A More “Conventional” Way to Perform Percutaneous Endopyeloplasty: A Feasibility Study

Objective Percutaneous endopyeloplasty is a horizontal suturing of the endopyelotomy incision via a unique percutaneous tract. We present a feasibility study of our technique of percutaneous endopyeloplasty using a conventional suture with a laparoscopic needle holder via the nephroscope. Materials and Methods A longitudinal endopyelotomy incision is performed through a 24-Fr working sheath placed via an upper calyx. Then an initial suture is placed, approximating the endopyelotomy incision distal and proximal apex, using a conventional absorbable 13-mm needle suture with a lengthened 3.5-mm pediatric laparoscopic needle holder, via the nephroscope. If possible, an additional 2 sutures are eventually placed, 1 on either side of the initial midline suture. Results Percutaneous endopyeloplasty, using a conventional suture with a pediatric laparoscopic needle holder via a nephroscope, is technically possible, reproducible, and effective, and was performed in 10 consecutive patients. The tissue approximation provides a fast, full thickness ureteral healing. Endopyelotomy horizontal suturing leads to a wider caliber reconstruction of the ureteropelvic junction. Conclusion Percutaneous endopyeloplasty is a promising technique. Our procedure for endopyeloplasty is technically feasible and effective, with little need for highly specialized equipment. However, further technical experience and longer follow-up in a larger group of patients are necessary for more development of this technique.