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Ma W, Gao H, Chang M, Lu Z, Li D, Ding C, Bi D, Sun F. The construction of a nomogram to predict the prognosis and recurrence risks of UPJO. Front Pediatr 2024; 12:1376196. [PMID: 38633323 PMCID: PMC11022601 DOI: 10.3389/fped.2024.1376196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
Objective This study was conducted to explore the risk factors for the prognosis and recurrence of ureteropelvic junction obstruction (UPJO). Methods The correlation of these variables with the prognosis and recurrence risks was analyzed by binary and multivariate logistic regression. Besides, a nomogram was constructed based on the multivariate logistic regression calculation. After the model was verified by the C-statistic, the ROC curve was plotted to evaluate the sensitivity of the model. Finally, the decision curve analysis (DCA) was conducted to estimate the clinical benefits and losses of intervention measures under a series of risk thresholds. Results Preoperative automated peritoneal dialysis (APD), preoperative urinary tract infection (UTI), preoperative renal parenchymal thickness (RPT), Mayo adhesive probability (MAP) score, and surgeon proficiency were the high-risk factors for the prognosis and recurrence of UPJO. In addition, a nomogram was constructed based on the above 5 variables. The area under the curve (AUC) was 0.8831 after self cross-validation, which validated that the specificity of the model was favorable. Conclusion The column chart constructed by five factors has good predictive ability for the prognosis and recurrence of UPJO, which may provide more reasonable guidance for the clinical diagnosis and treatment of this disease.
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Affiliation(s)
- Wenyue Ma
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hongjie Gao
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Mengmeng Chang
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zhiyi Lu
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Ding Li
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Chen Ding
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Dan Bi
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Fengyin Sun
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Ceyhan E, Dogan HS, Tekgul S. Our experience on management of failed pediatric pyeloplasty. Pediatr Surg Int 2020; 36:971-976. [PMID: 32542506 DOI: 10.1007/s00383-020-04699-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of the study was to assess the outcomes of salvage procedures after failed pediatric pyeloplasty. Recurrent ureteropelvic junction obstruction treatment is a difficult course. The salvage surgery is more challenging in the pediatric population. We aimed to assess the outcomes of salvage procedures after failed pediatric pyeloplasty to determine the most efficient surgical intervention. METHODS 40 children with 41 renal units who have been treated for recurrent ureteropelvic junction obstruction after pyeloplasty were analyzed retrospectively. The outcomes of all initial and sequent interventions were assessed including redo pyeloplasty, endopyelotomy and balloon dilatation. RESULTS Children's mean age at initial intervention for failed pyeloplasty was 45.9 (± 46.4) months. Our mean follow-up time after the initial intervention was 46.9 (± 46.6) months. The success rate of our initial treatment methods was 48.7% (20/41). Although redo pyeloplasty was the most successful intervention (83.3%) than DJS placement (45.5%), endopyelotomy (50%) and balloon dilatation (30.8%), the statistical difference was not significant in the initial operations. The overall success rates of redo pyeloplasty, double-J stent placement, endopyelotomy and balloon dilatation were 78.9%, 46.1%, 38.8% and 29.4%, respectively (p < 0.05). CONCLUSIONS Redo pyeloplasty provides the best improvement in recurrent ureteropelvic junction obstruction in children. In selected patients, minimal invasive methods such as endopyelotomy and balloon dilatation offer alternative treatment.
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Affiliation(s)
- Erman Ceyhan
- Faculty of Medicine, Department of Urology, Hacettepe University, Ankara, Turkey. .,Department of Urology, Baskent University Konya Hospital, Konya, Turkey.
