1
|
Zhu XJ, Huang LQ, Liu S, Dong J, Zhu HB, Chen CJ, Wang LX, Guo YF, Deng YJ, Lu RG. Comparison of proximal and distal laparoscopic ureteroureterostomy for complete duplex kidneys in children. Int Urol Nephrol 2024:10.1007/s11255-024-04108-3. [PMID: 38861105 DOI: 10.1007/s11255-024-04108-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/03/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE To compare efficacy of proximal and distal laparoscopic ureteroureterostomy (UU) for complete duplex kidneys in children. METHODS Patients who underwent laparoscopic UU for complete duplex kidneys between December 2016 and July 2022 were reviewed retrospectively. 71 patients who had normal lower pole moiety without vesicoureteral reflux (VUR) were recruited. All of them underwent ultrasound, voiding cystourethrography (VCUG), renal scintigraphy, and magnetic resonance urography preoperatively. Proximal laparoscopic UU was performed in 35 patients and distal laparoscopic UU in 36 patients. Double J stents were placed in normal lower pole moieties. Clinical data, including general information, diagnosis, surgical management, imaging characteristics, clinical symptoms and postoperative complications (classified according to the modified Clavien-Dindo classification), and length of stay were recorded. Measurement date comparisons between groups were performed by t test, counting date were analyzed by chi-square test. RESULTS The study consisted of 71 patients (56 females and 15 males) with complete duplex kidneys (41 in left kidney and 30 in right kidney). The patients' mean age was 34 m (range 3-161 m) and follow-up ranged from 25 to 81 m. No significant difference was found in age and follow-up time between the two groups. Laparoscopic UU was performed in all patients successfully. The operation time of the two groups was 108.42 ± 26.95 min for distal UU vs 121.46 ± 35.15 min for proximal UU(p = 0.14). No significant difference in postoperative complications was seen between the two groups (22.2% vs 31.4%, p = 0.345). However, in terms of the grading of postoperative complications, the proximal UU group had a higher grade (3 of them had a grade of IV) and more serious complications. CONCLUSIONS There was no significant difference in the overall incidence of complications between distal and proximal UU. Compared with proximal laparoscopic UU, distal laparoscopic UU is easier to perform with less injury to the peripheral tissues. Postoperative complications of proximal UU are more serious and more difficult to manage. We recommend complete duplex kidney ureteral reconstruction with distal UU.
Collapse
Affiliation(s)
- Xiao-Jiang Zhu
- Department of Urology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Li-Qu Huang
- Department of Urology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Saisai Liu
- Department of Urology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Jun Dong
- Department of Urology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Hao-Bo Zhu
- Department of Urology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Chen-Jun Chen
- Department of Urology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Li-Xia Wang
- Department of Urology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Yun-Fei Guo
- Department of Urology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China
| | - Yong-Ji Deng
- Department of Urology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
| | - Ru-Gang Lu
- Department of Urology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
| |
Collapse
|
2
|
Kim JS, Shalaby-Rana E, Krill A, Pohl H, Majd M. Hydronephrotic lower moiety of duplex systems: Observations using diuresis renography. Clin Imaging 2024; 109:110138. [PMID: 38579501 DOI: 10.1016/j.clinimag.2024.110138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE The purpose of this study is to characterize the prevalence and behavior of hydronephrosis of non-refluxing lower moiety of duplex kidneys using MAG-3 diuresis renography. We compare our data to previous case series and ureteropelvic junction obstruction of single systems. MATERIALS AND METHODS An IRB-approved database of over 5000 diuresis renograms performed in 2025 patients was queried to identify cases of hydronephrosis of lower moiety of duplex kidneys suspicious for ureteropelvic obstruction, excluding those with hydroureter or reflux. Kidney function and post-furosemide drainage parameters on initial and follow-up diuresis renograms were recorded. Medical records and patient outcomes were reviewed. RESULTS In total, 19 renal units were identified in 18 patients (11 male, 7 female), age range 0.5 months to 17.8 years, including one patient with bilateral lower moiety hydronephrosis. Initial diuresis renograms in 12 asymptomatic patients (13 renal units) with antenatal hydronephrosis demonstrated varying drainage patterns from normal to obstructed. Follow-up studies showed worsening drainage in 3 patients, who all underwent surgery. Drainage improved in 4 patients and remained unchanged in 5 patients (6 renal units). Of the 6 patients presenting with Dietl's crisis, 5 showed obstructive drainage on initial diuresis renogram, 2/5 with decreased function. All 5 obstructed patients underwent surgery. CONCLUSION Hydronephrosis of the lower moiety of a duplex system is rare and behaves similarly to single systems. The majority are diagnosed antenatally, display a dynamic nature, and may present with acute obstruction. Diuresis renography is a valuable tool in its evaluation and management.
