Management of failed pyeloplasty patients with recurrent pelvi-ureteric junction obstruction

Introduction: Recurrent pelvi-ureteric junction obstruction (PUJO) poses significant management challenges, and the optimal salvage procedure remains debated. This study evaluated outcomes of various salvage interventions using a structured selection algorithm and standardized objective endpoints. Methods: This prospective study included 40 patients with recurrent PUJO following previous pyeloplasty. Treatment allocation—redo pyeloplasty, endopyelotomy, ureterocalycostomy, or DJ stenting—was based on renal function, hydronephrosis grade, and intraoperative retrograde pyelogram findings including stricture length and distensibility. The primary endpoint was radiological success at ⩾3 months, defined as improvement or stabilization of drainage (T½ < 20 min) without further intervention. Secondary endpoints included symptomatic improvement, renal functional stability (change ⩾ 5 ml/min/1.73 m 2 ), and complications. Results: Redo pyeloplasty achieved the highest success rate (91.7%), followed by endopyelotomy (76.9%), DJ stenting (100% in one patient), and ureterocalycostomy (50%). Overall success was 85% (34/40). However, the differences in success among the procedures were not statistically significant ( p = 0.284). Six patients (15%) met criteria for failure. No major perioperative complications were observed. Conclusions: Salvage management of recurrent PUJO using a structured algorithm provides favorable overall success. Redo pyeloplasty demonstrated the highest success rate, although superiority over endopyelotomy did not reach statistical significance in this cohort. Larger prospective studies are needed to validate procedure selection criteria and refine individualized salvage strategies.