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Xie Q, Wang C, Su C, Shi B, Li Y, Huang J, Chen C. Feasibility and Effectiveness of Repeat Laparoscopic Pyeloplasty for Recurrent Ureteropelvic Junction Obstruction in Pediatric Patients. J Endourol 2024; 38:584-589. [PMID: 38545757 DOI: 10.1089/end.2023.0577] [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] [Indexed: 04/17/2024] Open
Abstract
Objective: To assess the outcomes of redo laparoscopic pyeloplasty (RLP) in pediatric patients with recurrent ureteropelvic junction obstruction (UPJO) in contrast to redo open pyeloplasty (ROP). In addition, evaluate the feasibility and efficacy of RLP as a treatment modality for recurrent UPJO in children. Materials and Methods: The data of 44 patients from March 2012 to March 2022, who underwent redo pyeloplasty, were retrospectively reviewed. In Group RLP, the children underwent RLP, whereas ROP was attempted in Group ROP. Demographics, clinical manifestations, surgical duration, hospitalization duration, complication rates, and treatment success were examined within the respective groups. Moreover, preoperative and postoperative measurements of anterior-posterior diameter of the renal pelvis (APD), preoperative assessment of differential renal function (DRF), and the percentage of improvement in DRF (PI-DRF) were subject to analysis. Results: The study included 28 patients who underwent RLP (Group RLP), and 16 patients who underwent ROP (Group ROP). In all cases, the Anderson-Hynes technique was employed. There was no significant difference between the two groups regarding age, body mass index, gender distribution, affected side, preoperative APD, postoperative APD, and preoperative DRF. In comparison to Group ROP, Group RLP exhibited a shorter hospitalization duration, a longer surgical procedure duration, and a higher percentage improvement in PI-DRF. The median follow-up period for Group RLP was 25 months, whereas it was 25.5 months for Group ROP. Notably, the success rates were similar between the two groups, with a success rate of 89.2% in RLP and 87.5% in ROP (p = 0.634). Conclusion: RLP has a comparable success rate to ROP and is a safe, effective, and feasible procedure for the treatment of failed pyeloplasty in children.
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Affiliation(s)
- Qike Xie
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Congjun Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Cheng Su
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bo Shi
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yong Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junqiang Huang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chao Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Hamamoto S, Taguchi K, Kawase K, Unno R, Isogai M, Torii K, Iwatsuki S, Etani T, Naiki T, Okada A, Yasui T. Efficacy of Robot-Assisted Ureteroureterostomy in Patients with Complex Ureteral Stricture after Ureteroscopic Lithotripsy. J Clin Med 2023; 12:7726. [PMID: 38137795 PMCID: PMC10743600 DOI: 10.3390/jcm12247726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Ureteral stricture (US) postureteroscopic lithotripsy (URSL) has emerged as a severe complication with the widespread use of laser technology. Furthermore, managing a complex US is challenging. Therefore, this study evaluated the efficacy of robot-assisted ureteroureterostomy (RAUU) in addressing US post-URSL and analyzed the pathology of transected ureteral tissues to identify the risk factors for US. METHODS we conducted a prospective cohort study on patients who underwent RAUU for URSL-induced US from April 2021 to May 2023. RESULTS A total of 14 patients with a mean age of 49.8 years were included in this study. The mean stricture length on radiography was 22.66 ± 7.38 mm. Nine (64.2%) patients had experienced failure with previous interventions. The overall success rate was 92.9%, both clinically and radiographically, without major complications, at a mean follow-up of 12.8 months. The pathological findings revealed microcalcifications and a loss of ureteral mucosa in 57.1% and 28.6% of patients, respectively. CONCLUSIONS The RAUU technique shows promise as a viable option for US post-URSL in appropriately selected patients despite severe pathological changes in the ureter. Therefore, the migration of microcalcifications to the site of ureteral perforation may be a significant factor contributing to US development.
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Affiliation(s)
- Shuzo Hamamoto
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya 4678601, Japan; (K.T.); (K.K.); (R.U.); (M.I.); (K.T.); (S.I.); (T.E.); (T.N.); (A.O.); (T.Y.)
