There are a variety of accepted treatments for primary or secondary ureteropelvic junction (UPJ) obstruction.
- Although open pyeloplasty remains the gold standard, several endoscopic and laparoscopic techniques are available as alternative treatment options.
These techniques include:
- Laparoscopic transperitoneal pyeloplasty,
- Antegrade endoscopic endopyelotomy and endopyeloplasty,
- Retrograde endopyelotomy, and
- Retrograde balloon dilatation alone.
Open pyeloplasty is an invasive, dismembering treatment with a mean postoperative hospital stay of 6 days.
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 (mean, 245 minutes).
We devised a new method for treating primary UPJ obstruction using a detachable inflatable spacer balloon positioned stream up through 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 reason for developing a new method to treat UPJ obstruction was to try to help patients using a minimally invasive, straightforward, and fast procedure with a fast recovering time and without organ or skin scars.
The procedure can be done in 30 minutes. Is much less invasive than a laparoscopic approach or robot surgery. This means a considerable reduction in OR time, complications and costs to 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 done on an out patient base.
In case a waist in the balloon (visible on X-ray fluoroscopy) does not appear while filling the balloon with contrast medium, it probably is a secondary stenosis, caused by external compression.
In case a waist is visible at higher balloon pressures it’s a primary stenosis caused by intrinsic wall factors.