Collapse
Affiliation(s)
- Jane S Kim
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America.
| | - Eglal Shalaby-Rana
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America.
| | - Aaron Krill
- Division of Urology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America.
| | - Hans Pohl
- Division of Urology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America.
| | - Massoud Majd
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America
| |
Collapse
|
3
|
Alsaikhan B, Abugamza F, Almuhanna A, Bakarmom M, Alhussaini S, Hajek D. Duplex Kidney in Adults: a Systematic Review of the Literature. Curr Urol Rep 2023; 24:591-600. [PMID: 37943428 DOI: 10.1007/s11934-023-01190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE OF REVIEW In this study, we describe a rare case of a male with a duplex renal collecting system with ectopic ureter insertion into the prostate who presented with sepsis and required urgent laparoscopic radical nephrectomy. This study offers urologists and emergency care practitioners a great overview of the variety of manifestations, anatomic differences, and therapeutic approaches for similar patients. RECENT FINDINGS modified reconstructive strategy could be a method of choice when addressing particular anatomies, such as incomplete duplex kidneys with ureteropelvic junction obstruction in both upper and lower poles when the obstruction is close to the confluence of the two ureters. There is a spectrum of acute presentations and management strategies in adult patients with duplex collecting systems. The majority of patients presenting with obstruction and infection are managed surgically with hemi-nephrectomy; stable patients who present with less extensive anomalies were managed conservatively or with ureteral dilatation or deroofing.
Collapse
Affiliation(s)
- Bader Alsaikhan
- Division of Urology, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Faisal Abugamza
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali Almuhanna
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Bakarmom
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saleh Alhussaini
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - David Hajek
- Division of Urology, Department of Surgery, North York General Hospital, Toronto, ON, Canada
| |
Collapse
|
4
|
Ujkic L, Haeffner K, Praus F, Pohl M, Pohlmann PF, Kroenig M, Frankenschmidt A, Gratzke C, Schoenthaler M. Personalized Surgical Management Offers Full Restitution and Unimpaired Quality of Life to Patients with Duplex Kidneys and Associated Pathologies: 30-year Follow-up at a Tertiary Referral Center. EUR UROL SUPPL 2023; 57:106-112. [PMID: 38020523 PMCID: PMC10658413 DOI: 10.1016/j.euros.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Duplex kidneys may be associated with additional pathologies with an indication for surgery. Various surgical approaches have been described. However, little is known about long-term outcomes and quality of life (QoL) for these patients. Objective To present long-term outcomes and QoL data up to 30 yr after surgical treatment of duplex kidneys and associated pathologies. Design setting and participants We collected clinical and operative data for all patients who underwent surgery for complicated duplex kidney at our institution from 1990 to 2018. All patients were invited for a follow-up examination or telephone interview. Outcome measurements and statistical analysis We evaluated renal function, clinical outcomes, residual dilation of the upper urinary tract, and health-related QoL. Results and limitations Of the 176 patients included, 173 were available for follow-up (mean 140.5 mo). Surgical treatment involved an upper-tract, lower-tract, or combined approach in 11%, 56%, and 33% of cases, respectively. Rates of perioperative complications (8%) and secondary surgery (10%) were low. Overall, 95% of our patients achieved full restitution. Renal function was preserved in all cases, with recurrent urinary tract infections reported by just 2% and urinary incontinence by 1%. Good health-related QoL was reported by 98% of patients. Those without full restitution included six patients who underwent total nephrectomy and two boys who underwent multiple surgeries and urinary diversion. Our results are limited by their retrospective nature, including partly incomplete data sets. Conclusions Management of duplex kidneys and associated pathologies is complex and highly individual. By planning a personal approach for each patient it is possible to achieve full bodily integrity and good QoL for most of these patients. Patient summary Almost all patients undergoing surgery for duplex kidneys and associated pathologies will lead a life without body impairment and good quality of life.This trial is registered in the German Clinical Trials Register as DRKS00022542.