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3
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Chandrasekharam VVS, Babu R. A systematic review and metaanalysis of open, conventional laparoscopic and robot-assisted laparoscopic techniques for re-do pyeloplasty for recurrent uretero pelvic junction obstruction in children. J Pediatr Urol 2022; 18:642-649. [PMID: 36117037 DOI: 10.1016/j.jpurol.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 08/14/2022] [Accepted: 08/28/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE About 3% of primary pyeloplasties may require a re-do pyeloplasty for recurrent uretero pelvic junction obstruction (UPJO) making it an uncommon operation even in large volume centers. In this MA we have compared the outcomes of open (OP), laparoscopic (LP) and robot assisted LP (RALP) approaches in managing recurrent UPJO. METHODS Pubmed/Index medicus etc. were searched for re-do pyeloplasty (Open OR Laparoscopic OR Robot-assisted) AND (Redo OR Reoperative OR failed) AND (child OR pediatric OR paediatric), for articles published between 2001 and 2021. Duplicate publications were identified and removed. Articles with grossly incomplete data and errors in reporting were excluded, as were articles reporting <5 cases. The systematic review was carried out according to PRISMA guidelines and meta-analysis of proportions was carried out using MetaXL 5.3. RESULTS A total of 18 articles on re-do pyeloplasty were included in the analysis. In total, there were 87, 77 and 123 redo pyeloplasties in OP, LP and RALP groups respectively. The I2 statistics for OP, LP and RALP showed low heterogeneity with I2 of 24%, 0% and 20% respectively. LFK index was 0.88, 0.30 and 1.62 for OP, LP and RALP respectively, suggesting no or minor publication bias. The overall success rates of OP, LP and RALP re-do pyeloplasty were 93.1% (95% CI 86-98), 92.1% (95% CI 83-96) and 89.4% (95% CI 83-96) respectively (summary table). The success rate between the techniques was not significantly different, with p values (x2) of 1 (OP vs LP), 0.5 (OP vs RALP) and 0.6 (LP vs RALP). Overall, redo RALP took significantly longer time than redo LP (p < 0.001, Fisher's). Overall, RALP had significantly shorter hospital stay than LP (p < 0.001) and LP had significantly shorter hospital stay than OP (p < 0.001). The complication rate was 9% in OP and LP and 16% in RALP, the difference being not statistically significant (p value 1, 0.26 and 0.27 for OP vs LP, OP vs RALP and LP vs RALP respectively, x2). CONCLUSIONS In conclusion MIS techniques (LP and RALP) seem to be good alternatives to OP for redo pyeloplasty in children, with comparable success and complications. Redo RALP had longer duration of surgery but shorter hospital stay than redo LP. With comparable success & complication rate between RALP and LP, this MA could not favor one over the other for redo pyeloplasty.
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Affiliation(s)
- V V S Chandrasekharam
- Pediatric Surgery, Pediatric Urology & MAS, Ankura Hospitals for Women and Children, Hyderabad, Telangana, India.
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Du T, Qi P, He L, Yang S, Zhang B, Shang P. Comparison of Secondary and Primary Minimally Invasive Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2022; 32:871-883. [PMID: 35319279 DOI: 10.1089/lap.2021.0771] [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: 11/12/2022] Open
Abstract
Objective: To compare the outcomes of secondary minimally invasive pyeloplasty (MIP) versus primary MIP for the patients with ureteropelvic junction obstruction (UPJO). Materials and Methods: We searched all the literature of PubMed, Web of Science, EMBASE, and Cochrane Library comparing secondary MIP and primary MIP and performed a systematic review and meta-analysis. Results: We included 15 studies involving 1637 patients with 1371 in the primary MIP group and 266 in the secondary MIP group. There were no significant differences in length of hospital stays, and the risk of hematuria, urinary tract infection, intestinal obstruction, stent complications, and overall complications (P > .05). Comparing with the secondary MIP group, the primary MIP group has shorter operative time (mean difference [MD] = -36.91 minutes, 95% confidence interval [CI]: -50.21 to -23.62, P < .00001), less estimated blood loss (MD = -16.70 mL, 95% CI: -31.60 to -1.80, P = .03), lower risk of urinary leakage and injury of blood vessel (relative risk [RR] = 0.32, 95% CI: 0.11-0.93, P = .04) (RR = 0.10, 95% CI: 0.02-0.61, P = .01), and higher success rate (RR = 1.07, 95% CI: 1.02-1.11, P = .003). The robot-assisted pyeloplasty is superior to the laparoscopic pyeloplasty in controlling the amount of blood loss in the secondary operation. Conclusions: Considering the poorer outcomes of secondary surgery, we believe that special attention should be paid to not missing crossing vessels, and it would be more prudent to perform a more definitive procedure with pyeloplasty instead of endopyelotomy for primary UPJO.
