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Cassaro F, Impellizzeri P, Montalto AS, D'Antoni S, Bagnara V, Romeo C, Arena S. Comparative Outcomes of Laparoscopic, Retroperitoneoscopic, and One-Trocar-Assisted-Pyeloplasty in Pediatric Ureteropelvic Junction Obstruction: A Scoping Review of Literature. J Laparoendosc Adv Surg Tech A 2025. [PMID: 40420547 DOI: 10.1089/lap.2025.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2025] Open
Abstract
Introduction: Ureteropelvic junction obstruction (UPJO) is a common condition in pediatric urology, with various surgical techniques employed for treatment, including laparoscopic pyeloplasty (LP), retroperitoneoscopic pyeloplasty (RP), and One-Trocar-Assisted-Pyeloplasty (OTAP). This review compares intraoperative and postoperative complications, recurrence rates, and outcomes among these methods. Materials and Methods: A scoping review of the literature from 2000 to 2024 was conducted, analyzing studies on LP, RP, and OTAP in pediatric UPJO patients. We included studies in English and excluded those involving other surgical techniques and mixed adult-pediatric cases. Data extracted from eligible studies included the number of cases, patient age, operative time, complications, recurrence rates, and conversion to open surgery. Results: A review of 81 studies involving 3549 pediatric patients compared three surgical techniques: LP (2719 patients), RP (399 patients), and OTAP (476 patients). OTAP had the highest rates of minor intraoperative complications (8%) and conversions to open surgery (7.6%). LP and RP showed lower intraoperative complication rates (1.8% and 4.3%) and conversion rates (0.81% and 4.24%). Postoperative complications and recurrence rates were similar across all techniques, with OTAP having the fewest minor postoperative complications (0.8%) and the shortest surgical times (111.5 minutes). Conclusions: LP, RP, and OTAP are all effective treatments for pediatric UPJO, with comparable success rates and low recurrence rates. OTAP offers fewer minor postoperative complications in confront of LP and faster surgical times but has a higher conversion rate. LP and RP are more suitable for older patients, whereas OTAP seems to be more appropriate for younger patients.
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Affiliation(s)
- Fabiola Cassaro
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
| | - Pietro Impellizzeri
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Angela Simona Montalto
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Santi D'Antoni
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Vincenzo Bagnara
- Paediatric Surgery Unit, Polyclinic G.B. Morgagni, Catania, Italy
| | - Carmelo Romeo
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Salvatore Arena
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
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Zhao P, Wang C, Mao K, Luo Z, Li Y, Zhou G, Tan H, Liu H, Mao Y, Ma H, Shang X, Liu B. Comparative study of different surgical approaches for treatment of UPJ obstruction according to the degree/severity of hydronephrosis factor. Front Pediatr 2022; 10:966292. [PMID: 35989992 PMCID: PMC9386036 DOI: 10.3389/fped.2022.966292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the efficacy of two different surgical approaches during and after pyeloplasty according to the degree/severity of hydronephrosis factor. MATERIALS AND METHODS Sixty child patients with UPJ obstruction admitted to our hospital from August 2019 to October 2021 were collected. Patients who underwent retroperitoneal laparoscopic pyeloplasty (RPLP) were enrolled into Group A (n = 20), while those who received transperitoneal laparoscopic pyeloplasty (TLP) were selected as Group B (n = 40). Clinical parameters, including gender, age, laterality of UPJ obstruction, degree/severity of hydronephrosis, body weight, operation time, drainage tube indwelling time, complete oral feeding time, and length of hospital stay, were compared between the two groups. RESULTS All 60 child patients were operated upon successfully without conversion to open surgery. There were no statistically significant differences in gender, age, laterality of UPJ obstruction, and body weight between the two groups, while the operation time of TLP was shorter than that of RPLP, indicating a statistically significant difference (P < 0.001). The differences in complete oral feeding time, drainage tube indwelling time, and length of hospital stay were statistically significant between the two groups, and RPLP was superior to TLP in terms of postoperative recovery time (P < 0.001). A stratified comparison showed that there were no statistically significant differences in anteroposterior diameter ≤ 20 mm, while there were statistically significant differences in anteroposterior diameter >20 mm. Hydronephrosis is reviewed after 3 months of the operation, degree/severity of hydronephrosis have been reduced. CONCLUSION Both RPLP and TLP are safe and feasible in the treatment of UPJ obstruction, and their overall surgical effects are equivalent. For child patients with anteroposterior diameter ≤ 20 mm, RPLP is available, while patients with anteroposterior diameter >20 mm, TLP is recommended.
