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. The procedure is not more difficult to perform or time consuming 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.