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Affiliation(s)
- Tianci Du
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Peng Qi
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Liangzhi He
- Department of Pediatric Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Shujun Yang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Biao Zhang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Panfeng Shang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
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5
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Personalized application of machine learning algorithms to identify pediatric patients at risk for recurrent ureteropelvic junction obstruction after dismembered pyeloplasty. World J Urol 2021; 40:593-599. [PMID: 34773476 DOI: 10.1007/s00345-021-03879-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To develop a model that predicts whether a child will develop a recurrent obstruction after pyeloplasty, determine their survival risk score, and expected time to re-intervention using machine learning (ML). METHODS We reviewed patients undergoing pyeloplasty from 2008 to 2020 at our institution, including all children and adolescents younger than 18 years. We developed a two-stage machine learning model from 34 clinical fields, which included patient characteristics, ultrasound findings, and anatomical variation. We fit and trained with a logistic lasso model for binary cure model and subsequent survival model. Feature importance on the model was determined with post-selection inference. Performance metrics included area under the receiver-operating-characteristic (AUROC), concordance, and leave-one-out cross validation. RESULTS A total of 543 patients were identified, with a median preoperative and postoperative anteroposterior diameter of 23 and 10 mm, respectively. 39 of 232 patients included in the survival model required re-intervention. The cure and survival models performed well with a leave-one-out cross validation AUROC and concordance of 0.86 and 0.78, respectively. Post-selective inference showed that larger anteroposterior diameter at the second post-op follow-up, and anatomical variation in the form of concurrent anomalies were significant model features predicting negative outcomes. The model can be used at https://sickkidsurology.shinyapps.io/PyeloplastyReOpRisk/ . CONCLUSION Our ML-based model performed well in predicting the risk of and time to re-intervention after pyeloplasty. The implementation of this ML-based approach is novel in pediatric urology and will likely help achieve personalized risk stratification for patients undergoing pyeloplasty. Further real-world validation is warranted.
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6
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Szavay P. Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction. J Laparoendosc Adv Surg Tech A 2021; 31:1214-1218. [PMID: 34609910 DOI: 10.1089/lap.2021.0452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
For ureteropelvic junction obstruction (UPJO), the standard of surgical care is dismembered pyeloplasty. This applies both for intrinsic but also for extrinsic etiology of the UPJO. When in 1995, Peters described for the first time laparoscopic pyeloplasty in children, the era of laparoscopic pediatric urological surgery began. Nowadays, laparoscopic dismembered pyeloplasty in children has evolved to become the gold standard. In this article, we report a standardized technique of laparoscopic transperitoneal dismembered pyeloplasty for infants and children. The described single steps of the procedure are reproducible regardless of age and weight and thus offer a high surgical success rate.
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Affiliation(s)
- Philipp Szavay
- Department of Pediatric Surgery, Lucerne Children's Hospital, Lucerne, Switzerland
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7
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Abstract
Uretero-pelvic junction obstruction (UPJO) is the most common cause of hydronephrosis in infants and children. Historically, this condition has been approached surgically through a retroperitoneal approach as described by Anderson and Hynes aiming for an open dismembered pyeloplasty. A true evolution of laparoscopy in pediatric urology took place within the last 30 years. Laparoscopy developed from a merely diagnostic tool for non-palpable testes to "interventional" laparoscopy for extirpative surgery. Finally the era of reconstructive pediatric laparoscopic urology started, when in 1995 Peters described the first laparoscopic pyeloplasty in a child. Laparoscopic dismembered pyeloplasty now has become the preferred surgical treatment of UPJO. It offers excellent visualization of the anatomy, accurate anastomotic suturing, thus the precise reconstruction of the UPJ along with good functional outcome. This article aims to provide the current status, indication and operative technique of laparoscopic dismembered pyeloplasty for UPJO in infants and children.