| | - Hasan Serkan Dogan
- Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Hacettepe University, Ankara, Turkey
| | - Serdar Tekgul
- Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Hacettepe University, Ankara, Turkey
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Smith KE, Holmes N, Lieb JI, Mandell J, Baskin LS, Kogan BA, Walker RD. Stented versus nonstented pediatric pyeloplasty: a modern series and review of the literature. J Urol 2002; 168:1127-30. [PMID: 12187251 DOI: 10.1016/s0022-5347(05)64607-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Dismembered pyeloplasty remains the principal surgical therapy for pediatric ureteropelvic junction obstruction, although the method of postoperative drainage continues to be debated. We compared stented versus nonstented repairs in a modern series. MATERIALS AND METHODS We evaluated 117 pediatric dismembered pyeloplasties performed by 3 pediatric urologists at 2 institutions from 1991 to 2000. Hospital stay, success rate and complication rate were reviewed. Results were compared with 833 evaluable cases in the literature. RESULTS Of the 52 stented repairs urological complications developed in 6 (12%), including symptomatic urinary tract infection in 3 and temporary obstruction in 3. Of the 65 nonstented repairs urological complications developed in 10 (15%), including prolonged leakage in 3, urinoma in 3, obstruction in 3 and urinary tract infection in 1. Mean hospitalization plus or minus standard error was shorter in the stented group (2.1 +/- 0.89 versus 2.6 +/- 1.1 days, p <0.02). We identified 9 previous studies comparing a total of 339 stented with 494 nonstented repairs. Overall the number of complications was almost equal (12% versus 14%) but the stented group had more infections, whereas more leaks occurred in the nonstented group. The nonstented group required more secondary procedures (12 of 339 versus 45 of 494, p = 0.003). Hospital stay was 12 days for stented and 5 days for nonstented repair in these earlier series. CONCLUSIONS In children the outcome of stented pyeloplasty is similar to that of nonstented repair. In contrast to previous reports, using a stent for drainage should not necessitate a longer hospital stay.
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Affiliation(s)
- Karen E Smith
- Division of Urology, Albany Medical College, Department of Urology, University of California-San Francisco Medical Center, San Francisco, California, USA
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Jabbour ME, Goldfischer ER, Klima WJ, Stravodimos KG, Smith AD. Endopyelotomy after failed pyeloplasty: the long-term results. J Urol 1998; 160:690-2; discussion 692-3. [PMID: 9720522 DOI: 10.1016/s0022-5347(01)62757-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Endopyelotomy has been proposed as a technique to treat ureteropelvic junction obstruction after failed open pyeloplasty. However, to our knowledge no long-term results of this treatment have been reported. We report the long-term followup of a cohort of patients in whom pyeloplasty failed and who subsequently were treated with endopyelotomy. MATERIALS AND METHODS From January 1985 to February 1996, 72 patients in whom open surgical pyeloplasty failed were treated with percutaneous endopyelotomy. Mean patient age was 35 years (range 5 to 82). The interval between pyeloplasty and subsequent failure ranged from 2 months to 30 years (mean 57 months). The major presenting symptoms were pain in 82% of cases, fever and urinary tract infections in 37.5%, stone formation in 25% and gross hematuria in 21%. RESULTS Antegrade endopyelotomy using a hooked knife was performed in all patients with no unusual difficulty and minimal complications. A total of 63 patients (87.5%) had long lasting clinical and radiographic treatment success after a mean followup of 88.5 months. Of the 9 endopyelotomy failures (12.5%) 7 (77.8%) were detected immediately after stent removal at 6 weeks, 1 (11.1%) at 6 months and 1 (11.1%) at 10 months postoperatively (mean failure interval 3.3 months). The failures were corrected with repeat endopyelotomy in 1 patient, pyeloplasty in 3, ileal interposition in 1 and nephrectomy in 4. CONCLUSIONS Endopyelotomy is the treatment of choice for recurrent ureteropelvic junction obstruction after failed pyeloplasty, with a high and sustained long-term success rate and no reported new failures after 1-year followup. Furthermore, endopyelotomy is technically easier with less morbidity than repeat open pyeloplasty.
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Affiliation(s)
- M E Jabbour
- Department of Urology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York, USA
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Hussain S, Frank JD. Complications and length of hospital stay following stented and unstented paediatric pyeloplasties. BRITISH JOURNAL OF UROLOGY 1994; 73:87-9. [PMID: 8298904 DOI: 10.1111/j.1464-410x.1994.tb07462.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To ascertain the necessity for the use of nephrostomies and ureteric stents after paediatric pyeloplasties. PATIENTS AND METHODS Seventy children with a pelvi-ureteric junction obstruction underwent a dismembered pyeloplasty between March 1983 and March 1991 at The Bristol Royal Hospital for Sick Children. A nephrostomy and stent were not used routinely except for the first few months of the survey. Indications for their use were: surgery on a single kidney, an inflamed renal pelvis or a revision pyeloplasty. Urinary catheters were only used for those patients with proven or suspected vesicoureteric reflux. RESULTS Thirteen patients had a nephrostomy and stent inserted (Group 1) of whom three patients (23%) developed complications. Fifty-seven patients had only a wound drain inserted (Group 2) of whom nine (16%) developed complications. The hospital stay of 12.1 days for patients in Group 1 was significantly longer than the 5.4 days for Group 2 (P value < 0.05). Long-term radiological and/or radio-isotopic follow-up showed improvement in function and/or drainage in 95% of both groups. CONCLUSIONS These findings support the concept that paediatric pyeloplasties can be safely performed at any age without the insertion of a nephrostomy tube or stent and that hospital stay is therefore significantly reduced.
