Endopyelotomy Surgery

Overview

Endopyelotomy is a surgical procedure performed to eliminate obstructions at the ureteropelvic junction (UPJ), often caused by:

Genetic anomalies
Kidney stones
Scar tissue from previous surgeries

Symptoms of UPJ Obstruction:

Side discomfort
Frequent urinary retention
Leakage
Swelling of the kidneys with fluid
Aching pains in the urinary tract

Endopyelotomy targets the surgical relief of such obstruction using a minimally invasive approach.

How is Endopyelotomy Performed?

The procedure involves endoscopic access to the urethra and bladder. Using specific tools (including lasers), the surgeon incises or dilates the constriction to improve blood circulation. It is less invasive than open surgery and has benefits such as:

Less postoperative pain
Shorter recovery time
Fewer complications

Indications for Surgery

Widening of a narrowed ureter
Obstruction relief at the UPJ

A nephrostomy tube is inserted through an incision into the kidney. A ureteric stent is then introduced to ensure urine flow. The nephrostomy tube is removed after stent placement; the stent remains for several weeks.

Types of Endopyelotomy

Antegrade Endopyelotomy

Access through the side via nephrostomy tube
Blade used to incise UPJ
Duration: 2–3 hours
Nephrostomy tube kept in place post-op

Retrograde Endopyelotomy

Endoscopic access via urethra to the UPJ
Uses dilation and cutting tools
Duration: ~2 hours
Done under general, regional, or IV anesthesia

Benefits

Shorter hospital stay
Quicker recovery
Less postoperative pain
Reduced medication need
Faster return to daily life
Minimally invasive with reduced scarring

The technique enables precise incision planning, avoiding large-caliber stents, and promoting better surgical outcomes.

Frequently Asked Questions

Q: What kind of problems can endopyelotomy cause?
A: Complications may be serious (e.g., vascular, ureteral, or pulmonary injury), minor (e.g., infection, stent issues), or result in failure to relieve obstruction.

Q: How is endopyelotomy performed?
A: A telescope is inserted into the bladder under general anesthesia. Using X-rays and guidewires, the obstruction is incised with a laser fiber.

Q: Where is the incision made?
A: At the UPJ, through the renal pelvis or ureter lumen, using incision or balloon dilation.

Q: What is the duration of endometriosis surgery?
A: It can take 1 to 6 hours depending on severity and extent of lesions removed.