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Affiliation(s)
- Peng Zhao
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Cao Wang
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Kaiyi Mao
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhen Luo
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yingbo Li
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guangxu Zhou
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hongyang Tan
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Liu
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yucheng Mao
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hong Ma
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xianhui Shang
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Bin Liu
- Guizhou Children's Hospital, Zunyi, China.,Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Polok M, Borselle D, Toczewski K, Apoznański W, Jędrzejuk D, Patkowski D. Laparoscopic versus open pyeloplasty in children: experience of 226 cases at one centre. Arch Med Sci 2020; 16:858-862. [PMID: 32542088 PMCID: PMC7286323 DOI: 10.5114/aoms.2019.84496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/08/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of the study was to compare the efficacy of laparoscopic versus open dismembered pyeloplasty in children. MATERIAL AND METHODS Two hundred and twenty-six Anderson-Hynes pyeloplasties were performed, out of which 131 by open access (OP) and 95 by laparoscopic access (LP). Retrospective analysis of data was performed. The median follow-up was 3 years for LP patients and 6 years for OP patients (p < 0.05). RESULTS Success was achieved in 87 (91.57%) patients who had LP surgeries and in 121 (91.7%) patients who had OP (p > 0.05). Eight patients in the LP group and nine in the OP group required another surgery because of recurrent UPJO, and one patient in the OP group required a nephrectomy. The median operating time was 125 min (range: 70-225) for LP surgeries and 90 (40-200) for OP surgeries (p < 0.05). In the last 30 LP procedures, operation time decreased to a median of 95 min. Improvement in ultrasound analysis of the kidney was achieved in 89.06% of patients who had LP and 82.35% of patients who had OP. A stable or better function of the kidney in diuretic renography was achieved in 87.5% of patients in the LP group and 96.15% of patients in the OP group. CONCLUSIONS Laparoscopic and open pyeloplasty is a highly efficient procedure employed to treat UPJO in children with comparable success rates in both groups. In experienced hands, it is possible to reduce the LP operation time to that comparable to the OP group.
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Affiliation(s)
- Marcin Polok
- Department of Paediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland
- Corresponding author: Marcin Polok MD, PhD, Department of Paediatric Surgery and Urology, Medical University of Wroclaw, 52 Curie-Sklodowskiej St, 50-369 Wroclaw, Poland, Phone: +48 603 525 239, E-mail:
| | - Dominika Borselle
- Department of Paediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland
| | - Krystian Toczewski
- Department of Paediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland
| | - Wojciech Apoznański
- Department of Paediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland
| | - Diana Jędrzejuk
- Department of Endocrinology, Diabetology and Isotope Therapy, Medical University of Wroclaw, Wroclaw, Poland
| | - Dariusz Patkowski
- Department of Paediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland
