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Nguyen QT, Nguyen TM, Le DA, Nguyen LVM, Dang TT, Nguyen SH, Nguyen VHK, Nguyen LT. Long-term outcome of retroperitoneoscopic one-trocar-assisted pyeloplasty: a single-center and single-surgeon experience. Int Urol Nephrol 2024:10.1007/s11255-024-04091-9. [PMID: 38797767 DOI: 10.1007/s11255-024-04091-9] [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: 04/13/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE The aim of this study was to assess the long-term outcomes of retroperitoneoscopic one-trocar-assisted pyeloplasty (OTAP) for ureteropelvic junction obstruction (UPJO) in children. METHODS This retrospective analysis included 70 pediatric cases, all under the age of 5, diagnosed with UPJO and treated with the OTAP technique between May 2011 and June 2013 by a single surgeon. A single 10 mm operative scope with a 5 mm working channel was utilized to mobilize the ureteropelvic junction (UPJ) and exteriorize it through the trocar insertion site. Subsequently, conventional Anderson-Hynes dismembered pyeloplasty was conducted extracorporeally. Patient's demographics, operative time, hospital stay, complications, and success rate were evaluated. RESULTS Seventy pediatric patients (65 males and 5 females) underwent OTAP, with ages at the time of operation ranging from 1 month to 5 years (mean = 22.6 ± 18.6 months). The mean operative time was 74.8 ± 15.2 min. There was a significant reduction in the mean renal pelvis size from 34.3 ± 8.1 mm preoperatively to 13.8 ± 4.7 mm postoperatively (p < 0.05). Moreover, the mean differential renal function (DRF) increased from 47.9 ± 9.8% preoperatively to 51.2 ± 5.9% postoperatively (p < 0.05). All patients experienced an uneventful postoperative recovery, with a median hospital stay of 3.4 days. The success rate was 95.7%, with a median follow-up time of 75 months (range: 6-125 months). CONCLUSION OTAP is a safe and feasible minimally invasive technique to correct ureteropelvic junction obstruction in children. It could be considered as a treatment of choice for children under the age of 5 as it combines the advantages of open and retroperitoneoscopic pyeloplasty and presents excellent long-term outcomes. TRIAL REGISTRATION NUMBER NCT06349161 April 4th, 2024, retrospectively registered.
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Affiliation(s)
- Quang Thanh Nguyen
- Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Vietnam
- College of Health Science, VinUniversity, Hanoi, Vietnam
| | - Thuy Mai Nguyen
- Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Vietnam
| | - Dung Anh Le
- Department of Pediatric Surgery, The National Hospital of Pediatrics, Hanoi, Vietnam
| | | | - Trang Thu Dang
- College of Health Science, VinUniversity, Hanoi, Vietnam
| | | | | | - Liem Thanh Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Health Care System, Vinmec Times City, Minh Khai, Hanoi, Vietnam.
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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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Comparison of 30-day postoperative outcomes of open and minimally invasive pyeloplasty utilizing the prospective National Surgical Quality Improvement Program-Pediatric database. J Pediatr Urol 2019; 15:355.e1-355.e8. [PMID: 31229417 DOI: 10.1016/j.jpurol.2019.05.022] [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: 03/25/2019] [Accepted: 05/18/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Open pyeloplasty (OP) has traditionally been the standard for the operative management of ureteropelvic junction obstruction in children. With advances in minimally invasive pyeloplasty (MIP) techniques, it is quickly becoming a popular alternative in both adult and pediatric population. OBJECTIVE To evaluate the differences in outcomes between MIP and OP for the surgical correction of ureteropelvic junction obstruction in children. STUDY DESIGN Data were obtained from the pediatric National Surgical Quality Improvement Program 2012-2017. We identified 1280 patients who underwent MIP and 1190 patients who underwent OP between 2012 and 2017. Propensity score matching was utilized to adjust for baseline differences. Univariate and multivariable regression were performed to assess odds of complications and procedure-related readmission. RESULTS Patients who underwent OP had a significantly decreased operative time (192.42 vs 142.00 min, p < 0.001) compared to MIP. There was no significant difference in the rates of overall peri-operative complications (3.7% [MIP] vs 2.4% [OP] p = 0.397). On multivariable analysis, patients undergoing OP had a lower risk of procedure-related readmission (odds ratio [OR] 0.404, 95% confidence interval [CI] 0.157-0.951, p = 0.046) than MIP. In a multivariable linear regression model, the risk of having any postoperative complication, regardless of surgical approach, decreased with increasing patient age (OR 0.945, 95% CI 0.893-0.996, p = 0.037). DISCUSSION Although recent small, retrospective institutional studies have found decreased hospitalization time of MIP as compared to OP, in our large prospective database, we found no such association. While some studies suggest a higher rate of wound complications in the OP group, this was not reproduced in our study as well. MIP was, in fact, associated with higher rate of readmissions as compared to the OP group, which may act as a surrogate of long-term complications in these patients. CONCLUSION MIP offers an alternative to OP in the pediatric population with similar rates of peri-operative complications. However, our study shows decreased odds of procedure-related readmission in OP, which may serve as a surrogate for less postoperative complications in these patients.
