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Comparison of Retrograde Endo-Pyelotomy and Endo-Balloon Rupture of the Ureteropelvic Junction in a Porcine Model

1994; Lippincott Williams & Wilkins; Volume: 152; Issue: 6 Part 2 Linguagem: Inglês

10.1016/s0022-5347(17)31649-x

1527-3792

Margaret S. Pearle, Young Tae Moon, Robert C. Endicott, Stephanie M. Gardner, Peter A. Humphrey, Ralph V. Clayman,

Urological Disorders and Treatments

No AccessJournal of Urology1 Dec 1994Comparison of Retrograde Endo-Pyelotomy and Endo-Balloon Rupture of the Ureteropelvic Junction in a Porcine Model Margaret S. Pearle, Young Tae Moon, Robert C. Endicott, Stephanie M. Gardner, Peter Humphrey, and Ralph V. Clayman Margaret S. PearleMargaret S. Pearle Current address: Division of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75235-9110. More articles by this author , Young Tae MoonYoung Tae Moon More articles by this author , Robert C. EndicottRobert C. Endicott More articles by this author , Stephanie M. GardnerStephanie M. Gardner More articles by this author , Peter HumphreyPeter Humphrey More articles by this author , and Ralph V. ClaymanRalph V. Clayman More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)31649-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Excellent results and durable success have been achieved with antegrade and retrograde endo-pyelotomy for treating primary and secondary ureteropelvic junction obstruction. Recently, a 30F dilating balloon was used to rupture the ureteropelvic junction (ENDOBRST) with encouraging results. While balloon distention of the ureteropelvic junction is a technically simpler procedure than endo-pyelotomy, clinical and laboratory data comparing the 2 methods are lacking. In an acute and chronic animal study we compared endo-pyelotomy via a ureteral cutting balloon incision to balloon rupture (that is 30F) of the normal ureteropelvic junction in each of 20 female farm pigs. Eight pigs were harvested acutely after treatment, and a macroscopic and histological examination of the treated ureteropelvic junction was completed. In 11 chronic pigs after endo-pyelotomy a 7F double pigtail ureteral stent was placed bilaterally and then removed after 6 weeks. Evaluation in the chronic group consisted of a furosemide washout renogram and retrograde pyelogram immediately preoperatively and 6 weeks after stent removal. The animals were likewise harvested 6 weeks after stent removal. One control pig underwent passage of the balloon cutting catheter and balloon dilating catheters without activation or dilation, respectively. Ureteral stents were placed bilaterally for 6 weeks and the pig was otherwise treated similarly to the other chronic study animals. In the acute group all ureters after endo-pyelotomy demonstrated retroperitoneal extravasation of contrast material. At harvest the ureters had been cleanly incised along a length of 3 to 4cm. through the adventitial layer. In contrast, the balloon treated ureters showed free retroperitoneal extravasation in only half of the animals. Among the balloon treated ureters 7 of 8 had a linear tear of varying length (1 to 5cm.) involving all but a thin adventitial layer of tissue. Histologically, the endo-pyelotomy ureters demonstrated a clean, linear transmural incision with virtually no destruction of surrounding tissue in 6 cases. In the remaining 2 cases an incision into but not completely through the muscular layer was observed. The balloon treated ureters showed a perforation through the muscular wall in 7 cases. However, periureteral hemorrhage and urothelial loss were common findings. In the chronic group infection and continued urine extravasation from the endo-pyelotomy site resulted in a 45% mortality rate. Of the surviving 6 pigs 83% of the balloon treated and 67% of the endo-pyelotomy pigs had a patent ureteropelvic junction by retrograde pyelogram and renogram. Histologically, the 2 sides were indistinguishable, with both showing mild fibrosis and chronic inflammation. Overall, in the acute phase endo-pyelotomy provides a well defined, full thickness incision of the ureteropelvic junction. In contrast, balloon rupture of the ureteropelvic junction results in a ureterotomy of unpredictable length, breadth and depth. However, histologically, the 2 modalities are comparable in the chronic phase. In this study balloon distention appeared to be safe and as efficacious as an endo-pyelotomy. The potential clinical relevance of these findings requires further study. © 1994 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGnessin E, Yossepowitch O, Holland R, Livne P and Lifshitz D (2018) Holmium Laser Endoureterotomy for Benign Ureteral Stricture: A Single Center ExperienceJournal of Urology, VOL. 182, NO. 6, (2775-2779), Online publication date: 1-Dec-2009.NAKADA S, SABAN R, ZINE M, UEHLING D and BJORLING D (2018) IN VITRO PASSIVE SENSITIZATION OF THE URETER AS A BASIS FOR THE STUDY OF NONINFECTIOUS URETERAL INFLAMMATIONJournal of Urology, VOL. 160, NO. 5, (1924-1927), Online publication date: 1-Nov-1998. Volume 152Issue 6 Part 2December 1994Page: 2232-2239 Advertisement Copyright & Permissions© 1994 by The American Urological Association Education and Research, Inc.Keywordsureterballoon dilatationureteral obstructionruptureMetricsAuthor Information Margaret S. Pearle Current address: Division of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75235-9110. More articles by this author Young Tae Moon More articles by this author Robert C. Endicott More articles by this author Stephanie M. Gardner More articles by this author Peter Humphrey More articles by this author Ralph V. Clayman More articles by this author Expand All Advertisement PDF downloadLoading ...