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Affiliation(s)
- Philipp Szavay
- Department of Pediatric Surgery, Lucerne Children's Hospital, Luzern, Spitalstrasse 6000, Switzerland.
| | - Sabine Zundel
- Department of Pediatric Surgery, Lucerne Children's Hospital, Luzern, Spitalstrasse 6000, Switzerland
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Nascimento B, Andrade HS, Miranda EP, Barbosa JABA, Moscardi PR, Arap MA, Mitre AI, Srougi M, Srougi V, Duarte RJ. Laparoscopic pyeloplasty as an alternative to nephrectomy in adults with poorly functioning kidneys due to ureteropelvic junction obstruction. Int Urol Nephrol 2020; 53:269-273. [PMID: 32862329 DOI: 10.1007/s11255-020-02626-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate outcomes of laparoscopic pyeloplasty (LP) in adults with poorly functioning kidney due to ureteropelvic junction obstruction (UPJO). METHODS A retrospective comparative analysis was performed between adult patients who underwent LP due to UPJO with differential renal function (DRF) ≤ 15% and DRF > 15%. LP success rate and complications were assessed. LP success was defined as symptoms improvement and DRF improvement or stabilization. DRF and estimated glomerular filtration rate (eGFR) were analyzed before and 12 months after surgery to evaluate renal function recovery. DRF was estimated using Tc-99 m DMSA renal scintigraphy. RESULTS Among 121 LP performed in the study period at our institution, 15 and 42 were included in the DRF ≤ 15% and DRF > 15% groups, respectively. At a median follow-up of 17.8 months, all patients with DRF ≤ 15% reported symptoms improvement. LP success rate was 86.7% and 90.5% (p = 0.65) for patients with DRF ≤ 15% and DRF > 15%, respectively. There were no complications in the DRF ≤ 15% group, while there were three complications recorded in the DRF > 15% group (Clavien 2 and 3b). In the DRF ≤ 15% group, mean pre-operative and post-operative DRF was 9.5% ± 3.6 and 10.5% ± 7.8 (p = 0.49), respectively. Median pre-operative and post-operative eGFR was 68.5 ml/min and 79.8 ml/min (p = 0.93), respectively. Two patients had DRF improvement after LP. CONCLUSIONS LP in adult patients with UPJO and poor function kidneys is an effective and safe procedure. DRF recovery is seen in a minority of the patients; however, LP is an alternative to nephrectomy.
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Affiliation(s)
- Bruno Nascimento
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil
| | - Hiury S Andrade
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil
| | - Eduardo P Miranda
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil
| | - João Arthur Brunhara Alves Barbosa
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil. .,Hospital Israelita Albert Einstein, Av Albert Einstein 627, Sao Paulo, SP, 04652-900, Brazil.
| | - Paulo R Moscardi
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil
| | - Marco A Arap
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil.,Hospital Sirio Libanês, Rua Barata Ribeiro 387, Sao Paulo, SP, 01308-050, Brazil
| | - Anuar I Mitre
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil.,Hospital Sirio Libanês, Rua Barata Ribeiro 387, Sao Paulo, SP, 01308-050, Brazil
| | - Miguel Srougi
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil
| | - Victor Srougi
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil.,Hospital Moriah. Av. Moaci, 974, Sao Paulo, SP, 04083-002, Brazil
| | - Ricardo J Duarte
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil
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Leonardo CR, Muzzi A, Tavora JE, Soares RQ. The outcomes of mini-laparoscopic pyeloplasty in children - brazilian experience. Int Braz J Urol 2020; 46:253-259. [PMID: 32022515 PMCID: PMC7025835 DOI: 10.1590/s1677-5538.ibju.2019.0381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/30/2019] [Indexed: 11/23/2022] Open
Abstract
Objetive Pelvicureteric junction (PUJ) obstruction is the main cause of hydronephrosis in childhood. Open pyeloplasty has been the gold standard treatment of this condition with success rate above 90%. The role of laparoscopic pyeloplasty (LP) in children is less well defined and has slowly emerged as an alternative procedure. We report outcomes of our initial experience with LP in 38 children from 2 months of age. Materials and Methods From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported. Results Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the first 12hs. Mean hospitalization was 2 days (1-5). There were complications in 5 children not affecting the final outcome. Two patients had a re-obstruction requiring a second procedure with good result. The mean follow up was 18 months (13-36). The mean reduction on the postoperative APD was 41% - p<0,001 (end APD 5 to 41mm). Overall success rate was 94,7%. All children had good cosmetic results. Conclusions This is a small series limited by short follow up, however its data suggest that LP has good functional and cosmetic results, not compromising the success of the open procedure, regardless patient age.