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Andolfi C, Kumar R, Boysen WR, Gundeti MS. Current Status of Robotic Surgery in Pediatric Urology. J Laparoendosc Adv Surg Tech A 2019; 29:159-166. [DOI: 10.1089/lap.2018.0745] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Ciro Andolfi
- Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Rana Kumar
- Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - William R. Boysen
- Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Mohan S. Gundeti
- Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
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Abstract
Urinary tract dilatation (UTD) is the most common congenital anomaly detected on prenatal ultrasonography (US), affecting 1% to 3% of all pregnancies. This article focuses on the prenatal detection of UTD and the postnatal evaluation and management based on the UTD grading system risk assessment. Prophylactic antibiotics and postnatal imaging are discussed. The recent management trend is for a more conservative approach to minimize unnecessary testing and exposures to the fetus and neonate while detecting those who may have clinically significant disorder. The renal bladder US remains a critical part of the evaluation and helps guide further investigations.
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Affiliation(s)
- Andrea Balthazar
- Division of Urology, Department of Surgery, Virginia Commonwealth University School of Medicine, VCU Medical Center, PO Box 980118, Richmond, VA 23298-0118, USA
| | - C D Anthony Herndon
- Pediatric Urology, Division of Urology, Department of Surgery, Children's Hospital of Richmond, Virginia Commonwealth University School of Medicine, VCU Medical Center, PO Box 980118, Richmond, VA 23298-0118, USA.
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6
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Boysen WR, Gundeti MS. Robot-assisted laparoscopic pyeloplasty in the pediatric population: a review of technique, outcomes, complications, and special considerations in infants. Pediatr Surg Int 2017; 33:925-935. [PMID: 28365863 DOI: 10.1007/s00383-017-4082-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 12/16/2022]
Abstract
Ureteropelvic junction obstruction is a common condition encountered by the pediatric urologist, and treated with pyeloplasty when indicated. Recent technological advancements and a shift across all surgical fields to embrace minimally invasive surgery have led to increased utilization of minimally invasive pyeloplasty. Conventional laparoscopy is a reasonable choice, but its use is limited by the technical challenges of precise suturing in a confined space and the associated considerable learning curve. Robotic technology has simplified the minimally invasive approach to pyeloplasty, offering enhanced visualization and improved dexterity with a fairly short learning curve. As utilization of robotic pyeloplasty continues to increase, we sought to critically assess the literature on this approach. We begin with a review of the technical aspects of robot-assisted laparoscopic pyeloplasty including tips for surgical proficiency and patient safety. Outcomes and complications from the contemporary literature are reviewed, as well as special considerations in the pediatric population including infant pyeloplasty, cost concerns, training, and postoperative diversion/drainage.
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Affiliation(s)
- William R Boysen
- Pediatric Urology, Comer Children's Hospital, The University of Chicago Medicine and Biological Sciences, 5841 S. Maryland, P-217, MC 7122, Chicago, IL, 60637, USA
| | - Mohan S Gundeti
- Pediatric Urology, Comer Children's Hospital, The University of Chicago Medicine and Biological Sciences, 5841 S. Maryland, P-217, MC 7122, Chicago, IL, 60637, USA.
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7
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Cobellis G, Nino F, Pierangeli F, Mariscoli F, Noviello C, Martino A. Retroperitoneoscopic One-Trocar-Assisted Pyeloplasty in Children: An Age-Related Evaluation. J Laparoendosc Adv Surg Tech A 2017; 27:651-654. [DOI: 10.1089/lap.2016.0457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Fabiano Nino
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Francesco Pierangeli
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Francesca Mariscoli
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Carmine Noviello
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Ascanio Martino
- Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche, Ancona, Italy
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Antoniou D, Karetsos C. Laparoscopy or retroperitoneoscopy: which is the best approach in pediatric urology? Transl Pediatr 2016; 5:205-213. [PMID: 27867841 PMCID: PMC5107381 DOI: 10.21037/tp.2016.10.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The emergence of minimally invasive surgery about 20 years ago revolutionized pediatric urology. Advances in pediatric devices allowed the widespread use of minimally invasive techniques in almost the entire range of pediatric urology. In this context, laparoscopy and later retroperitoneoscopy were developed and applied in a wide spectrum of urological diseases. Both approaches have since presented benefits and disadvantages that have been documented in various series. However, few comparative studies have been conducted. The aim of this review is to compare the two approaches and establish which is preferable in each field of pediatric urology.