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Zhang S, Li J, Li C, Xie X, Ling F, Liang Y, Liu G. Evaluation of the clinical value of retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction in infants: A single-center experience involving 22 consecutive patients. Medicine (Baltimore) 2019; 98:e17308. [PMID: 31577723 PMCID: PMC6783229 DOI: 10.1097/md.0000000000017308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Retroperitoneal laparoscopic pyeloplasty (RLP) is 1 method for treating ureteropelvic junction obstruction (UPJO) in children, but reports are more common in children than in infants younger than 2 years old. The purpose of this study was to evaluate the clinical value of RLP for infants with UPJO.From January 2015 to December 2017, a retrospective analysis of 22 infants aged 2 to 24 (11.95 ± 6.00) months with UPJO who were treated with RLP in our hospital was performed. During the same period, 14 infants who underwent conventional transperitoneal laparoscopic pyeloplasty (TLP) were compared with those who underwent RLP. Postoperative recovery and complications, including bleeding, infection, urinary leakage and anastomotic stenosis, postoperative resumption of oral feeding, postoperative hospitalization time and surgical success rate were evaluated. Drainage and function were assessed with isotope scan at 6 months and later during the yearly follow-up and by intravenous urography (IVU) and mercaptoacetyltriglycine (MAG3) renography.Both groups underwent successful surgery. The operative time in the RLP group was 88 to 205 (120.59 ± 24.59) min, and there was no significant difference compared with the TLP group (P = .767). The estimated intraoperative blood loss was 2 to 10 (3.75 ± 1.59) ml, which was not significantly different between the 2 groups (P = .386). In the RLP group, the mean postoperative resumption of oral feeding was faster than that in the TLP group (3.55 ± 0.74 vs 5.50 ± 0.85 hour, P < .001), and the postoperative hospitalization time was shorter in the TLP group than in the RLP group (6.59 ± 0.50 vs 7.07 ± 0.47 day, P = .007 < .05). Follow-up lasted from 6 months to 3 years, and there was a significant reduction in postoperative hydronephrosis in both groups (P < .05, respectively).RLP is a safe procedure for infants. This procedure is associated with relatively little trauma, a quick recovery and good cosmetic effects. RLP also has the advantages of relatively little interference with the abdominal cavity and sufficient operating space; thus, this technique is worth promoting.
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Lombardo R, Martos R, Ribal MJ, Alcaraz A, Tubaro A, De Nunzio C. Retroperitoneoscopy in urology: a systematic review. MINERVA UROL NEFROL 2019; 71:9-16. [PMID: 30607927 DOI: 10.23736/s0393-2249.18.03235-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In the past years, several authors have focused on the role of retroperitoneoscopic laparoscopy in the treatment of urological diseases. Aim of our study is to systematically review the available literature on retro-peritoneoscopic laparoscopy in urology. EVIDENCE ACQUISITION A systematic review of the literature using the Medline, Scopus, and Web of Science databases for relevant articles published until June 2018 was performed using both the Medical Subjects Heading and free test protocols. The MeSH search was conducted by combining the following terms: "retroperitoneoscopy," "posterior laparoscopy," "retroperitoneoscopic." Only randomized clinical trials were included in the analysis. Risk of bias assessment and forest plots were used to summarize data. EVIDENCE SYNTHESIS Nine RCTs on simple, partial and radical nephrectomy, pyeloplasty, ureterolithotomy and nephrolithotomy comparing RP to other techniques were included in the analysis. Retroperitoneoscopic approach in simple or radical nephrectomy is to be considered a valid alternative to transperitoneal laparoscopic approach. Outcomes and safety profiles (6-8% conversion rate) are similar and the approach depends on surgeon's preferences. Randomized studies analyzing retroperitoneoscopic pyeloplasty showed better results in terms of perioperative morbidity (tramadol use: 147 vs. 179 mg, P=0.002) and return to normal activities when compared to either anterior laparoscopic either to minimally invasive open approach. Two randomized studies have confirmed the efficacy (stone-free rate: 94%) and safety (no Clavien-Dindo >II complications) of ureterolithotomy and nephrolithotomy (stone-free rate: 95%) in the management of large renal and ureteral stones. CONCLUSIONS Retroperitoneoscopic approach in urological diseases is a valid alternative to the anterior approach. Evidence suggest lower morbidity for the retroperitoneoscopic approach however technical complexity may limit its widespread.
