✦ UPJ Obstruction Treatment

Endopyelotomy (Acucise / Laser)

Q: Is endopyelotomy as effective as pyeloplasty?

No — success rates are 70–80% vs >95% for pyeloplasty; endopyelotomy is reserved for secondary obstruction or selected primary cases.

Q: Who should not have endopyelotomy?

Patients with crossing lower-pole vessels, long strictures, or primary UPJ obstruction are better treated with pyeloplasty to avoid bleeding and higher failure rates.

Q: Can I have pyeloplasty if endopyelotomy fails?

Yes — failed endopyelotomy does not preclude salvage laparoscopic or open pyeloplasty; most patients remain good candidates. Your consultant will provide specific guidance based on your individual clinical situation and recovery.

Endoscopic Incision of the Ureteropelvic Junction to Relieve Obstruction

30–60 min PROCEDURE

Day Care / 1 Day HOSPITAL STAY

70–80% SUCCESS RATE

1–2 Weeks RECOVERY

What is Endopyelotomy (Acucise / Laser)?

Endopyelotomy is an endoscopic procedure in which the obstructed UPJ is incised using a cutting electrode (Acucise balloon catheter) or laser (holmium or cold knife) under fluoroscopic and endoscopic guidance. The incision extends through the full thickness of the UPJ, allowing the stenosis to heal in a wider configuration. While less durable than pyeloplasty, endopyelotomy is suitable for secondary UPJ obstruction, short intrinsic strictures, or patients unfit for surgery. The procedure is performed under general or spinal anaesthesia with a hospital stay of Day Care / 1 Day.

Patients with secondary UPJ obstruction (post-pyeloplasty), short intrinsic UPJ strictures without crossing vessels, or those unfit for open or laparoscopic surgery. Patients must be adequately fit for anaesthesia and free from active systemic infection before proceeding.

How the Procedure Works

Scope Insertion

Ureteroscope or percutaneous nephroscope advanced to the UPJ.

Imaging Guidance

UPJ obstruction confirmed under direct vision and fluoroscopy.

UPJ Incision

Holmium laser or Acucise electrode used to incise the UPJ at the lateral aspect.

Incision Confirmation

Full thickness incision confirmed by peristaltic activity and widened lumen.

Stent Placement

DJ stent placed for 4–6 weeks to maintain patency during healing.

Outcomes

30–60 minDURATION

Day Care / 1 DayHOSPITAL STAY

70–80%SUCCESS RATE

1–2 WeeksFULL RECOVERY

Who Needs This Treatment?

→Minimally invasive endoscopic procedure — no open or laparoscopic incisions.
→Suitable for secondary UPJ obstruction after failed pyeloplasty.
→Day-case or overnight procedure with rapid recovery.
→Avoids open or laparoscopic surgery in carefully selected patients.
→Success rates of 70–80% for short secondary strictures.
→Definitive pyeloplasty remains available if endopyelotomy fails.

"Endopyelotomy has a clear role in secondary UPJ obstruction and selected primary cases. When pyeloplasty is not appropriate or refused, a carefully performed endoscopic incision can provide lasting relief."

— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon

Common Questions

Frequently Asked

Is endopyelotomy as effective as pyeloplasty?+

Who should not have endopyelotomy?+

Can I have pyeloplasty if endopyelotomy fails?+

Not sure which treatment is right for you?

Book a consultation with Dr. Vipin Reddy and get a personalised treatment plan.

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