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Li P, Ma Y, Jin X, Xiang L, Li H, Wang K. Comparative efficacy and safety of different minimal invasive pyeloplasty in treating patients with ureteropelvic junction obstruction: a network meta-analysis. World J Urol 2023; 41:2659-2669. [PMID: 37566142 DOI: 10.1007/s00345-023-04559-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE In recent years, the minimally invasive surgical treatment methods of ureteropelvic junctional obstruction (UPJO) have been diverse, but its approach and choice of surgical method are controversial. This network meta-analysis (NMA) aimed to compare the safety and effectiveness of minimally invasive surgeries for UPJO, which included robotic or laparoscopic pyeloplasty, via the retroperitoneal or transperitoneal approach. METHODS We searched relevant RCTs in PubMed, Embase, Web of Science, the Cochrane Library, and CNKI. To assess the results of operative time, complications and success rate, pairwise, and NMA were carried out. The models for analyses were performed by Revman 5.3, Addis V1.16.8 and R software. RESULTS A total of 6 RCTs were included in this study involving four types of surgeries: transperitoneal laparoscopic pyeloplasty (T-LP), retroperitoneal laparoscopic pyeloplasty (R-LP), robot-assisted transperitoneal pyeloplasty (T-RALP), and robot-assisted retroperitoneal pyeloplasty (R-RALP). This study consisted of 381 patients overall. T-RALP had a quicker operational duration (SMD = 1.67, 95% CI 0.27-3.07, P = 0.02) than T-LP. According to the NMA's consistency model, T-RALP improved the surgical success rate more than T-LP (RR = 6303.19, CI 1.28 to 1.47 × 1011). Ranking probabilities indicated that RALP could be the better option than LP and retroperitoneal approach was comparable to transperitoneal approach. All procedures had high surgical success rates and few complications. CONCLUSION Outcomes for four surgical approaches used in the UPJO were comparable, with T-RALP being the most recommended approach. Selection between the transperitoneal and retroperitoneal approaches primarily depended on the surgeon's preference. Higher quality evidence is needed to further enhance the result.
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Affiliation(s)
- Puhan Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Liyuan Xiang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Miyano G, Masuko T, Ohashi K, Hamano A, Suda K, Seo S, Ochi T, Koga H, Lane GJ, Tada M, Yanai T, Yamataka A. Recovery of bowel function after transperitoneal or retroperitoneal laparoscopic pyeloplasty. A multi-center study. Pediatr Surg Int 2021; 37:1791-1795. [PMID: 34498175 DOI: 10.1007/s00383-021-04990-3] [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] [Accepted: 08/01/2021] [Indexed: 11/25/2022]
Abstract
AIM To document the recovery of bowel function (BF) in children after transperitoneal (TP) or retroperitoneal (RP) laparoscopic pyeloplasty. METHODS Data were obtained retrospectively from four centers between 2008 and 2019 for TP (n = 51) and RP (n = 58). Each surgeon chose which technique to perform. RESULTS Subject demographics were not significantly different. Differences in operative times were not significant (RP: 241 min versus TP: 225 min). Mean duration/requirement for postoperative epidural/intravenous analgesia were not significantly different (TP: 1.4 days versus RP: 1.3 days) and (TP: 66.7% versus RP: 67.2%), respectively. Postoperative nasogastric (NG) intubation was more common in RP (TP: 19.6% versus RP: 44.8%; p < .05). NG aspiration (TP: 0.15 mL/kg/hr versus RP: 0.16 mL/kg/hr), nausea (TP: 31.4% versus RP: 17.2%), and vomiting (TP: 19.6% versus RP: 15.5%) were not significantly different. There were no perioperative complications (including ileus). Abdominal distention was problematic in one case per group (TP: 2.0% versus RP: 1.7%). Times for oral liquid (TP: 0.69 day versus RP: 0.83 day), solid food (TP: 0.88 day versus RP 1.07 days), and the first bowel movement (TP: 2.86 days versus RP: 2.79 days), were not significantly different. CONCLUSIONS BF recovery would appear to be consistent, independent of technique.
