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Prof. Dr. Ali Avanoğlu
UPJ Obstruction • After surgery and follow-up

Endoscopic Methods: Who Is a Candidate for Endopyelotomy and Balloon Dilation?

Endopyelotomy and balloon dilation are endoscopic methods that widen UPJ obstruction from the inside, using thin instruments passed through the urinary tract or the skin, without an incision. Because their success is lower than pyeloplasty's, they aren't for everyone — they're used in selected cases, especially adults and older children who've already had surgery.

Who this is forFamilies asking "isn't there a way without an incision?", and adolescent and adult patients looking for options for a recurrent narrowing
Reading≈6 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of UPJ obstruction.Read the full treatment overview on the hub page
internal incision(or balloon dilation)endoscopeENDOPYELOTOMY: internal incisionENDOSCOPIC · NO INCISIONlumen widenedJJ stent (4–6 weeks)incision heals over the stentAFTER: healing over the stentSUCCESS LOWER THAN PYELOPLASTY
internal incision(or balloon dilation)endoscopeENDOPYELOTOMY: internal incisionENDOSCOPIC · NO INCISIONlumen widenedJJ stent (4–6 weeks)incision heals over the stentAFTER: healing over the stentSUCCESS LOWER THAN PYELOPLASTY
endopyelotomy: internal incision with an endoscope → healing over the stent
01 · What an endoscopic method means, and how it differs from pyeloplasty02 · Success rates: below pyeloplasty03 · Who is a candidate, and who isn't04 · Does it have a place in children?05 · After the procedure: stent, follow-up, and when to see a doctor
In brief5 madde
  • What an endoscopic method means, and how it differs from pyeloplasty: In pyeloplasty, the narrow segment is removed and the ureter is re-sewn to the renal pelvis — the junction is rebuilt.
  • Success rates: below pyeloplasty: In adult series, endopyelotomy success is reported at roughly 65–85%, compared with roughly 90–95% for pyeloplasty (open, laparoscopic, or robotic).
  • Who is a candidate, and who isn't: Endoscopic methods give more lasting results in cases where the narrowing is short and thin, the kidney's function is preserved, and there is no vessel pressing on it…
  • Does it have a place in children?: In children, the first treatment for UPJ obstruction is Anderson–Hynes pyeloplasty; endopyelotomy is not recommended as first-line treatment in pediatric guidelines.
  • After the procedure: stent, follow-up, and when to see a doctor: After endopyelotomy, a JJ stent stays in for a few weeks and is removed with a short procedure; during the stent period, frequent urination, burning, mild bloody…
01

What an endoscopic method means, and how it differs from pyeloplasty

In pyeloplasty, the narrow segment is removed and the ureter is re-sewn to the renal pelvis — the junction is rebuilt. In endoscopic methods, the narrowing is left in place and widened from the inside: either cut (endopyelotomy) or opened with a balloon (balloon dilation). This makes endoscopic methods less invasive, but they don't remove the underlying cause of the narrowing.

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  • Endopyelotomy is a full-thickness incision of the narrow segment; the cut is made either through the urinary tract (retrograde) or through a path opened from the skin to the kidney (antegrade), using a laser, cold knife, or electrocautery as the cutting tool. A JJ (double-J) stent is left in place for a few weeks afterward so the cut area stays open while it heals.
  • In balloon dilation, the narrowing is widened by inflating a balloon advanced over a thin wire; some balloons carry a cutting wire that incises at the same time. Balloon dilation alone has even lower long-term success than endopyelotomy, so its role is limited and it's mostly considered for very short, thin narrowings or as a temporary solution.
02

Success rates: below pyeloplasty

In adult series, endopyelotomy success is reported at roughly 65–85%, compared with roughly 90–95% for pyeloplasty (open, laparoscopic, or robotic). This gap is the basis for how the method is chosen: avoiding an incision is an advantage, but the chance of needing a second procedure is higher.

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  • In cases with a previously failed pyeloplasty (redo), endopyelotomy success is given in the literature at roughly 40–70%; redo pyeloplasty, by comparison, is reported at roughly 85–95%. So even for a recurrent narrowing, the endoscopic method is usually considered the second choice.
  • These figures mostly come from adult reviews and case series; there is no EAU or AUA guideline specific to adult UPJ obstruction, and data on endopyelotomy in children is even more limited. So these numbers should be read with the note "varies by center and case," and the decision should be made for the individual patient.
03

Who is a candidate, and who isn't

Endoscopic methods give more lasting results in cases where the narrowing is short and thin, the kidney's function is preserved, and there is no vessel pressing on it from outside. The suitability criteria listed in textbooks are below; these are guiding principles, not hard thresholds.