Collapse
Affiliation(s)
- Lidija Ujkic
- Department of Urology, University of Freiburg Medical Center, Freiburg, Germany
| | - Karsten Haeffner
- Department of Pediatric Nephrology, University of Freiburg Medical Center, Freiburg, Germany
| | - Friederike Praus
- Department of Urology, University of Freiburg Medical Center, Freiburg, Germany
| | - Martin Pohl
- Department of Pediatric Nephrology, University of Freiburg Medical Center, Freiburg, Germany
| | | | - Malte Kroenig
- Department of Pediatric Surgery, Altona Children’s Hospital, Hamburg, Germany
| | | | - Christian Gratzke
- Department of Urology, University of Freiburg Medical Center, Freiburg, Germany
| | - Martin Schoenthaler
- Department of Urology, University of Freiburg Medical Center, Freiburg, Germany
| |
Collapse
|
5
|
Nishio H, Mizuno K, Matsumoto D, Tozawa K, Yasui T, Hayashi Y. Combination of robot-assisted laparoscopic pyeloplasty for lower moiety ureteropelvic junction obstruction in a partial duplex system and percutaneous endoscopic surgery for renal calculi reusing the port for robotic pyeloplasty. IJU Case Rep 2023; 6:390-393. [PMID: 37928294 PMCID: PMC10622201 DOI: 10.1002/iju5.12630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/19/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Ureteropelvic junction obstruction is often associated with renal calculus formation. However, there is no report of using robot-assisted laparoscopic pyeloplasty combined with percutaneous endoscopic surgery for ureteropelvic junction obstruction and renal calculi in a partial duplex system. Case presentation A 19-year-old female patient with lower moiety ureteropelvic junction obstruction and renal calculi in a partial duplex system was referred to our hospital because of left lumbar pain, left acute pyelonephritis, and an increase in left renal calculi during follow-up at the referral hospital. To prevent the complication of percutaneous nephrolithotripsy following pyeloplasty, robot-assisted laparoscopic pyeloplasty combined with percutaneous endoscopic surgery was performed. Two years after surgery, the patient reported no left lumbar pain. Conclusion The combination of robot-assisted laparoscopic pyeloplasty and percutaneous endoscopic surgery can be proposed as a safe and less-invasive treatment option for ureteropelvic junction obstruction and renal calculi in a partial duplex system.
Collapse
Affiliation(s)
- Hidenori Nishio
- Department of Pediatric UrologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Kentaro Mizuno
- Department of Pediatric UrologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Daisuke Matsumoto
- Department of Nephro‐UrologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Keiichi Tozawa
- Department of Medical Safety ManagementNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Takahiro Yasui
- Department of Nephro‐UrologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Yutaro Hayashi
- Department of Pediatric UrologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| |
Collapse
|
6
|
Wang SB, Wan L, Wang Y, Yi ZJ, Xiao C, Cao JZ, Liu XY, Tang RP, Luo Y. Laparoscopic treatment of bilateral duplex kidney and ectopic ureter: A case report. World J Clin Cases 2022; 10:8344-8351. [PMID: 36159542 PMCID: PMC9403705 DOI: 10.12998/wjcc.v10.i23.8344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/26/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Duplication of the renal pelvis is a common congenital malformation of the urinary system. About one-third of cases are complete unilateral duplication of the renal pelvis, while bilateral duplication is extremely rare. Herein, we described a single case of bilateral renal duplication with double ureteral orifice ectopic vaginal fistula treated with laparoscopy.
CASE SUMMARY A 6-year-old girl suffering from long-term vaginal leakage was admitted on June 10, 2018. She was diagnosed with complete duplication of both kidneys and ureters and ectopic opening of both ureters combined with ureterovaginal fistula. The patient received laparoscopic ectopic ureteral bladder replantation and was followed up for 2 years. No renal function damage and vaginal leakage were found.
CONCLUSION Laparoscopic bladder-ureter reimplantation could effectively determine the location and number of ectopic ureters by imaging and cystoscopy.