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Affiliation(s)
- Dimitrios Antoniou
- Sulaiman Al Habib Hospital - Al Takhassusi, Takhassusi Road, 11393 Riyadh, KSA
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Xu N, Chen SH, Xue XY, Zheng QS, Wei Y, Jiang T, Li XD, Huang JB, Cai H. Comparison of Retrograde Balloon Dilatation and Laparoscopic Pyeloplasty for Treatment of Ureteropelvic Junction Obstruction: Results of a 2-Year Follow-Up. PLoS One 2016; 11:e0152463. [PMID: 27019289 PMCID: PMC4809589 DOI: 10.1371/journal.pone.0152463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 03/15/2016] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the efficacy of laparoscopic pyeloplasty relative to retrograde balloon dilatation for the treatment of ureteropelvic junction obstruction (UPJO). Methods This retrospective study enrolled UPJO patients with stricture length < 2 cm who had been treated with laparoscopic pyeloplasty (LP; 44 cases) or balloon dilatation (BD; 38 cases) from Jan 2010 to Jan 2012, according to patients’ preference after consultation. Demographics and clinical parameters were collected. Patients were followed-up at 3, 6, 12, and 24 months. Ultrasonography, intravenous urography, and diuretic renography were applied to evaluate the remission of hydronephrosis. Results Both groups were comparable with respect to age, UPJO location, gender, and other baseline parameters. Compared to the LP group, patients receiving BD experienced significantly shorter operative time, analgesia time, hospital stay, and urethral catheter indwelling time, and less cost (P<0.001). Three and 6 months after their respective procedures, the success rates of the LP (97.7%, both) and BD (94.7% and 86.8%) groups were similar, and at 12 and 24 months the long-term success rate of LP (95.5%, both) was better than that of BD (78.9% and 71.0%). Conclusions LP showed better long-term success rate than did BD in the management of UPJO with length of stricture < 2 cm. Considering that BD is more minimally invasive, simpler and easier to perform, and costs less, we recommend it for some selective UPJO patients as the first-line therapy.
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Affiliation(s)
- Ning Xu
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350005, People’s Republic of China
| | - Shao-Hao Chen
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350005, People’s Republic of China
| | - Xue-Yi Xue
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350005, People’s Republic of China
| | - Qing-Shui Zheng
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350005, People’s Republic of China
- * E-mail:
| | - Yong Wei
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350005, People’s Republic of China
| | - Tao Jiang
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350005, People’s Republic of China
| | - Xiao-Dong Li
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350005, People’s Republic of China
| | - Jin-Bei Huang
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350005, People’s Republic of China
| | - Hai Cai
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350005, People’s Republic of China
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Ciftci H, Akin Y, Savas M, Yeni E. Functional Results of Laparoscopic Pyeloplasty in Children: Single Institute Experience in Long Term. Urol Int 2016; 97:148-52. [PMID: 26855385 DOI: 10.1159/000443212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the long-term functional outcomes of laparoscopic pyeloplasty (LP) in children for consecutive cases of single institute. MATERIALS AND METHODS Our laparoscopy database was investigated for children in terms of LP between June 2008 and April 2015. All the patients had ureteropelvic junction obstruction (UPJO) and LP was performed. Demographic data including age, gender, side of UPJO, operation time, estimated blood loss (EBL), hospital stay and complications according to Clavien classifications were recorded. Renal ultrasonography and diethylenetriamine penta-acetate (DTPA) scintigraphies were respectively performed 3, 12 and 24 months after surgery. Statistical analyses were performed and p value was accepted as significant at <0.05. RESULT Mean follow-up was 34 ± 4.7 months. The mean age was 13 (6-72) months. A total of 153 (110 boys and 43 girls) LP patients enrolled. Of that, 93 (60.78%) LP were in left side and 60 (39.21%) were in right side. Three cases needed open conversation according to difficulties in anastomosis. Aberrant crossing vessel was observed in 12 (7.84%) patients. The mean operation time was 155 ± 21 min and the mean EBL was 22 ± 11.1 ml. The mean hospital stay was 3.4 days. Anastomotic leakage was the common complication (in 13 patients) that was successfully managed conservatively (Clavien 1). Eight patients experienced unsuccessful LP and underwent open pyeloplasty (Clavien 3b). The mean split renal function significantly increased in DTPA scintigraphy in follow-up. The overall success was 91%. CONCLUSIONS The LP procedure can be an effective and safe surgical method for childhood UPJO, specifically in the experienced hands of pioneer centers.
