Comparative study of different surgical approaches for treatment of UPJ obstruction according to the degree/severity of hydronephrosis factor

An assisted suspension fixation technique in transperitoneal laparoscopic pyeloplasty for infants and young children with ureteropelvic junction obstruction: a retrospective cohort study

Background

Anderson-Hynes pyeloplasty is a classic and highly effective technique for treating congenital ureteropelvic junction obstruction (UPJO). Laparoscopic minimally invasive surgery (MIS) has become the preferred approach for infants and young children. However, a small working area and the complexity of reconstruction procedure pose significant challenges. This study aims to evaluate the efficacy and safety of four-point suspension fixation technique in laparoscopic dismembered pyeloplasty (LDP) for infants and young children with UPJO.

Methods

This retrospective cohort enrolled 37 infants and young children diagnosed with UPJO and underwent transperitoneal LDP between 2014 and 2020. The 37 cases were divided into two Groups based on whether suspension fixation was applied during the transperitoneal LDP. Clinical characteristics and follow-up data of these cohorts were retrospectively collected and analyzed. Continuous variables with a normal distribution were expressed as mean ± standard deviation (SD) and analyzed using independent sample t-tests. Non-normally distributed continuous variables were reported as interquartile range (IQR) and analyzed with the Mann-Whitney U-test.

Results

In Group A, 21 cases underwent conventional LDP without suspension fixation, while in Group B, 16 cases underwent "suspension fixation" LDP. The operative time (237.9±63.0 vs. 186.4±52.3 min, P=0.01), anastomotic suturing completion time (125.2±21.6 vs. 75.9±12.1 min, P<0.001), and postoperative hospital stay duration [6.0 (4.0, 7.5) vs. 4.5 (3.0, 6.5) days, P=0.04] were significantly shorter in Group B than in Group A, and the intraoperative blood loss [15.0 (5.0, 21.0) vs. 7.5 (5.0, 10.8) mL, P=0.04] in Group B was significantly lower than that in Group A. There were no significant differences between the two Groups in preoperative and anteroposterior renal pelvic diameter (APD), postoperative days to drainage tube removal, and postoperative days to removal of double J (D-J) sent. In Group A, one case developed anastomotic stenosis during follow-up, which improved after ureteral balloon dilation. In Group B, one case developed recurrent febrile urinary tract infection (UTI) within two months of D-J stent removal and was ultimately cured with antibiotic treatment during follow-up. The success rates were 95.2% (20/21) in Group A and 93.8% (15/16) in Group B. Other cases who were followed up showed no recurrence of stenosis, urine leakage, or recurrent UTI.

Conclusions

The use of assisted suspension fixation in transperitoneal LDP is safe and efficient for infants and young children, helping to reduce operative time, overcome the small laparoscopic operating area, and address the steep learning curve, making it a valuable approach.

Efficacy of Endopyelotomy for Secondary Pelvi-Ureteric Junction (PUJ) Obstruction in Terms of Improvement in Renal Function

Objective The objective of this study is to measure renal function improvement after endopyelotomy for secondary pelvi-ureteric junction (PUJ) obstruction using technetium-99m diethylene-triamine-pentaacetate (DTPA) renal scintigraphy. Material and methods This descriptive study was carried out at the Department of Urology, Institute of Kidney Diseases, Peshawar, Pakistan from June 1, 2021, to May 31, 2023. The study included 118 secondary PUJ blockage patients who underwent endopyelotomy. Patient demographics, clinical history, and preoperative imaging findings were obtained. DTPA renal scintigraphy assessed renal function improvement postoperatively at intervals to determine the efficacy of endopyelotomy. Results The majority of the patients included in the study were male (n=65, 55.1%). The average age of the patients was 45.2 years, with the majority falling within the age range of 46-60 years (n=42, 35.6%). All patients had ultrasonography and computed tomography imaging done, and preoperative renal functions were obtained. Comorbidities included hypertension in 32 (27.12%) and diabetes in 18 (15.25%). DTPA renal scintigraphy showed improved renal function in 81.35% of patients at three months, 88.13% at six months, and 83.05% at 12 months; 15.3% of patients needed further treatments, and 5.1% had PUJ blockage recurrence. Conclusion This study offers significant insights into the results and complexities of endopyelotomy in patients suffering from PUJ blockage. The findings indicate that the technique efficiently enhances kidney function and alleviates symptoms in most patients. However, the study also emphasizes the need to monitor patients undergoing this procedure.