Collapse
Affiliation(s)
- Shu-Bin Wang
- Department of Urology, Pangang Group General Hospital, Panzhihua 617099, Sichuan Province, China
| | - Li Wan
- Department of Urology, Pangang Group General Hospital, Panzhihua 617099, Sichuan Province, China
| | - Yong Wang
- Department of Urology, Pangang Group General Hospital, Panzhihua 617099, Sichuan Province, China
| | - Zheng-Jin Yi
- Department of Urology, Pangang Group General Hospital, Panzhihua 617099, Sichuan Province, China
| | - Chuan Xiao
- Department of Urology, Pangang Group General Hospital, Panzhihua 617099, Sichuan Province, China
| | - Jing-Zhao Cao
- Department of Urology, Pangang Group General Hospital, Panzhihua 617099, Sichuan Province, China
| | - Xiang-Yu Liu
- Department of Urology, Pangang Group General Hospital, Panzhihua 617099, Sichuan Province, China
| | - Rui-Peng Tang
- Department of Urology, Pangang Group General Hospital, Panzhihua 617099, Sichuan Province, China
| | - Yun Luo
- Department of Urology, Pangang Group General Hospital, Panzhihua 617099, Sichuan Province, China
| |
Collapse
|
7
|
Deeg KH. Sonographic differential diagnosis of duplex kidneys. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:332-353. [PMID: 35488089 DOI: 10.1055/a-1749-5136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Duplex kidneys have two renal pelvises and two ureters, which can join on the way to the urinary bladder but can also enter the bladder separately. A distinction must be made between normal and pathological duplex kidneys. In normal duplex kidneys, both renal pelvises are normal in width, and the upper and lower poles are approximately the same size. Furthermore, ureters are not dilated, and the upper and lower poles of the kidneys are not cystically altered. In contrast, pathological duplex kidneys, occurring in about 50 % of cases, are characterized by dilation of one or both renal pelvises. Additionally, one or both ureters may be dilated. Megaureters may be obstructive or refluxive. If a megaureter is present, a ureterocele must be ruled out, as well as an ectopically opening ureter. A pathological duplex kidney must always be assumed if one pole of the kidney is hypoplastic. Hypoplasia of the upper renal pole is often associated with an obstructive megaureter. Vesicoureteral reflux into the lower pyelon is common in hypoplasia of the lower pole. In the presence of vesicoureteral reflux, the associated (lower) pyelon is dilated when the bladder is full or during micturition. In addition, there is a dilated ureter. On the other hand, the pyelon can have a normal width when the bladder is empty. In rare cases, one pole may be cystically altered in pathological duplex kidneys. In this instance, segmental multicystic dysplastic duplex kidney must be differentiated from segmental multicystic nephroma.
Collapse
Affiliation(s)
- Karl-Heinz Deeg
- Pediatric Clinic, University of Erlangen/Nuremberg, Erlangen, Germany
| |
Collapse
|
8
|
Zhu W, Xiong S, Xu C, Zhu Z, Li Z, Zhang L, Guan H, Huang Y, Zhang P, Zhu H, Lin J, Li X, Zhou L. Initial experiences with preoperative three-dimensional image reconstruction technology in laparoscopic pyeloplasty for ureteropelvic junction obstruction. Transl Androl Urol 2022; 10:4142-4151. [PMID: 34984180 PMCID: PMC8661249 DOI: 10.21037/tau-21-590] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/28/2021] [Indexed: 11/06/2022] Open
Abstract
Background To explore the clinical value of three-dimensional image reconstruction technology (3DIT) on preoperative surgical planning and perioperative outcomes in laparoscopic pyeloplasty (LP). Methods Data of 25 patients with ureteropelvic junction obstruction (UPJO) admitted to our hospital from January 2018 to January 2019 was analyzed retrospectively. All patients underwent preoperative enhanced computed tomography (CT) scanning. In the 12 cases in the 3DIT group, preoperative planning involved the use of virtual operation and morphometry based on reconstruction of the CT data into three-dimensional (3D) images. Surgery in the other 13 cases was performed with traditional CT examination. Demographic, surgical outcome, and postoperative parameters were compared between these two groups. Results Reconstructed 3D images clearly showed the spatial structural relationships between the UPJO and surrounding blood vessels. In all 25 cases surgery was completed with no conversion to open surgery. Preoperative 3DIT analyses resulted in significant improvements to mean operation time (107.76 vs. 141.58 min, P=0.024), mean time of dissociating ureteropelvic junction (UPJ) (11.26 vs. 19.40 min, P=0.020), and mean estimated blood loss volume (23.84 vs. 49.16 mL, P=0.028). There were no statistically significant differences in perioperative complications, postoperative hospital stays or postoperative drainage time. Conclusions 3DIT based on enhanced CT scans is of clinical value in the treatment of UPJO, as it can provide accurate anatomical information and reliable guidance for preoperative operation planning, and it facilitates image-guided LP.
