6t6rotomie externe) and was popularized by Davis in 1943 as an open procedure (intubated ureterotomy). Although confirmed by experimental and clinical data, this pioneer work remained underexploited in the treatment of UPJ obstruction because of the excellent results of standard open pyeloplasty. The devel-