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Affiliation(s)
- Cristiane Reis Leonardo
- Departamento de Urologia Pediátrica, Neocentro - Hospital Vila da Serra, Nova Lima, MG, Brasil
| | - Alexandra Muzzi
- Departamento de Cirurgia Pediátrica, Neocentro - Hospital Vila da Serra, Nova Lima, MG, Brasil
| | - José Eduardo Tavora
- Departamento de Urologia, Neocentro - Hospital Vila da Serra, Nova Lima, MG, Brasil
| | - Rodrigo Q Soares
- Departamento de Urologia, Neocentro - Hospital Vila da Serra, Nova Lima, MG, Brasil
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Al-Hazmi H, Peycelon M, Carricaburu E, Manzoni G, Neel KF, Ali L, Grapin C, Paye-Jaouen A, El-Ghoneimi A. Redo Laparoscopic Pyeloplasty in Infants and Children: Feasible and Effective. Front Pediatr 2020; 8:546741. [PMID: 33240828 PMCID: PMC7683417 DOI: 10.3389/fped.2020.546741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose: To determine the feasibility and effectiveness of redo laparoscopic pyeloplasty among patients with failed previous pyeloplasty, specifically examining rates of success and complications. Materials and Methods: We retrospectively reviewed the charts of all patients, who underwent redo laparoscopic pyeloplasty from 2006 to 2017. This included patients who underwent primary pyeloplasty at our institution and those referred for failures. Analysis included demographics, operative time, complications, length of hospital stay, complications, and success. Success was defined as improvement of symptoms and hydronephrosis and/or improvement in drainage demonstrated by diuretic renogram, especially in those with persistent hydronephrosis. Descriptive statistics are presented. Results: We identified 22 patients who underwent redo laparoscopic pyeloplasty. All had Anderson-Hynes technique except two cases in which ureterocalicostomy was performed. Median (IQR) follow-up was 29 (2-120) months, median time between primary pyeloplasty and redo laparoscopic pyeloplasty was 12 (7-49) months. The median operative time was 200 (50-250) min, and median length of hospital stay was 3 (2-10) days. The procedure was feasible in all cases without conversion. During follow-up, all but two patients demonstrated an improvement in the symptoms and the degree of hydronephrosis. Ninety-one percent of patients experienced success and no major complications were noted. Conclusions: Redo laparoscopic pyeloplasty is feasible and effective with a high success rate and low complication rate.
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Affiliation(s)
- Hamdan Al-Hazmi
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,College of Medicine and King Saud University Medical City, King Saud University, Riyad, Saudi Arabia
| | - Matthieu Peycelon
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,University of Paris, Paris, France
| | - Elisabeth Carricaburu
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Gianantonio Manzoni
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,Department of Pediatric Urology Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Khalid Fouda Neel
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,College of Medicine and King Saud University Medical City, King Saud University, Riyad, Saudi Arabia
| | - Liza Ali
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Christine Grapin
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,University of Paris, Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,University of Paris, Paris, France
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11
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Wang Q, Lu Y, Hu H, Zhang J, Qin B, Zhu J, Dirie NI, Zhang Z, Wang S. Management of recurrent ureteral stricture: a retrospectively comparative study with robot-assisted laparoscopic surgery versus open approach. PeerJ 2019; 7:e8166. [PMID: 31824773 PMCID: PMC6898986 DOI: 10.7717/peerj.8166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/05/2019] [Indexed: 12/11/2022] Open
Abstract
Background Management of recurrent ureteral stricture is challenging. Consensus on the best surgical choice has not been demonstrated. In this study, we aim to report our experience in treating recurrent ureteral stricture and demonstrate whether robot-assisted procedure for redo ureteral surgery is as effective as open procedure while remaining less invasive. Methods We retrospectively assessed 41 patients (22 robot-assisted surgeries and 19 open surgeries) who underwent consecutive robot-assisted and open procedures for redo ureteral surgery from January 2014 to 2018 in our institution. Perioperative outcomes, including demographics, operative time, estimated blood loss, complications, pain scores, success rate and cost, were compared between two groups. Results There was no significant intergroup difference in terms of age, body mass index, gender composition and American Society of Anesthesiologists scores. A total of 31 patients underwent redo pyeloplasty and ten underwent redo uretero-ureterostomy. Compared with open group, robot-assisted group showed shorter operative time (124.55 min vs. 185.11 min, p < 0.0001), less estimated blood loss (100.00 mL vs. 182.60 mL, p = 0.008) and higher cost (61161.77¥ vs. 39470.79¥, p < 0.0001). Complication rate and pain scores were similar between two groups. Median follow-up periods were 30 and 48 months for robot-assisted and open group respectively. Success rate in the robot-assisted (85.71%) and the open group (82.35%) was not significantly different. Conclusions Robot-assisted surgery for recurrent stricture after previous ureteral reconstruction is as effective as open procedure and is associated with shorter operative time and less estimated blood loss.