Collapse
Affiliation(s)
- Weijie Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Chunru Xu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Zhenpeng Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Yanbo Huang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Jian Lin
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| |
Collapse
|
9
|
Analgesic Efficacy of Quadratus Lumborum Block in Infants Undergoing Pyeloplasty. SURGERIES 2021. [DOI: 10.3390/surgeries2030028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Post-operative analgesic management is challenging in infants and opioids have been the standard of care. However, they are associated with adverse effects which may negatively impact infants. In this retrospective cohort study, we sought to explore the postoperative analgesic efficacy of quadratus lumborum (QL) block in the infant population undergoing dorsal lumbotomy pyeloplasty. Chart review of 34 infants (≤12 months) who underwent dorsal lumbotomy pyeloplasty between 2016–2020 was performed. Post-operative pain was assessed using externally validated pain scales (CRIES & FLACC) and monitored hemodynamics (pulse and blood pressure). Opioid doses were standardized by using morphine milligram equivalency (MME). The Prescription Database Monitoring Program (PDMP) was utilized to determine if discharge opioid prescriptions were filled. Of 34 patients, 13 received the QL block. Mean age at the time of surgery was 6.2 months ± 3.2 months. The QL group received 0.8 MME postoperatively, whereas the non-QL group received 0.9 MME (p = 0.82). The QL group (20%) filled their discharge opioid prescription less frequently compared to non-QL group (100%) (p = 0.002). There were no observed differences between pain scale or hemodynamic variables. Further studies are warranted to explore QL block’s efficacy for post-operative infant pain management.
Collapse
|
10
|
Peng Y, Zhang Z, Shen C, Yu W, Wang G, Zhou L. Surgical management of incomplete duplex kidney with both upper and lower moieties ureteropelvic junction obstruction: a case report with modified reconstructive method. Transl Androl Urol 2021; 10:1792-1796. [PMID: 33968666 PMCID: PMC8100859 DOI: 10.21037/tau-20-1393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
An incomplete duplex kidney combined with ureteropelvic junction obstruction is a rare entity, and the surgical management strategy is highly individualized according to the anatomic variability. Currently, there is no literature report of the specific reconstructive method for the condition when obstruction occurs in both the upper and lower units of the duplex kidney. In this case report, a 60-year-old female with a right solitary kidney was admitted to our hospital. The patient suffered intermittent right flank pain and had an occasionally palpable abdominal mass for seven years. Computed tomography and intravenous pyelography revealed an incomplete duplex kidney with obstruction in both the upper and lower units with a proximal confluence. A specially designed reconstructive method, including an ureteropyelostomy between the upper pole ureter and lower pole pelvis, plus a dismembered pyeloplasty between the lower pole pelvis and common ureter, was used, with no intra- or postoperative complications. The patient remained symptom free at the 6-month, 1-year and 2-year follow-ups. A diuretic renal scan showed better drainage, and ultrasound revealed no significant hydronephrosis. Thus, our specially modified reconstructive strategy could be a method of choice when addressing particular anatomies, such as incomplete duplex kidneys with ureteropelvic junction obstruction in both upper and lower poles when the obstruction is close to the confluence of the two ureters.
Collapse
Affiliation(s)
- Yiji Peng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhongyuan Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Gang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| |
Collapse
|
11
|
Chabani-Cheballah N, Chauveau H, Lombart M, Hamzy M, Buisson P. Giant neonatal hydronephrosis of the upper pole of a complete duplicated renal system. Arch Pediatr 2021; 28:345-347. [PMID: 33715935 DOI: 10.1016/j.arcped.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/28/2021] [Accepted: 02/21/2021] [Indexed: 11/19/2022]
Abstract
Ureteropelvic junction obstruction (UPJO) in the upper pole of a complete duplicated renal system is extremely rare. We report a case that was diagnosed prenatally and we review 10 cases published in the literature. Diagnoses of adrenal hematoma and cystic neuroblastoma were suspected on prenatal ultrasound, based on the severity of dilatation and the difficulty of identifying the exact origin of this anomaly. Neonatal magnetic resonance imagery (MRI) was subsequently able to show a normal adrenal gland. Surgical management is similar to that of a single-system pyeloureteral junction obstruction. Since this situation is very rare, we believe cystoscopy can be useful to confirm diagnosis of UPJO associated with complete duplication, especially in the absence of preoperative MRI. Among the 11 surgical cases previously published, seven patients underwent pyeloplasty and four heminephrectomy.
