Beng Jit Tan

Ureteropelvic junction obstruction repair: when, how, what?

Purpose of review To review factors that affect the success of ureteropelvic junction obstruction repair and recent developments in minimally invasive procedures for the repair of ureteropelvic junction obstruction. Recent findings Recent reports and studies further confirm earlier findings that the success rate of endopyelotomy is decreased when a crossing vessel is the primary cause of ureteropelvic junction obstruction, poor renal function and significant hydronephrosis. Various minimally invasive procedures have emerged recently for the treatment of ureteropelvic junction obstruction. These include laparoscopic pyeloplasty, robotically assisted laparoscopic procedures, and percutaneous endopyeloplasty. These procedures offer potential advantages over conventional endopyelotomy, including better success rates in the presence of crossing vessels, wider caliber reconstruction of the ureteropelvic junction, and full-thickness healing with primary intent. Summary With such a large variety of minimally invasive procedures for the treatment of ureteropelvic junction obstruction available, the treatment choice for ureteropelvic junction obstruction must be based on several factors, including the success and morbidity of the procedures, the surgeons experience, the cost of the procedure, and the patients choice.

Percutaneous Approach to Transitional Cell Carcinoma of the Upper Urinary Tract

The preliminary rationale for endoscopic management of upper tract transitional cell carcinoma (UTTCC) was to preserve renal parenchyma and to decrease the morbidity of therapy. In this regard, endoscopic management was introduced to treat patients with UTTCC in an anatomic or functional solitary kidney, patients with bilateral disease, and patients who were not candidates for open surgery due to underlying comorbidity. Today, endoscopic management remains the standard of care for such patients, as long as they have noninvasive disease. A percutaneous approach, in particular, has proven to be an effective minimally invasive treatment for large (>1.5 cm), low-grade UTTCC limited to the calices, renal pelvis, and proximal ureter. Because of the high incidence of recurrence and progression, elective endourologic management for grade III T1 tumors is not recommended. Some controversy still exists regarding the use of endoscopic management in patients with a normal contralateral kidney, in those who have multiple tumors in the same kidney or ipsilateral collecting system, and in patients with a solitary kidney with high-grade disease. This chapter describes the technique and discusses results of recent studies on percutaneous management of UTTCC. Recent results of instillation immuno- and chemotherapy for upper tract urothelial carcinoma are also discussed.