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Affiliation(s)
- Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy -
| | - Raul Martos
- Department of Urology, Hospital Clínic, Barcelona, Spain
| | - Maria J Ribal
- Department of Urology, Hospital Clínic, Barcelona, Spain
| | | | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Cerulo M, Escolino M, Turrà F, Roberti A, Farina A, Esposito C. Benefits of Retroperitoneoscopic Surgery in Pediatric Urology. Curr Urol Rep 2018; 19:33. [DOI: 10.1007/s11934-018-0777-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Prospective evaluation of retroperitoneal laparoscopic pyeloplasty in children in the first 2 years of life: Is age a risk factor for conversion? J Pediatr Urol 2017; 13:511.e1-511.e4. [PMID: 28483468 DOI: 10.1016/j.jpurol.2017.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 03/22/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Laparoscopic pyeloplasty in children has stood the test of time. A clear advantage of laparoscopic pyeloplasty over open pyeloplasty has been proven both by retrospective and prospective trials. The aim of the current study was to address, in a prospective design, the outcomes, safety, conversion rates and risk factors for conversion in children aged <2 years who underwent retroperitonoscopic pyeloplasty by a single surgeon. PATIENTS AND METHODS In the period April 2014 to May 2016, 15 children with a median age of 6 months (range 1-24) and ureteropelvic junction (UPJ) obstruction were operated by a single surgeon using retroperitonoscopic pyeloplasty with antegrade renal stenting. The position and sites of tracers are shown in the figure. RESULTS With a median follow-up of 6 months, there were no recurrent cases of UPJO; one child had postoperative complications and recovered conservatively; median hospital stay was 1 day (range 1-7); and conversion to open pyeloplasty was encountered in three children (20%) aged <3 months. A statistically significant difference between laparoscopic and converted cases was present concerning the age (P = 0.048); neither gender nor side was significantly different. DISCUSSION Laparoscopic pyeloplasty in young children has been reported in many retrospective trials. Retroperitonoscopic pyeloplasty in young children has not been reported in prospectively designed studies to address safety and outcome. The current study reported experience in young children, defining the age category <3 months as a high-risk group for conversion to open surgery, but not to higher incidence of complications. CONCLUSION Retroperitonoscopic pyeloplasty in children aged <2 years is feasible, safe and successful. High conversion rates to open pyeloplasty have to be expected in children aged <3 months.
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Liu D, Zhou H, Ma L, Zhou X, Cao H, Tao T, Luo X, Chen S. Comparison of Laparoscopic Approaches for Dismembered Pyeloplasty in Children With Ureteropelvic Junction Obstruction: Critical Analysis of 11-Year Experiences in a Single Surgeon. Urology 2016; 101:50-55. [PMID: 27765585 DOI: 10.1016/j.urology.2016.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The choice of different laparoscopic approaches of laparoscopic pyeloplasty (LP) in children remains controversial. We present a comparison of different approaches of LP in children and a critical analysis of 11-year experiences in a single surgeon. MATERIALS AND METHODS There were 1750 patients (1889 sides) who underwent LP between 2003 and 2014 reviewed. The diagnosis and outcomes of ureteropelvic junction obstruction (UPJO) were reviewed based on clinical and imaging data. Retroperitoneal laparoscopic pyeloplasty (RPLP) were performed in 451 cases (RPLP group), conventional transperitoneal laparoscopic pyeloplasty (CTLP) were performed in 311 cases (CTLP group), transumbilical single-site laparoscopic pyeloplasty (TSLP) were performed in 322 cases (TSLP group), and transumbilical multiport laparoscopic pyeloplasty (TMLP) were performed in 805 cases (TMLP group). We assessed preoperative clinical data and outcomes, and analyzed the transition experience. Data are expressed as medians for continuous variables. RESULTS The start of oral feeding, hospital stay, and the operative time of RPLP group were 1.10 ± 0.10 days, 5.22 ± 1.32 days, and 138.2 ± 20.1 minutes, respectively. Compared with the other 3 groups, the start of oral feeding was the soonest, hospital stay was the shortest, and the operative time was the longest in the RPLP group (P < .01 or .05). The cosmetic result of the TMLP group was 7.07 ± 1.20 scores, and there are significant differences in cosmetic results between the TMLP group and the other 3 groups (P < .05). CONCLUSION Although the 4 laparoscopic approaches for LP in children with UPJO are safe and efficient procedures with equivalent success rates, we recommend RPLP or TMLP as a treatment option for children with UPJO.