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Affiliation(s)
- Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takayuki Masuko
- Department of Pediatric Urology, Saitama Children's Hospital, Saitama, Japan
| | - Kensuke Ohashi
- Department of Pediatric Urology, Ibaraki Children's Hospital, Ibaraki, Japan
| | - Atsushi Hamano
- Department of Urology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kazuto Suda
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Shogo Seo
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Minoru Tada
- Department of Pediatric Urology, Ibaraki Children's Hospital, Ibaraki, Japan
| | - Toshihiro Yanai
- Department of Pediatric Urology, Saitama Children's Hospital, Saitama, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Juntendo University School of Medicine, Tokyo, Japan
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Wu G, Li H, Zhong P, Chen D, Zhang Z, Guo Z, Zhuo Y, Xue L, Lai C. Initial Experience with the Comprehensive Modified Laparoscopic Pyeloplasty Technique Based on Membrane Anatomy for Treating Ureteropelvic Junction Obstruction. Urol Int 2021; 106:487-494. [PMID: 34844250 DOI: 10.1159/000519929] [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: 04/17/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the objective was to present our initial experience and evaluate the feasibility of the novel comprehensive modified laparoscopic pyeloplasty (CMLP) technique based on membrane anatomy. MATERIALS AND METHODS Forty-eight patients underwent CMLP from February 2016 to October 2020. CMLP involves the following: dissection of the ureter was based on the fascia or fusion fascia formed by embryonic development. The ureter was separated from the ureteral sheath, and the pelvis and ureter were incised with incomplete amputation. The first stitch was placed between the lower point of the spatulated ureter and the lowest corner of the renal pelvis to ensure correct orientation of the anastomosis; anastomosis of the renal pelvis and ureter was performed using the touchless technique. RESULTS All CMLPs were completed successfully without conversion. The mean overall operating time was 230.96 min. The median estimated blood loss was 50.00 (interquartile range 20.00-57.50) mL. The average postoperative hospital stay was 9.31 days. The average follow-up time was 24.73 months. No major complications occurred. In 1 case, revision laparoscopic pyeloplasty was performed, but the obstruction persisted after double J stent removal, so ultimately, the double J stent required regular replacement. Another asymptomatic patient with hydronephrosis experienced failed treatment and is still under follow-up. The overall success rate was 95.83% (46/48). The success rate in patients with recurrent ureteropelvic junction obstruction (UPJO) was 87.5% (7/8). CONCLUSIONS CMLP is a practical and effective treatment option for UPJO with a high success rate. An advantage of CMLP is the clear surgical field.
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Affiliation(s)
- Guohao Wu
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, Dongguan, China,
| | - Haomin Li
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Peifeng Zhong
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Dongjiang Chen
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhihua Zhang
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zexiong Guo
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yumin Zhuo
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lianfang Xue
- Department of Pharmacy, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Caiyong Lai
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, Dongguan, China.,Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Ji F, Chen L, Wu C, Li J, Hang Y, Yan B. Meta-Analysis of the Efficacy of Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction via Retroperitoneal and Transperitoneal Approaches. Front Pediatr 2021; 9:707266. [PMID: 34395345 PMCID: PMC8357990 DOI: 10.3389/fped.2021.707266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/24/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: This study aimed to evaluate the clinical efficacy of laparoscopic pyeloplasty (LP) for ureteropelvic junction obstruction (UPJO) via retroperitoneal and transperitoneal approaches. Method: A systematic literature search on keywords was undertaken using PubMed, Cochrane Library, Embase, China Nation Knowledge (CNKI), and Wanfang. The eligible literature was screened according to inclusion and exclusion criteria. Meta-analysis was performed by using RevMan 5.0 software. Results: According to the inclusion and exclusion criteria, 12 studies were identified with a total of 777 patients. Four hundred eight patients were treated with retroperitoneal laparoscopic pyeloplasty (RLP), and 368 patients were treated with transperitoneal laparoscopic pyeloplasty (TLP). The meta-analysis results showed that the two approaches were similar in terms of presence of postoperative hospital stay, postoperative complication, the rate of conversion, and recurrence (p > 0.05). The operative time in the TLP group was significantly shorter than the RLP group (MD = 16.6; 95% CI, 3.40-29.80; p = 0.01). The duration of drainage was significantly shorter (MD = -1.06; 95% CI, -1.92 to -0.19; p = 0.02), and the score of postoperative visual analog score (VAS) was significantly lower in the RLP group than in the TLP group (MD = -0.52; 95% CI, -0.96 to -0.08; p = 0.02). Conclusion: Both approaches have good success rates and low postoperative complication rates. RLP provides a shorter duration of drainage and lower VAS score, but it takes more operative time than TLP.