  • A short narrowing (roughly under 2 cm) and thin.
  • Preserved split (renal) function (roughly above 25%).
  • Mild-to-moderate hydronephrosis; the renal pelvis not excessively widened.
  • No crossing vessel (ruled out by imaging).
  • A secondary narrowing (after a previous pyeloplasty), a patient with high anesthesia risk, or the patient's clear preference.
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  • The situations where endopyelotomy is not recommended are also clear: the presence of a crossing vessel (the incision could injure the vessel, and the narrowing would persist from the vessel's pressure), severe hydronephrosis and a very widened renal pelvis, very low function, and a long narrowing. In these situations, pyeloplasty is both safer and more lasting.
  • If a crossing vessel is suspected, the anatomy is checked before the procedure with MR urography or CT angiography; in children this evaluation is done with MR urography. If a vessel is confirmed, the endoscopic method is generally taken off the table.
04

Does it have a place in children?

In children, the first treatment for UPJ obstruction is Anderson–Hynes pyeloplasty; endopyelotomy is not recommended as first-line treatment in pediatric guidelines. Because the main cause in infants is a non-contracting narrow segment, and the renal pelvis is usually widened, widening it with a cut has lower durability.

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  • In children, endoscopic methods are limited to short, recurrent narrowings after pyeloplasty, and are mostly considered in older children and adolescents. Even in these cases, redo pyeloplasty is considered first at most centers; endopyelotomy comes up for selected children with high anesthesia risk or where avoiding open surgery is preferred.
  • In our practice, the decision is made through the joint assessment of two pediatric urology specialists; because we also have adult urology experience, the endoscopic method can also be applied to adolescents and adults by the same team.
05

After the procedure: stent, follow-up, and when to see a doctor

After endopyelotomy, a JJ stent stays in for a few weeks and is removed with a short procedure; during the stent period, frequent urination, burning, mild bloody urine and flank pain when urinating are expected symptoms. See a doctor the same day if there's fever, severe pain, dark bloody urine, or inability to pass urine.

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  • Follow-up tracks the course of the widening and function with ultrasound and MAG3 diuretic renography when needed. With endoscopic methods, failure usually shows up within the first year, which is why check-ups are more frequent during that period.
  • If the endoscopic method fails, the door isn't closed: pyeloplasty or redo pyeloplasty can still be done, with high success. In cases with an accompanying stone, the stone can also be cleared during the endoscopic procedure — but treating the stone alone does not resolve the narrowing.
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Frequently asked questions
Does endopyelotomy replace pyeloplasty?
No. Its success, roughly 65–85%, is below pyeloplasty's (90–95%). It can be an option with a short narrowing, good function and no crossing vessel — particularly after a previous operation, or in a patient with high anesthesia risk.
Can my child's narrowing be opened with a balloon instead of an incision?
In children, the first treatment is pyeloplasty; balloon dilation and endopyelotomy are not recommended as first-line treatment. They can come up only for a short, recurrent narrowing after pyeloplasty, in selected older children and adolescents.
Why isn't endopyelotomy done if there's a crossing vessel?
The incision could injure the vessel lying next to the junction, and the narrowing would persist from the vessel's pressure, so it doesn't give a lasting result. In this situation, pyeloplasty, which preserves the vessel and moves the ureter in front of it, is preferred; the vessel is checked with MR urography beforehand.
How long does the stent stay in after endopyelotomy?
Usually a few weeks; the duration varies by center and by the narrowing's characteristics. The stent is removed with a short procedure. See a doctor the same day if there's fever, severe pain, or dark bloody urine during the stent period.
←Previous • After surgery and follow-upIf the Narrowing Comes Back: Redo Pyeloplasty
Related pagesFull index →
After surgery and follow-upIf the Narrowing Comes Back: Redo PyeloplastyPyeloplasty is a single, lasting operation for most children; but in a small group, the narrowing comes back. This page explains why recurrent UPJ obstruction happens, how it's recognized, and which options exist — redo (repeat) pyeloplasty chief among them.Pyeloplasty and approachesWhat Is Pyeloplasty? The UPJ Obstruction Surgery, Step by StepPyeloplasty is the operation that repairs the narrow junction (UPJ) between the renal pelvis and the ureter. This page explains why the operation is done, the steps from preparation to discharge, and the question families ask most: "how many surgeries are needed."By age, and special situationsRedo Pyeloplasty in AdultsPyeloplasty performed in childhood lasts a lifetime for the large majority; in a small number of people the narrowing becomes symptomatic again years later. This page explains how recurrent UPJ obstruction is evaluated in adults, and the redo (repeat) repair options.By age, and special situationsUPJ Obstruction and Kidney Stones TogetherIn UPJ obstruction, urine pooling in the renal pelvis (stasis) makes stone formation easier — and a stone can be the first sign of the narrowing. This page explains which comes first, and how the two are treated together when both problems are present.
UPJ Obstruction topic clustersMain treatment page →
Basics 7Diagnosis and evaluation 6Follow-up or surgery? 7Conservative follow-up 5Pyeloplasty and approaches 7After surgery and follow-up 6By age, and special situations 7
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