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Affiliation(s)
- Dehong Liu
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| | - Huixia Zhou
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China.
| | - Lifei Ma
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| | - Xiaoguang Zhou
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| | - Hualin Cao
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| | - Tian Tao
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| | - Xiaolong Luo
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
| | - Shaojun Chen
- Department of Pediatric Urology, Bayi Children's Hospital, PLA Army General Hospital (formerly The Military General Hospital of Beijing PLA), Beijing, China
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Kumar M, Singh SK, Arora S, Mittal V, Patidar N, Sureka SK, Ansari MS. Follow-up imaging after pediatric pyeloplasty. Indian J Urol 2016; 32:221-6. [PMID: 27555681 PMCID: PMC4970394 DOI: 10.4103/0970-1591.185090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: The duration, methods and frequency of radiographic follow-up after pediatric pyeloplasty is not well-defined. We prospectively evaluated a cohort of children undergoing pyeloplasty to determine the method for follow-up. Methods: Between 2000 and 2008, children undergoing pyeloplasty for unilateral ureteropelvic junction obstruction were evaluated for this study. All patients were evaluated preoperatively with protocol ultrasound (USG) and diuretic renal scan (RS). On the basis of preoperative split renal function (SRF), these patients were divided into four groups – Group I: SRF > 40%, Group II: SRF 30–39%, Group III: SRF 20–29%, and Group IV: SRF 10–19%. In follow-up, USG and RS were done at 3 months and repeated at 6 months, 1 year, and then yearly after surgery for a minimum period of 5 years. Improvement, stability, or worsening of hydronephrosis was based on the changes in anteroposterior (AP) diameter of pelvis and caliectasis on USG. Absolute increase in split renal function (SRF) >5% was considered significant. Failure was defined as increase in AP diameter of pelvis and decrease in cortical thickness on 3 consecutive USG, t½ >20 min with obstructive drainage on RS and/or symptomatic patient. Results: 145 children were included in the study. Their mean age was 3.26 years and mean follow-up was 7.5 years. Pre- and post-operative SRF remain unchanged within 5% range in 35 of 41 patients (85%) in Group I. While 9 of 20 patients (45%) in Group II, 23 of 50 patients (46%) in Group III, and 14 of 34 patients (41%) in Group IV exhibited changes >5% after surgery. 5 patients failed, 2 in Group III, and 3 in Group IV. None of the patients deteriorated in Group I and II. Conclusion: After pyeloplasty in children with a baseline split GFR >30%, if a diuretic renogram and USG performed 3 months postoperatively shows nonobstructive drainage with t½ <20 min and decreased hydronephrosis, no further follow-up is required.