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Affiliation(s)
- Halil Ciftci
- Department of Urology, Harran University School of Medicine, Sanliurfa, Turkey
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Ekin RG, Celik O, Ilbey YO. An up-to-date overview of minimally invasive treatment methods in ureteropelvic junction obstruction. Cent European J Urol 2015; 68:245-51. [PMID: 26251754 PMCID: PMC4526614 DOI: 10.5173/ceju.2015.543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/15/2015] [Accepted: 04/18/2015] [Indexed: 12/20/2022] Open
Abstract
Introduction Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction have been developed and are bcoming more popular. Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, for both the transperitoneal and retroperitoneal approaches. In this review, we aimed to analyze the current status of minimally invasive therapy of ureteropelvic junction obstruction. Material and methods A PubMed database search was conducted to examine minimally invasive treatments of ureteropelvic junction obstruction. Results A large number of cases have been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric populations. A clear advantage, in terms of hospital stay, of minimally invasive over open pyeloplasty was observed only in the adult population. Conclusions Studies have shown that minimally invasive pyeloplasty techniques are a safe, effective, and feasible in adult and pediatric populations.
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Affiliation(s)
- Rahmi Gokhan Ekin
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Orcun Celik
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Yusuf Ozlem Ilbey
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
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Hsi RS, Holt SK, Gore JL, Lendvay TS, Harper JD. National Trends in Followup Imaging after Pyeloplasty in Children in the United States. J Urol 2015; 194:777-82. [PMID: 25868576 DOI: 10.1016/j.juro.2015.03.123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Radiographic followup after pyeloplasty for the correction of ureteropelvic junction obstruction is not well defined in children. We characterize trends in frequency and modality of postoperative imaging after open and minimally invasive pediatric pyeloplasty. MATERIALS AND METHODS Using the MarketScan® database, we identified patients 0 to 18 years old undergoing pyeloplasty between 2007 and 2013. Followup imaging was classified as functional (diuretic renography, excretory urography) or nonfunctional (ultrasound, computerized tomography, magnetic resonance imaging). We excluded patients with less than 24 months of postoperative enrollment in MarketScan. Multivariate logistic regression was performed to determine associations between demographic variables and imaging use patterns. RESULTS We identified 926 patients with a mean ± SD followup of 3.6 ± 1.3 years, of whom 30% underwent minimally invasive pyeloplasty. Overall 5.9% of patients had no postoperative imaging available. Within the first 6 months postoperatively 853 patients (91%) underwent at least 1 imaging study and 192 (24%) underwent renography. Within the first 12 months postoperatively 91% of patients underwent at least 1 imaging study, most commonly ultrasound. After 12 months almost a third of the patients were not followed with imaging. Of the 71% undergoing imaging most underwent ultrasound. Younger age and female gender were independently associated with frequent imaging (at least yearly) on multivariate logistic regression. CONCLUSIONS Following pediatric pyeloplasty there is variation in modality and frequency of imaging followup. The majority of patients are followed with renal ultrasound, with less frequent use of functional imaging. Almost a third of patients do not undergo followup imaging after 1 year.
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Affiliation(s)
- Ryan S Hsi
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington.
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
| | - John L Gore
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
| | - Thomas S Lendvay
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
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14
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Recurrent Severe Abdominal Pain in the Pediatric Patient. J Emerg Med 2014; 46:627-31. [DOI: 10.1016/j.jemermed.2013.11.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 10/29/2013] [Accepted: 11/17/2013] [Indexed: 11/19/2022]
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15
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Autorino R, Eden C, El-Ghoneimi A, Guazzoni G, Buffi N, Peters CA, Stein RJ, Gettman M. Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis. Eur Urol 2013; 65:430-52. [PMID: 23856037 DOI: 10.1016/j.eururo.2013.06.053] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/26/2013] [Indexed: 12/15/2022]
Abstract
CONTEXT Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized. OBJECTIVE To critically analyze the current status of laparoscopic and robotic repair of UPJO. EVIDENCE ACQUISITION A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. EVIDENCE SYNTHESIS Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population. CONCLUSIONS Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.