Collapse
Affiliation(s)
- Nassima Chabani-Cheballah
- Department of Pediatric Surgery, University Hospital Center, Centre Hospitalier Universitaire d'Amiens, 1, rond-point Christian Cabrol, 80054 Amiens cedex 1, France
| | - Henry Chauveau
- Department of Pediatric Surgery, University Hospital Center, Centre Hospitalier Universitaire d'Amiens, 1, rond-point Christian Cabrol, 80054 Amiens cedex 1, France
| | - Melyne Lombart
- Department of Obstetrics and Gynecology, University Hospital Center, Centre Hospitalier Universitaire d'Amiens, 1, rond-point Christian Cabrol, 80054 Amiens cedex 1, France
| | - Mounia Hamzy
- Department of Pediatric Surgery, University Hospital Center, Centre Hospitalier Universitaire d'Amiens, 1, rond-point Christian Cabrol, 80054 Amiens cedex 1, France
| | - Philippe Buisson
- Department of Pediatric Surgery, University Hospital Center, Centre Hospitalier Universitaire d'Amiens, 1, rond-point Christian Cabrol, 80054 Amiens cedex 1, France.
| |
Collapse
|
12
|
Elbaset MA, Osman Y, Elgamal M, Sharaf MA, Ezzat O, Elmeniar AM, Abdelhamid A, Zahran MH. Long-term outcomes after pyeloplasty for pelvi-ureteric junction obstruction in adults associated with renal congenital anomalies: Age, sex and renal function matched analysis. Arab J Urol 2020; 19:173-178. [PMID: 34104493 PMCID: PMC8158229 DOI: 10.1080/2090598x.2020.1816600] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To assess the long-term outcomes after pyeloplasty for pelvi-ureteric junction obstruction (PUJO) associated with renal anomalies. Patients and methods: Data were collected for patients after pyeloplasty for PUJO associated with renal anomalies and analysed retrospectively. Long-term functional success was evaluated by comparing the renographic split renal function (SRF) and glomerular filtration rate (GFR) at last follow-up with baseline values. A change of 5% in SRF was considered significant. Factors affecting functional outcome were assessed. The outcomes were compared to an age, sex and renal function matched group with PUJO in otherwise normal kidneys (Group 2) to evaluate the pattern of difference in functional recoverability in both groups. This was assessed using repeated-measures analysis of variance. Results: The study initially included 70 adult patients, with a mean age of 31.8 years. At a median of 44 months, 55 patients completed follow-up (Group 1) and no statistically significant changes in GFR (P = 0.7) and SRF (P = 0.06) were found. In all, 17, four and 34 patients showed a decrease, increase and static SRF (functional success rate was 69%). Higher preoperative SRF (P = 0.02) and Anderson–Hynes (A–H) pyeloplasty (P = 0.003) were associated with functional preservation. In the comparison with the other matched group (Group 2), the patients in Group 2 had better functional recoverability after pyeloplasty than patients with associated anomalies [GFR (P = 0.001), SRF (P = 0.002) and functional success (P = 0.001)]. Conclusion: Functional preservation after pyeloplasty in associated renal anomalies could be achieved in 69% of patients, which was significantly lower than those with otherwise normal kidneys. A–H pyeloplasty and higher preoperative SRF were associated with better functional outcomes. Abbreviations: A–H: Anderson–Hynes; HSK: horseshoe kidneys; OR: odds ratio; PUJO: PUJ obstruction; SRF: split renal function; T1/2, half-time
Collapse
Affiliation(s)
- Mohamed A Elbaset
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Osman
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mostafa Elgamal
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed A Sharaf
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Osama Ezzat
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ali M Elmeniar
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Abdalla Abdelhamid
- Department of Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamad H Zahran
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| |
Collapse
|
13
|
Robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction with duplex system. Urol Case Rep 2020; 30:101138. [PMID: 32140419 PMCID: PMC7044749 DOI: 10.1016/j.eucr.2020.101138] [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] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/18/2020] [Indexed: 11/20/2022] Open
Abstract
Management of ureteropelvic junction obstruction with a duplex system is technically challenging even when laparoscopic procedure is the standard approach for ureteropelvic junction obstruction. The patient was an otherwise healthy 21-year-old woman who presented with symptomatic ureteropelvic junction obstruction with the duplex system, which was completely excised using a robot-assisted approach. Robotic assistance allows for proper tissue dissection, minimal manipulation of the normal ureter, and meticulous fine suturing and would overcome the potential challenges involved in the minimally invasive management of such complex anomalies as shown in this patient.