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Affiliation(s)
- Manoj Kumar
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjeet Kumar Singh
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sohrab Arora
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Varun Mittal
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nitesh Patidar
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M S Ansari
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Adam A, Smith GHH. Anderson-Hynes pyeloplasty: are we all really on the same page? ANZ J Surg 2015; 86:143-7. [DOI: 10.1111/ans.13114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Ahmed Adam
- Department of Paediatric Urology; Sydney Children's Hospital Network; Sydney New South Wales Australia
| | - Grahame H. H. Smith
- Department of Paediatric Urology; Sydney Children's Hospital Network; Sydney New South Wales Australia
- Department of Paediatric Urology; Children's Hospital at Westmead; Sydney New South Wales Australia
- Department of Paediatrics and Child health; The University of Sydney; Sydney New South Wales Australia
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11
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Hsi RS, Holt SK, Gore JL, Lendvay TS, Harper JD. National Trends in Followup Imaging after Pyeloplasty in Children in the United States. J Urol 2015; 194:777-82. [PMID: 25868576 DOI: 10.1016/j.juro.2015.03.123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Radiographic followup after pyeloplasty for the correction of ureteropelvic junction obstruction is not well defined in children. We characterize trends in frequency and modality of postoperative imaging after open and minimally invasive pediatric pyeloplasty. MATERIALS AND METHODS Using the MarketScan® database, we identified patients 0 to 18 years old undergoing pyeloplasty between 2007 and 2013. Followup imaging was classified as functional (diuretic renography, excretory urography) or nonfunctional (ultrasound, computerized tomography, magnetic resonance imaging). We excluded patients with less than 24 months of postoperative enrollment in MarketScan. Multivariate logistic regression was performed to determine associations between demographic variables and imaging use patterns. RESULTS We identified 926 patients with a mean ± SD followup of 3.6 ± 1.3 years, of whom 30% underwent minimally invasive pyeloplasty. Overall 5.9% of patients had no postoperative imaging available. Within the first 6 months postoperatively 853 patients (91%) underwent at least 1 imaging study and 192 (24%) underwent renography. Within the first 12 months postoperatively 91% of patients underwent at least 1 imaging study, most commonly ultrasound. After 12 months almost a third of the patients were not followed with imaging. Of the 71% undergoing imaging most underwent ultrasound. Younger age and female gender were independently associated with frequent imaging (at least yearly) on multivariate logistic regression. CONCLUSIONS Following pediatric pyeloplasty there is variation in modality and frequency of imaging followup. The majority of patients are followed with renal ultrasound, with less frequent use of functional imaging. Almost a third of patients do not undergo followup imaging after 1 year.
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Affiliation(s)
- Ryan S Hsi
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington.
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
| | - John L Gore
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
| | - Thomas S Lendvay
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
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Zhou H, Ming S, Ma L, Wang C, Liu X, Zhou X, Xie H, Tao T, Ma S, Cheng W. Transumbilical single-incision laparoscopic versus conventional laparoscopic upper pole heminephroureterectomy for children with duplex kidney: a retrospective comparative study. Urology 2014; 84:1199-204. [PMID: 25443934 DOI: 10.1016/j.urology.2014.07.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 07/13/2014] [Accepted: 07/22/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To present our experience regarding transumbilical single-incision laparoscopic heminephroureterectomy (SILH) in children with duplex kidney anomalies, and to investigate its feasibility and safety compared with those of conventional laparoscopic heminephroureterectomy (CLH). MATERIALS AND METHODS A matched-pair study comparing 34 SILHs and 34 CLHs performed by a single surgeon from 2007 to 2013 was presented. All SILHs were performed through a 2-cm periumbilical incision by using the port-access system, whereas CLH cases were performed via a transperitoneal 3-port approach. The groups were matched for age, gender, weight, laterality, and surgical indication of the patients. Data including demographics and perioperative and short-term outcomes of the patients were retrospectively compared. RESULTS The 2 groups were comparable in demographics, and surgical indications of the patients (P >.05). No significant difference was observed between SILH and CLH cases in terms of median operative time (105 vs 97 minutes; P = .06), estimated blood loss (22 vs 25 mL; P = .91), interval for oral intake (12 vs 12 hours; P = .69), analgesic requirement (9 vs 6 cases; P = .38), transfusion rate (0% for both; P = 1.00), complication rate (2.9% vs 0%; P = 1.00), postoperative hospital stay (5.0 vs 4.5 days; P = .59), and renal functional loss of the operated side at 3 months after surgery (5.4% vs 5.2%; P = .60). CONCLUSION SILH is feasible and safe in the hands of an experienced pediatric laparoscopic surgeon. Although the outcomes were comparable, better subjective cosmetic results of SILH were achieved.