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Affiliation(s)
- Qing Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuchao Lu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Henglong Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiaqiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Baolong Qin
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianning Zhu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Najib Isse Dirie
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zongbiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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12
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Is secondary robotic pyeloplasty safe and effective as primary robotic pyeloplasty? A systematic review and meta-analysis. J Robot Surg 2019; 14:241-248. [PMID: 31280462 DOI: 10.1007/s11701-019-00997-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/02/2019] [Indexed: 12/14/2022]
Abstract
Robot-assisted laparoscopic pyeloplasty (RLP) has excellent surgical safety and efficacy in primary pyeloplasty. In recent, the application of robotics has explored to more complex surgical conditions such as failed pyeloplasty. This meta-analysis aimed to evaluate the surgical and clinical outcomes of secondary RLP compared with primary RLP. Following PRISMA guidelines, we carried out an extensive literature search in the PubMed, Web of Science, Cochrane Library, Scopus, and Google Scholar to extract the published articles comparing primary vs. secondary RLP up to April 2019. Interested surgical and clinical outcomes were extracted from each study and then used RevMan 5.3 Software for meta-analysis comparison. Furthermore, the quality of each study was assessed using the Modified Newcastle-Ottawa Scale for cohort studies. Our search has yielded seven studies that met our inclusion criteria. These studies contained 613 vs. 107 patients in primary vs. secondary RLP, respectively. Using random effect model, the analysis showed no statistical difference between the groups in the presence of a crossing vessel, complications, length of hospital stays (LOS), and follow-up period. However, the operative time, estimated blood loss (EBL), and recurrence rate were significantly higher in the secondary RLP compared with primary RLP (p = 0.004), (p = 0.01), and (p = 0.04), respectively. Our results indicate that secondary RLP is associated with significantly increased operative time and EBL and higher recurrence rates compared with primary RLP. We believe that our findings might help surgeon's decision making in patient selection and consultation during redo pyeloplasty surgical planning.
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Szavay PO. Applications of Laparoscopic Transperitoneal Surgery of the Pediatric Urinary Tract. Front Pediatr 2019; 7:29. [PMID: 30805327 PMCID: PMC6378287 DOI: 10.3389/fped.2019.00029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/23/2019] [Indexed: 12/23/2022] Open
Abstract
Application of laparoscopy in pediatric urology has evolved over more than 30 years coming from a merely diagnostic use for non-palpable testes to "interventional" laparoscopy to extirpative surgery and finally to the era of reconstructive pediatric laparoscopic urology, when in 1995 Peters described the first laparoscopic pyeloplasty in a child. Laparoscopic surgery in pediatric urology became implemented increasingly in the twenty-first century with now present-day applications including the complete variety of all kind of indications for surgery for pediatric urological pathology. This article aims to provide a comprehensive overview of current indications, techniques, and outcomes of laparoscopic transperitoneal surgery of the upper as well as of the lower urinary tract for urological pathology in the pediatric patient population.