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Affiliation(s)
| | - Li Chen
- Kunming Children's Hospital, Kunming, China
| | | | - Jinrong Li
- Kunming Children's Hospital, Kunming, China
| | - Yu Hang
- Kunming Children's Hospital, Kunming, China
| | - Bing Yan
- Kunming Children's Hospital, Kunming, China
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Chua ME, Ming JM, Kim JK, Milford KL, Silangcruz JM, Ren L, Rickard M, Lorenzo AJ. Meta-analysis of retroperitoneal vs transperitoneal laparoscopic and robot-assisted pyeloplasty for the management of pelvi-ureteric junction obstruction. BJU Int 2020; 127:687-702. [PMID: 33030262 DOI: 10.1111/bju.15264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine differences in perioperative outcomes between retroperitoneal and transperitoneal approaches for laparoscopic pyeloplasty (LP) to manage pelvi-ureteric junction obstruction (PUJO) through a meta-analysis of comparative studies. METHODS A systematic search was performed in January 2020. Comparative studies were evaluated according to Cochrane Collaboration recommendations. Assessed outcomes included success and complication rates, conversion to open surgery, operative time (OT), length of hospital stay (LOS), estimated blood loss (EBL), analgesic requirements, regular diet resumption, and drain duration. Relative risk (RR) and standardised mean difference (SMD) with 95% confidence intervals (CIs) were extrapolated. Subgroup analyses were performed according to study design and techniques. International Prospective Register of Systematic Reviews (PROSPERO) number: CRD42020163303. RESULTS A total of 18 studies describing 2007 cases were included. Overall pooled effect estimates did not show statistically significant differences between the approaches with regards to success rate (RR 0.99; 95% CI 0.97, 1.01), complications (RR 1.09; 95% CI 0.82, 1.45), OT (SMD 0.61; 95% CI -0.04, 1.26), LOS (SMD -0.30; 95% CI -0.63, 0.04), EBL (SMD -0.53; 95% CI -1.26, 0.21), or analgesic requirements (SMD -0.51; 95% CI -1.23, 0.21). Compared to the transperitoneal approach, retroperitoneal LP had a higher conversion rate (RR 2.40; 95% CI 1.23, 4.66); however, patients resumed diets earlier (SMD -2.49; 95% CI -4.17, -0.82) and had shorter drain duration (SMD -0.31; 95% CI -0.57, -0.05). CONCLUSION The evidence suggests that there are no significant differences in success rate, OT and complications between transperitoneal and retroperitoneal LP. Conversion rates are higher with the retroperitoneal approach; however, return to diet occurs faster and drain duration is shorter when compared to the transperitoneal approach.