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Affiliation(s)
- Huixia Zhou
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China.
| | - Shaoxiong Ming
- The Second Military Medical University, Shanghai, People's Republic of China
| | - Lifei Ma
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Chao Wang
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Xin Liu
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Xiaoguang Zhou
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Huawei Xie
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Tian Tao
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Sichao Ma
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Wei Cheng
- Department of Paediatrics, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia; Department of Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia; Department of Surgery, Beijing United Family Hospital, Beijing, People's Republic of China
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Zhou H, Liu X, Xie H, Ma L, Zhou X, Tao T, Ma S, Cheng W. Early experience of using transumbilical multi-stab laparoscopic pyeloplasty for infants younger than 3 months. J Pediatr Urol 2014; 10:854-8. [PMID: 24636485 DOI: 10.1016/j.jpurol.2013.12.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Minimally invasive surgery is increasingly being adopted in pediatric urology practice. The aim of this study is to investigate the feasibility and the safety of transumbilical multi-stab laparoscopic pyeloplasty (TMLP) as a treatment for infants younger than 3 months with severe hydronephrosis. METHODS We retrospectively reviewed 63 infants younger than 3 months with severe hydronephrosis who underwent TMLP from June 2010 to March 2013. The operative indications included: 1) prenatal diagnosis of hydronephrosis with anteroposterior renal pelvic diameter greater than 3 cm and Society of Fetal Urology (SFU) Grade 4 hydronephrosis; 2) ipsilateral differential renal function being less than 40%. Patients were followed up with physical examinations, ultrasound and radionuclide scans. RESULTS The operations were successfully performed in all 63 patients. There was no conversion, no requirement of additional trocar placement and no intraoperative complication. The median age was 54 (47-87) days. The median operative time was 75 (53-118) minutes. The patients were followed up for 12 (6-36) months. The anastomoses were proved to be patent and the renal parenchymal thickness increased. The renal pelvic anteroposterior diameters were reduced and the renal functions were improved (p < 0.01). In addition, the scars were barely noticeable. CONCLUSIONS TMLP for infants younger than 3 months with severe hydronephrosis is feasible, safe and minimally invasive. The cosmetic results are excellent.
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Affiliation(s)
- Huixia Zhou
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China.
| | - Xin Liu
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China; Medical School, Nankai University, Tianjin, People's Republic of China
| | - Huawei Xie
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Lifei Ma
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Xiaoguang Zhou
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Tian Tao
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Sichao Ma
- Department of Urology, Bayi Children's Hospital Affiliated to Beijing Military Region General Hospital, Beijing, People's Republic of China
| | - Wei Cheng
- Department of Pediatrics and Surgery, Southern Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
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Huang SY, Yeh CM, Chou CM, Chen HC. Hybrid procedure for pyeloplasty in infants and young children with ureteropelvic junction obstruction is a safe and effective alternative. FORMOSAN JOURNAL OF SURGERY 2014. [DOI: 10.1016/j.fjs.2013.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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15
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Autorino R, Eden C, El-Ghoneimi A, Guazzoni G, Buffi N, Peters CA, Stein RJ, Gettman M. Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis. Eur Urol 2013; 65:430-52. [PMID: 23856037 DOI: 10.1016/j.eururo.2013.06.053] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/26/2013] [Indexed: 12/15/2022]
Abstract
CONTEXT Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized. OBJECTIVE To critically analyze the current status of laparoscopic and robotic repair of UPJO. EVIDENCE ACQUISITION A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. EVIDENCE SYNTHESIS Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population. CONCLUSIONS Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.