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Affiliation(s)
- Philipp O Szavay
- Department of Pediatric Surgery, Lucerne Children's Hospital, Lucerne, Switzerland
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14
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Baek M, Silay MS, Au JK, Huang GO, Elizondo RA, Puttmann K, Janzen NK, Seth A, Roth DR, Koh CJ. Quantifying the Additional Difficulty of Pediatric Robot-Assisted Laparoscopic Re-Do Pyeloplasty: A Comparison of Primary and Re-Do Procedures. J Laparoendosc Adv Surg Tech A 2018; 28:610-616. [PMID: 29406807 DOI: 10.1089/lap.2016.0691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Re-do pyeloplasty after failed open or laparoscopic ureteropelvic junction (UPJ) obstruction correction can be a challenging procedure because of scar formation at the previous anastomosis site and decreased vascularity of the ureter. This study compared the perioperative parameters for pediatric robot-assisted laparoscopic (RAL) primary and re-do pyeloplasties with an emphasis on the intra-operative parameters. MATERIALS AND METHODS We compared the perioperative parameters of pediatric RAL procedures performed by a single surgeon at a tertiary care children's hospital for both primary ureteropelvic junction obstruction (UPJO) and recurrent UPJO after a previous open or laparoscopic procedure over 2013-2015. The operative time was subdivided as total operative time, console time, port placement time, dissection time to UPJ, and anastomosis time. RESULTS A total of 65 pediatric RAL pyeloplasty procedures for UPJO were performed (55 primary and 10 re-do pyeloplasties) during the study period. The console times were 43.3% longer for re-do pyeloplasties than for primary pyeloplasties (133.0 ± 30.7 versus 92.8 ± 24.0 minutes, respectively, P < .01). The re-do cases had longer operative times, especially for UPJ exposure (52.2 ± 21.0 versus 28.0 ± 14.0 minutes, P < .01). There were no conversions to open surgery or significant perioperative complications. There was no difference in hospital pain medication usage and hospital length of stay between the 2 groups. The treatment success rates were 98.2% (54/55) and 100% (10/10), respectively. CONCLUSIONS RAL re-do pyeloplasty is associated with significantly longer operative times as compared with primary pyeloplasties, especially during the exposure of the UPJ, but it is overall a safe and effective surgical modality for persistent/recurrent UPJO in children. As surgeons are increasingly asked for more accurate predictions of operative time lengths when scheduling cases, this information can be helpful for surgeons when scheduling these cases and with counseling families.
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Affiliation(s)
- Minki Baek
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas.,3 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Mesrur Selcuk Silay
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas.,4 Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University , Istanbul, Turkey
| | - Jason K Au
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Gene O Huang
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Rodolfo A Elizondo
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Kathleen Puttmann
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Nicolette K Janzen
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Abhishek Seth
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - David R Roth
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Chester J Koh
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
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Abstract
Laparoscopic pyeloplasty (LP) is more beneficial than open procedures. However, studies on laparoscopic management of cases with secondary ureteropelvic junction obstruction (SUPJO) after previous failed pyeloplasty in the pediatric population are lacking. This meta-analysis aimed to assess the difference between redo LP (RLP) and redo open pyeloplasty (ROP) for children with SUPJO, focusing on certain criteria. All recent studies on RLP and ROP in children with SUPJO were searched. Search engines such as Medline, PubMed, and The Cochrane Library of Systematic Reviews were used. Sixty citations were specified. Two reviewers extracted data independently, screened the titles, and assessed the quality of each citation. Continuous data reported as a weighted mean difference (WMD) (95% confidence interval) and dichotomous data reported as relative risk were used. We measured the length of hospital stay (LOS) and operative time using weighted mean and success and complication rates using risk difference and odds ratio (OR). A random effects model was used to pool OR that was tested for heterogeneity. We specified six publications that minutely met our eligibility standards. Meta-analysis of given data resulted in the following: ROP showed reduction in operative time by 12 min (WMD: 12.7 min; P = 0.14). RLP had shorter LOS than ROP (WMD: 0.6 days; P < 0.01). No difference was observed in complication and success rates (OR: 0.8; P = 0.50 and OR: 1.2; P = 0.51, respectively). In conclusion, RLP seems to be better than ROP in terms of LOS reduction; however, both are comparable with respect to success and complication rates, especially postoperative urine leakage.
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Affiliation(s)
- Hamdan Hammad Alhazmi
- Department of Surgery, Division of Urology, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Wan J. This Month in Pediatric Urology. J Urol 2017. [DOI: 10.1016/j.juro.2016.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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