Abstract
The authors have added to the considerable literature that already exists and substantiates the general effectiveness of endopyelotomy as an alternative to open pyeloplasty. The success of an endopyelotomy does not appear to change whether it is performed by a percutaneous antegrade approach or by retrograde access. Although the authors make a case for the retrograde ureteroscopic approach to endopyelotomy, the rate of success does not appear to be significantly altered from that cited in previously published reports, whether the endopyelotomy was performed under direct endoscopic visualization or with fluoroscopic guidance. A claim is made that direct ureteroscopic visualization could avoid potential bleeding secondary to blind incision into crossing vessels. However, the authors also clearly state that arterial pulsations were never visualized in the posterolateral direction, which is the recommended position for the “blind” Acucise endopyelotomy, a technique performed under fluoroscopic guidance.
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