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Affiliation(s)
- Riccardo Autorino
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Service, Second University of Naples, Naples, Italy.
| | - Christopher Eden
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Hôpital Robert Debré, Assistance Publique-Hopitaux de Paris, University of Paris Diderot, Paris, France
| | - Giorgio Guazzoni
- Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy
| | - Nicolòmaria Buffi
- Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy
| | - Craig A Peters
- Department of Pediatric Surgery, Children's National Medical Center, Washington, DC, USA
| | - Robert J Stein
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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van der Toorn F, van den Hoek J, Wolffenbuttel KP, Scheepe JR. Laparoscopic transperitoneal pyeloplasty in children from age of 3 years: our clinical outcomes compared with open surgery. J Pediatr Urol 2013; 9:161-8. [PMID: 22321813 DOI: 10.1016/j.jpurol.2012.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 01/09/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report clinical outcomes for laparoscopic pyeloplasty (LP) in children compared with open pyeloplasty (OP) and literature findings. PATIENTS AND METHODS In a prospective study, the outcomes of 57 consecutive transperitoneal LP in children from the age of 3 years were analyzed and compared with a matched historic control group of OP and with series of LP in the literature. Successful result was defined as resolution of symptoms, no conversion or re-operation, improved hydronephrosis, and/or improved renographic drainage. RESULTS Mean operative time was 177 (SD 50.5)min in the LP group and 108 (SD 25.6)min in the OP group (p < 0.001). Mean hospital stay was 1.2 (SD 0.46) days in the LP and 6.7 (SD 1.2) days in the OP group. Improvement in renographic drainage was observed more often after LP than after OP (98% vs 83%; p = 0.010). A successful result was reported in 56 (98%) LP and 54 (95%) OP (p = 0.298) patients. Our LP series demonstrates a high success rate compared to literature data. CONCLUSIONS Our LP has a similar success rate and more often improved renographic drainage in comparison to OP. Furthermore, our LP demonstrates a shorter hospital stay and favorable outcomes compared to the literature. We thus regard LP as standard treatment for repair of ureteropelvic junction obstruction in children from the age of 3 years.
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Affiliation(s)
- Fred van der Toorn
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC Rotterdam, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
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Transumbilical laparoendoscopic single-site pyeloplasty in infants and children: initial experience and short-term outcome. Pediatr Surg Int 2012; 28:321-5. [PMID: 22205576 DOI: 10.1007/s00383-011-3040-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2011] [Indexed: 10/25/2022]
Abstract
BACKGROUND Scar-free abdominal wall surgery is a research hotspot in recent years. This study presented surgical skills of transumbilical laparoendoscopic single-site pyeloplasty (LESS-P) for pediatric patients with ureteropelvic junction obstruction (UPJO) and its clinical application. METHODS Twenty-four pediatric patients with UPJO had transumbilical LESS-P performed by the same surgeon from June to December 2010. Among them, 16 were males and 8 females aged from 2 to 62 months with average of 14 months. Eighteen patients had obstruction on the left ureteropelvic junction and six on the right. The renal pelvis and ureter were anastomosed using 5-0 absorbable sutures and a double-J ureteric stent was placed through the anastomotic stoma. RESULTS All operations were successful. None was converted to open surgery and no additional sheath tube or incision besides umbilicus was needed. No intraoperative complications occurred. Ectopic blood vessels were found in two cases during surgery. The mean operative time was 145 min, and the average blood loss about 10 ml. Abdominal drainage tubes were remained for 2-9 days after surgery. The mean postoperative hospital time was 7 days. Two patients had postoperative urinary fistula, which naturally disappeared at 4 and 7 days of postoperation, respectively. Ultrasound and diuretic renal scintigraphy in follow-up found 23 patients had significantly decreased renal pelvis diameter. Although the other one showed no obvious change, but diuretic renography showed significantly improved excretion as indicated by increased glomerular filtration rate from 29 ml/min before surgery to 46 ml/min 6 months after surgery. CONCLUSION Pediatric transumbilical LESS-P is not only safe and effective but also can well meet patient's aesthetic desire for scar-free abdominal wall.
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Experience with retroperitoneoscopy in pediatric surgical oncology. Surg Endosc 2011; 25:2748-55. [DOI: 10.1007/s00464-011-1583-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 12/28/2010] [Indexed: 10/18/2022]
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