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Retrograde Endopyelotomy and Endoureterotomy with the Acucise device is most frequently reported as the preferred minimally invasive treatment for patients with ureteropelvic junction obstruction.1 The popularity of the procedure is largely due to its simplicity, less invasive nature and greater patient tolerance. Since Applied introduced the device over a decade ago, over 35,000 Acucise procedures have been performed. A long term success rate of 81%2 for primary strictures and 100% for secondary strictures has been reported.3
The Acucise device is a balloon catheter with a thin electrosurgical cutting wire that incises the stricture. The procedure is performed under fluoroscopy and can take less than an hour. It may be completed using IV sedation or general anesthesia. At the end of the procedure, an endopyelotomy stent is left indwelling for 4-6 weeks. Most patients leave the hospital within 24 hours.
The Acucise system is packaged in one convenient kit with all of the components necessary for a successful procedure. The Applied UroWIRE® guidewire and Forté® AxP ureteral access sheath allow the surgeon to easily access the stricture site, advance the balloon for a precise and controlled incision and receive immediate feedback to confirm the incision. The Applied 7-10® endopyelotomy stent is also included to provide a comfortable scaffold for the healing ureter.
Indications:
Retrograde incision of the ureter and ureteropelvic junction (UPJ)
Contraindications:
Strictures greater than 2 centimeters in length
Mid-ureteral strictures due to risks to the underlying iliac vessels
Ureteroenteric anastomotic strictures which cross the aorta or iliac vessels
1. Kim, H. et al: Use of New Technology in Endourology and Laparoscopy by American Urologists: Internet and Postal Survey. Urology, 56:5, 2000.
2. Nadler, R.B., et al: Acucise Endopyelotomy: Assessment of Long-Term Durability. J of Urology, 156: 1094-1098, 1996.
3. Preminger, G.M., et al: A Multicenter Clinical Trial Investigating the Use of a Fluoroscopically controlled cutting balloon catheter for the management of Ureteral and Ureteropelvic Junction Obstruction. J of Urol May 1997; 1625-1629.
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