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Affiliation(s)
- Michael E Chua
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Urology, St. Luke's Medical Center, QC, NCR, Quezon City, Philippines
| | - Jessica M Ming
- Section of Urology, Department of Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Jin Kyu Kim
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Karen L Milford
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Lily Ren
- Learning Commons, Learning Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Lane Medical Library, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
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Dirie NI, Wang Q, Wang S. Two-Dimensional Versus Three-Dimensional Laparoscopic Systems in Urology: A Systematic Review and Meta-Analysis. J Endourol 2019; 32:781-790. [PMID: 29969912 PMCID: PMC6156697 DOI: 10.1089/end.2018.0411] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Laparoscopy is widely used in the urological field. This systematic review and a meta-analysis were conducted to assess the clinical and surgical efficacy of the three-dimensional (3D) laparoscopic system in comparison with two-dimensional (2D) laparoscopy for treatment of different urological conditions. METHODS Following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic literature search in Web of Science, PubMed, Cochrane Library, and EMBase was carried out to identify relevant studies published up to May 2018. Articles published in the English language of both randomized and observational studies comparing 3D and 2D laparoscopic systems in urological surgeries were included. Level of evidence and quality assessments of all included studies were conducted. Interested data were extracted for comparison and meta-analysis. RESULTS Our literature search generated 17 studies comparing 3D and 2D laparoscopic systems in different urological surgeries. Of these, 13 studies containing 548 and 449 patients operated on with 2D and 3D laparoscopic systems, respectively, were included for meta-analysis. These 13 studies were divided into three groups according to surgical type. Group 1: Partial nephrectomy (PN); operative time (p = 0.19), estimated blood loss (EBL) (p = 0.51), dissecting time (p = 0.58), and suturing time (p = 0.28) were not statistically significant between 2D and 3D laparoscopic systems. However, warm ischemia time during PN was significantly shorter during 3D laparoscopy (p < 0.00001). Group 2: Pyeloplasty; this procedure showed no significant difference between the two systems. Group 3: Radical prostatectomy (RP); shorter operative time (p < 0.0001) and lower EBL (p = 0.001) were associated with the 3D laparoscopic system. CONCLUSION Three-dimensional laparoscopy mainly improves the depth of perception, leading to better visibility, which is important for some complex urological surgeries such as PN, pyeloplasty, and RP. Based on our findings, 3D laparoscopy seems to provide better clinical and surgical outcomes in some urological procedures compared with conventional 2D laparoscopy.
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Affiliation(s)
- Najib Isse Dirie
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
| | - Qing Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, P.R. China
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Lombardo R, Martos R, Ribal MJ, Alcaraz A, Tubaro A, De Nunzio C. Retroperitoneoscopy in urology: a systematic review. MINERVA UROL NEFROL 2019; 71:9-16. [PMID: 30607927 DOI: 10.23736/s0393-2249.18.03235-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In the past years, several authors have focused on the role of retroperitoneoscopic laparoscopy in the treatment of urological diseases. Aim of our study is to systematically review the available literature on retro-peritoneoscopic laparoscopy in urology. EVIDENCE ACQUISITION A systematic review of the literature using the Medline, Scopus, and Web of Science databases for relevant articles published until June 2018 was performed using both the Medical Subjects Heading and free test protocols. The MeSH search was conducted by combining the following terms: "retroperitoneoscopy," "posterior laparoscopy," "retroperitoneoscopic." Only randomized clinical trials were included in the analysis. Risk of bias assessment and forest plots were used to summarize data. EVIDENCE SYNTHESIS Nine RCTs on simple, partial and radical nephrectomy, pyeloplasty, ureterolithotomy and nephrolithotomy comparing RP to other techniques were included in the analysis. Retroperitoneoscopic approach in simple or radical nephrectomy is to be considered a valid alternative to transperitoneal laparoscopic approach. Outcomes and safety profiles (6-8% conversion rate) are similar and the approach depends on surgeon's preferences. Randomized studies analyzing retroperitoneoscopic pyeloplasty showed better results in terms of perioperative morbidity (tramadol use: 147 vs. 179 mg, P=0.002) and return to normal activities when compared to either anterior laparoscopic either to minimally invasive open approach. Two randomized studies have confirmed the efficacy (stone-free rate: 94%) and safety (no Clavien-Dindo >II complications) of ureterolithotomy and nephrolithotomy (stone-free rate: 95%) in the management of large renal and ureteral stones. CONCLUSIONS Retroperitoneoscopic approach in urological diseases is a valid alternative to the anterior approach. Evidence suggest lower morbidity for the retroperitoneoscopic approach however technical complexity may limit its widespread.
