There is a variety of accepted treatments for primary or secondary ureteropelvic junction (UPJ) obstructions. Open pyeloplasty remains the gold standard. Open pyeloplasty is an invasive (often a ‘dismembering pyeloplasty’) treatment with an average postoperative hospital stay of 6 days. Several endoscopic and laparoscopic techniques are now available as alternative treatment options.
These techniques include:
- Laparoscopic transperitoneal pyeloplasty
- Antegrade endoscopic endopyelotomy and endopyeloplasty
- Retrograde endopyelotomy
- Retrograde balloon dilatation alone
Laparoscopic and endoscopic techniques are less invasive than open pyeloplasty but they are associated with a long learning curve for the operator and a long operation time (average: 245 minutes).
We devised a new method for treating primary UPJ obstruction using a detachable inflatable spacer balloon positioned upstream of the bladder. First the obstruction is dilated with a special dilatation balloon. After doing that a double J catheter is placed followed by the spacer ballon catheter next to the double J. The procedure can be performed in 30 minutes, is a much less invasive way than a laparoscopic approach or robot surgery. Why make things harder when life is offering you this and follow the principle of least effort. It’s not more difficult to perform than bringing in a double J.
The procedure is straight forward and fast without making scars in organs and skin, resulting in a significant shorter patient recovering time. This means a considerable reduction in OR time, complications and compared to the much higher costs of robotic pyeloplasty, a relief to the expenses of the public health system.
To know if you deal with a primary UPJ obstruction or a secondary, a diagnostic dilatation with a common PTA balloon can be performed on the out-patient base.
In case a waist in the balloon (visible on X-ray fluoroscopy) does not appear, or disappears at low balloon pressure, while filling the balloon with contrast medium, it probably is a secondary stenosis, caused by external compression.
In case a waist remains visible at higher balloon pressures it’s most likely a primary stenosis caused by intrinsic wall factors.