Retrograde Cold-Knife Endopyelotomy in Secondary Stenosis of the Ureteropelvic Junction

Eleven retrograde endopyelotomies of the ureteropelvic junction (UPJ) have been performed; the treated stenosis had occurred in three cases after surgical lithotomy and in eight after plastic operation on the ampulla. With the use of a rigid ureteroscope, a deep incision of the stenotic portion was performed utilizing a cold knife until the peripheral fat was reached. Then, the area was dilated with a balloon. An indwelling double-J stent was left in place for 10 weeks and a percutaneous nephrostomy tube for 4 weeks. After 1 year, intravenous urography showed excellent patency of the stenotic tract in nine cases. Improved renal function was demonstrated with sequential scintigraphy in three patients, and a furosemide washout test showed a satisfactory flow in seven cases. In our series, the procedure proved to be rapid, simply executed, and trustworthy.