الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Continued good success rates of primary repair mean that secondary PUJO is a thankfully uncommon scenario for the clinician to manage. However it is important to appreciate the options that can be discussed with the patient if treatment failure occurs.
The mode of secondary intervention will be determined by individual upper tract anatomy, concurrent medical conditions, presence of symptoms, renal unit function and the modality of primary treatment.
Informed patient preference is a vital part of developing a patient centered management plan. Pragmatically, the local availability of individual techniques and the expertise of urological staff will also have an impact on the final decision.
The lack of standardized terms for treatment success and failure following primary and secondary intervention, makes clear comparisons between studies assessing different treatment modalities difficult.(109) There are no randomized controlled trials assessing different treatments in a secondary treatment context.
As experience with secondary treatment grows and further studies are published, we would agree with other authors that standardized terms would aid clinicians in assessing the literature and counseling their patients.(109,110)
The small overall numbers of secondary PUJO treatment reported in the literature makes clear conclusions difficult. However, it would appear that following primary pyeloplasty (laparoscopic or open) endopyelotomy carries a good balance of minimal co-morbidities and reasonable success rates.
Following primary endopyelotomy there is evidence to support secondary laparoscopic or open pyeloplasty as a good option. As laparoscopic pyeloplasty experience, in particular intra-corporeal suturing, continues to improve, it may be that secondary laparoscopic pyeloplasty develops a wider remit of indications in the management of secondary PUJO.
The increasing use of robotic assisted laparoscopic pyeloplasty may also be of use to surgeons attempting surgical repair of difficult secondary PUJO.
There will always be particularly challenging cases where more complex reconstruction is required. In these situations patients should be managed within a multi-disciplinary team environment and by surgeons with good experience in upper tract reconstruction.
In the present study, almost Tubeless mini-Perc laser endopyelotomy is an accepted minimally invasive procedure for failed primary treatment. Good renal function unit, stricture length less than 2 cm and absence of massive hydronephrosis are important factors for endopyelotomy outcome.
In the present study, antegrade mini-Perc endopyelotomy offers a reasonable success rate of 80% at average 1 day hospital stay,median time of 70 minutes and minimal comorbidities