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Affiliation(s)
- S Hussain
- Bristol Royal Hospital for Sick Children, UK
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Abstract
Improving diagnostic modalities, evolving concepts regarding perinatal renal physiology, and advances in surgical technique have contributed to an evolution in the management of infant pyeloplasties. Currently, the majority of patients present with a prenatal diagnosis of ureteropelvic junction obstruction and do not require surgical intervention prior to 4 weeks of age. Postnatal ultrasound, voiding cystourethrography, and nuclear renography complete the diagnostic evaluation, with intravenous urography and retrograde pyelography being unnecessary in the majority of infants. A decreasing incidence of complications and a shortening of hospital stay has been documented. We presently prefer a dismembered, nonintubated technique performed through a dorsal lumbotomy approach.
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Affiliation(s)
- C A Sheldon
- Division of Pediatric Urology, Children's Hospital Medical Center, Cincinnati, OH 45229-2899
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Kavoussi LR, Meretyk S, Dierks SM, Bigg SW, Gup DI, Manley CB, Shapiro E, Clayman RV. Endopyelotomy for secondary ureteropelvic junction obstruction in children. J Urol 1991; 145:345-9. [PMID: 1988728 DOI: 10.1016/s0022-5347(17)38335-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Percutaneous endopyelotomy has been shown to be successful in treating ureteropelvic junction obstruction in adults. Little data have been published regarding this procedure in children. We describe 4 patients 6.5 weeks to 5.5 years old who underwent percutaneous endopyelotomy to treat ureteropelvic junction obstruction following failed open dismembered pyeloplasty. Preoperative obstruction was demonstrated by a nephrostogram, diuretic renogram and/or ultrasonography. Percutaneous endopyelotomy was successful in relieving the obstruction in all 4 patients, although 2 required secondary endoscopic procedures. One patient had persistent obstruction 40 days after endopyelotomy at the ureteropelvic junction and, subsequently, required percutaneous resection of a persistent flap of obstructing tissue. In another patient a ureterovesical stricture was noted at the time of stent removal, which was treated by endoscopic incision. All patients have been followed from 1.5 to 3 years postoperatively. Followup diuretic renograms, ultrasound and/or excretory urography demonstrated a patent ureteropelvic junction in all patients and all have remained asymptomatic. Endopyelotomy appears to be safe and effective in treating secondary ureteropelvic junction obstruction in children.
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Affiliation(s)
- L R Kavoussi
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Vaccaro JP, Cronan JJ. Role of diagnostic imaging in the evaluation and treatment of post-operative complications of the urinary tract. BRITISH JOURNAL OF UROLOGY 1991; 67:113-24. [PMID: 2004220 DOI: 10.1111/j.1464-410x.1991.tb15091.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J P Vaccaro
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence
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Sibley GN, Graham MD, Smith ML, Doyle PT. Improving splintage techniques in pyeloplasty. BRITISH JOURNAL OF UROLOGY 1987; 60:489-91. [PMID: 3427329 DOI: 10.1111/j.1464-410x.1987.tb05026.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
One hundred patients undergoing pyeloplasty were studied and the outcome assessed with particular reference to the splintage technique used. A double J stent was used in 16 patients instead of a more traditional external drainage technique. The use of the double J stent for splintage of a pyeloplasty anastomosis was associated with a marked reduction in hospital stay and with fewer post-operative complications when compared with external drainage techniques. The double J stent is recommended in cases where a pyeloplasty anastomosis is to be splinted.
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Affiliation(s)
- G N Sibley
- Department of Urology, Addenbrooke's Hospital, Cambridge
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Mesrobian HG. Ureteropelvic junction obstruction of the upper pole moiety in complete ureteral duplication. J Urol 1986; 136:452-3. [PMID: 3735517 DOI: 10.1016/s0022-5347(17)44905-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Ureteropelvic junction obstruction of the upper pole moiety is reported in 2 patients with complete ureteral duplication. A normal upper pole ureter of a duplicated system in conjunction with upper pole dilatation should alert the urologist to the presence of an upper pole ureteropelvic junction obstruction. Traditional pyeloplasty techniques can be applied to this anomaly with successful salvage of renal parenchyma. The embryological implications of this combination of anomalies occurring in a single patient are discussed briefly.
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