Collapse
|
14
|
Lang-Motta G, Llorens de Knecht E, Gaya Sopena JM, Quiróz Madarriaga Y, Bujons Tur A. Videolaparoscopic lower pole heminephrectomy for treatment of a duplex kidney. J Pediatr Urol 2019; 15:193-194. [PMID: 30661744 DOI: 10.1016/j.jpurol.2018.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/16/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In a duplicated renal collecting system, or duplex kidney, the most frequent pathology presenting at the lower pole is the vesicoureteral reflux (VUR), which could lead to urinary tract infections (UTI) or even renal dysplasia. Under some circumstances, such as recurrent UTIs or impaired kidney function, heminephrectomy of the pathologic moiety is indicated. However, there are only few academic videos of laparoscopic lower pole heminephrectomy in the pediatric population available in literature. Therefore, we present a descriptive video of this procedure. METHODS This video exhibits a case report of a 15-month-old male patient who underwent a videolaparoscopic lower pole heminephrectomy as treatment of a refluxing non-functional lower moiety of a right duplex kidney. Moreover, the patient presented a refluxing contralateral ureter which was endoscopically corrected at the same time. RESULTS A laparoscopic right lower pole heminephrectomy associated with an endoscopic contralateral reflux treatment was performed. No complication occurred during hospital stay or at 30-day follow up. CONCLUSION Videolaparoscopic lower pole heminephrectomy is a safe and feasible procedure in the pediatric population. Associating an endoscopic correction of the contralateral side reflux at the same moment shows no additional morbidity or complication.
Collapse
Affiliation(s)
- G Lang-Motta
- Pediatric Urology Department, Fundació Puigvert, Barcelona, Spain
| | | | | | | | - A Bujons Tur
- Pediatric Urology Department, Fundació Puigvert, Barcelona, Spain.
| |
Collapse
|
15
|
Outcomes after Robotic-assisted Pyeloplasty in Patients Presenting with Pain Versus Nonpain Presenting Symptoms. Urology 2018; 125:111-117. [PMID: 30529338 DOI: 10.1016/j.urology.2018.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the impact of presenting symptom or incidental finding on symptomatic and radiographic outcomes after robotic-assisted pyeloplasty (RAP). METHODS We retrospectively reviewed the records of 143 patients at our institution who received pyeloplasty from 2001-2017. Patients without both pre- and postoperative radiographic data were excluded. Patients were grouped by primary presenting symptom into either pain at presentation (pain) or nonpain primary presenting symptom, including incidental findings (nonpain). Primary outcomes were persistence of postoperative symptoms and improvement in diuretic renogram half-times. RESULTS The study inclusion criteria was met by 105 patients. Pain was the most common presenting symptom (70.0%), followed by incidental finding (10.5%), infection (7.6%), hematuria (4.8%), hypertension (2.8%), elevated creatinine (2.8%), and nausea (1.0%). Patients with nonpain presentations were significantly more likely to have postoperative symptoms (P = .04), and less likely to improve on diuretic renogram (P = .03). Incidental presentation was found to be associated with greater likelihood of persistent postoperative symptoms compared with other presentations (36.3% vs 8.5%, P = .02). CONCLUSION Ureteropelvic junction obstruction (UPJO) patients presenting with pain, experience better symptom and radiographic improvement following RAP compared with patients presenting without pain. Incidental UPJO was the most common nonpain presentation and is associated with less symptomatic and radiographic benefit after RAP. These findings will help reconstructive urologists counsel patients with UPJO regarding outcomes of RAP.