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Affiliation(s)
- Riccardo Autorino
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Service, Second University of Naples, Naples, Italy.
| | - Christopher Eden
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Hôpital Robert Debré, Assistance Publique-Hopitaux de Paris, University of Paris Diderot, Paris, France
| | - Giorgio Guazzoni
- Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy
| | - Nicolòmaria Buffi
- Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy
| | - Craig A Peters
- Department of Pediatric Surgery, Children's National Medical Center, Washington, DC, USA
| | - Robert J Stein
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Turner RM, Fox JA, Tomaszewski JJ, Schneck FX, Docimo SG, Ost MC. Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants. J Urol 2013; 189:1503-7. [PMID: 23123373 DOI: 10.1016/j.juro.2012.10.067] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Robert M. Turner
- Department of Urology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Janelle A. Fox
- Department of Urology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jeffrey J. Tomaszewski
- Department of Urology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Francis X. Schneck
- Department of Urology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Steven G. Docimo
- Department of Urology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael C. Ost
- Department of Urology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Knoedler J, Han L, Granberg C, Kramer S, Chow G, Gettman M, Kimball B, Moriarty J, Kim S, Husmann D. Population-based comparison of laparoscopic and open pyeloplasty in paediatric pelvi-ureretic junction obstruction. BJU Int 2013; 111:1141-7. [DOI: 10.1111/bju.12039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- John Knoedler
- Department of Urology; Mayo Clinic; Rochester MN USA
| | - Leona Han
- Division of Health Care Policy and Research; Mayo Clinic; Rochester MN USA
| | | | | | - George Chow
- Department of Urology; Mayo Clinic; Rochester MN USA
| | | | - Brittany Kimball
- Division of Health Care Policy and Research; Mayo Clinic; Rochester MN USA
| | - James Moriarty
- Division of Health Care Policy and Research; Mayo Clinic; Rochester MN USA
| | - Simon Kim
- Department of Urology; Mayo Clinic; Rochester MN USA
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18
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Robot-Assisted Laparoscopic Reoperative Repair for Failed Pyeloplasty in Children: A Safe and Highly Effective Treatment Option. J Urol 2012; 188:932-7. [DOI: 10.1016/j.juro.2012.04.118] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Indexed: 11/22/2022]
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Kim EH, Tanagho YS, Traxel EJ, Austin PF, Figenshau RS, Coplen DE. Endopyelotomy for pediatric ureteropelvic junction obstruction: a review of our 25-year experience. J Urol 2012; 188:1628-33. [PMID: 22906656 DOI: 10.1016/j.juro.2012.02.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Indexed: 11/17/2022]
Abstract
PURPOSE We elucidate the role of endopyelotomy as a primary and secondary intervention for ureteropelvic junction obstruction in children. MATERIALS AND METHODS We retrospectively identified 79 pediatric patients who underwent endopyelotomy for ureteropelvic junction obstruction between 1986 and 2011. Eleven patients were lost to followup and were excluded from analysis. Patient demographics, operative information, complications and success rates were reviewed for the remaining 68 patients. Treatment success was defined as the absence of symptom recurrence and improved radiographic features on ultrasound, computerized tomography, diuretic renogram or excretory urogram at most recent followup. RESULTS Primary endopyelotomy data were analyzed in 37 patients with a median age of 11.1 years. The success rate was 65% at a median followup of 34 months (range 1.5 to 242). Treatment failure occurred in 13 patients with a median time to failure of 8 months (range 1.5 to 131). There were 8 cases of failure during 12 months of surgery. Secondary endopyelotomy data were analyzed in 31 patients with a median age of 6.5 years. The success rate was 94% at a median followup of 61 months (range 1 to 204). Treatment failure occurred in 2 patients at 1 and 6 months. Approximately two-thirds of all procedures used an antegrade approach. CONCLUSIONS Primary endopyelotomy is significantly less successful than pyeloplasty in the treatment of ureteropelvic junction obstruction in pediatric patients. However, secondary endopyelotomy following failed pyeloplasty represents a viable alternative to redo pyeloplasty.
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Affiliation(s)
- Eric H Kim
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA
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Scarless Pyeloplasty in the Pediatric Population. Urology 2012; 80:200-2. [DOI: 10.1016/j.urology.2012.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 03/03/2012] [Accepted: 03/09/2012] [Indexed: 12/15/2022]
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21
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