Collapse
|
16
|
Brunhara JA, Moscardi PRM, Mello MF, Andrade HS, Carvalho PA, Cezarino BN, Dénes FT, Lopes RI. Transperitoneal laparoscopic pyeloplasty in children: does upper urinary tract anomalies affect surgical outcomes? Int Braz J Urol 2018; 44:370-377. [PMID: 29368877 PMCID: PMC6050553 DOI: 10.1590/s1677-5538.ibju.2017.0224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 11/15/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the feasibility and outcomes of laparoscopic pyeloplasty in children with complex ureteropelvic junction obstruction (UPJO) and compare to children with iso-lated UPJO without associated urinary tract abnormalities. MATERIAL AND METHODS Medical records of 82 consecutive children submitted to transperitoneal laparoscopic pyeloplasty in a 12-year period were reviewed. Eleven cases were con-sidered complex, consisting of atypical anatomy including horseshoe kidneys in 6 patients, pelvic kidneys in 3 patients, and a duplex collecting system in 2 patients. Patients were di-vided into 2 groups: normal anatomy (group 1) and complex cases (group 2). Demographics, perioperative data, outcomes and complications were recorded and analyzed. RESULTS Mean age was 8.9 years (0.5-17.9) for group 1 and 5.9 years (0.5-17.2) for group 2, p=0.08. The median operative time was 200 minutes (180-230) for group 1 and 203 minutes (120-300) for group 2, p=0.15. Major complications (Clavien ≥3) were 4 (5.6%) in group 1 and 1 (6.3%) in group 2, p=0.52. No deaths or early postoperative complications such as: urinoma or urinary leakage or bleeding, occurred. The success rate for radiologic improvement and flank pain improvement was comparable between the two groups. Re-garding hydronephrosis, significant improvement was present in 62 patients (93.4%) of group 1 and 10 cases (90.9%) of group 2, p=0.99. The median hospital stay was 4 days (IQR 3-4) for group 1 and 4.8 days (IQR 3-6) for group 2, p=0.27. CONCLUSIONS Transperitoneal laparoscopic pyeloplasty is feasible and effective for the management of UPJO associated with renal or urinary tract anomalies.
Collapse
Affiliation(s)
- João Arthur Brunhara
- Unidade de Urologia Pediátrica, Faculdade de Medicina da Universidade de São Paulo - São Paulo, SP, Brasil
| | | | - Marcos Figueiredo Mello
- Unidade de Urologia Pediátrica, Faculdade de Medicina da Universidade de São Paulo - São Paulo, SP, Brasil
| | - Hiury Silva Andrade
- Unidade de Urologia Pediátrica, Faculdade de Medicina da Universidade de São Paulo - São Paulo, SP, Brasil
| | - Paulo Afonso Carvalho
- Unidade de Urologia Pediátrica, Faculdade de Medicina da Universidade de São Paulo - São Paulo, SP, Brasil
| | - Bruno Nicolino Cezarino
- Unidade de Urologia Pediátrica, Faculdade de Medicina da Universidade de São Paulo - São Paulo, SP, Brasil
| | - Francisco Tibor Dénes
- Unidade de Urologia Pediátrica, Faculdade de Medicina da Universidade de São Paulo - São Paulo, SP, Brasil
| | - Roberto Iglesias Lopes
- Unidade de Urologia Pediátrica, Faculdade de Medicina da Universidade de São Paulo - São Paulo, SP, Brasil
| |
Collapse
|
17
|
Clement K, Hendry J, Keeley FX, Aboumarzouk OM. Heminephrectomy in Adults: A Systematic Review with Cumulative Analysis. Urol Int 2017; 101:1-6. [PMID: 29224026 DOI: 10.1159/000485466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/17/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Duplex collecting system of the kidney is a relatively common abnormality, with the majority of symptomatic cases discovered in childhood. Treatment is commonly a heminephrectomy of the affected moiety. We aimed to conduct a systematic review of the literature to provide the best available evidence for heminephrectomy for duplex kidneys in the adult population. MATERIALS AND METHODS A literature search was conducted in September 2017 with no limitations being placed on language, region, date or publication type. Data were represented numerically and analysed cumulatively. RESULTS Seven retrospective studies with 66 patients were included. Of which, 56/66 operations were performed laparoscopically, 5/66 were robot-assisted and 5/66 were open procedures. Complete resolution of symptoms was reported in 53/55 (96.4%) of patients in five studies providing outcome data. Of the 6 studies reporting complications, there were a total of 9 complications (9/62, 14.5%), however 5 of these were found to be in one study alone. CONCLUSIONS This review emphasises the scarcity of evidence for heminephrectomy in adults. Nonetheless, it has been shown that this operation may be effective in alleviating patients' symptoms in addition to being safe in experienced hands.
Collapse
Affiliation(s)
- Keiran Clement
- Department of Urology, Glasgow Urological Research Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Jane Hendry
- Department of Urology, Glasgow Urological Research Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Francis X Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Omar M Aboumarzouk
- Department of Urology, Glasgow Urological Research Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom.,University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, United Kingdom.,Islamic Universities of Gaza, College of Medicine, Gaza, Palestina
| |
Collapse
|