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Affiliation(s)
- Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy -
| | - Raul Martos
- Department of Urology, Hospital Clínic, Barcelona, Spain
| | - Maria J Ribal
- Department of Urology, Hospital Clínic, Barcelona, Spain
| | | | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Zamfir Snykers C, De Plaen E, Vermersch S, Lopez M, Khelif K, Luyckx S, Philippe P, Varlet F, Steyaert H. Is Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants Under 1 Year of Age a Good Option? Front Pediatr 2019; 7:352. [PMID: 31608264 PMCID: PMC6773808 DOI: 10.3389/fped.2019.00352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/07/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose: Laparoscopic pyeloplasty in children younger than 1 year of age is still debatable due to its supposed technical difficulties and failure rate. We present our experience and outcome in infants. Materials and Methods: A retrospective study was conducted in 3 Departments of Pediatric Surgery. We reviewed the records of the children under 1 year of age operated on for ureteropelvic junction obstruction (UPJO), between 2007 and 2017. Anderson-Hynes laparoscopic transabdominal dismembered pyeloplasty was performed. Patients' demographics, results of preoperative and postoperative exams, perioperative details, complications, hospital stay, and long-term follow-up results were analyzed. Results: Sixty cases were operated on during this period (49 boys, 11 girls). Mean age at operation was 4.5 months (1-12 months). Mean operating time was 140 min (80-240 min). There was no conversion in this group. There were four early complications: 1 ileus, 1 hypertension immediately post-operatively requiring medical treatment, 1 omental herniation through a drain orifice, and 1 percutaneous transanastomotic stent migrated intra-abdominally. The two last children had to be reoperated. Mean hospital stay was of 2 days (1-10 days). Late complications: two patients (3.4%) presented a recurrence of UPJO, one had been re-operated 15 months later and for the patient with persistent hypertension, nephropexy was performed for malrotated kidney, 1 year after pyeloplasty. Long term follow-up with a mean of 2.8 years (1-10 years) showed that surgery improved mean pelvic dilatation from 31.8 mm (13-63 mm) preoperatively to 15.3 mm (4-40 mm) postoperatively (P < 0.0001). The renal function slightly improved, from a mean of 35.7% (5-55%) it passed to 40.5% (0-54%), p = 0.137. In three cases the operated kidney became finally non-functional and atrophic. Conclusions: Laparoscopic transperitoneal pyeloplasty is feasible and safe in children younger than 1 year of age. Nevertheless, it requires experience and good intra-abdominal suturing skills. Laparoscopic pyeloplasty has a success rate comparable with open treatment but with less morbidity and better cosmetic results.
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Affiliation(s)
- Corina Zamfir Snykers
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Elea De Plaen
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sophie Vermersch
- Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Manuel Lopez
- Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Karim Khelif
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Stephane Luyckx
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Paul Philippe
- Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Francois Varlet
- Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Henri Steyaert
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Li K, Hu C, Huang W, Si-Tu J, Lu L, Mao Y, Zhang H, Qiu J, Wang D. A modification with threading cannula needle-assisted 4-point suspension fixation for retroperitoneal laparoscopic pyeloplasty in children with ureteropelvic junction obstruction: a cohort study in single center. Int Urol Nephrol 2018; 51:193-199. [PMID: 30519979 PMCID: PMC6394441 DOI: 10.1007/s11255-018-2048-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/03/2018] [Indexed: 12/25/2022]
Abstract
Purpose To evaluate the effect and safety of modifying a threading cannula needle-assisted suspension fixation in retroperitoneal laparoscopic dismembered pyeloplasty (LDP) for children with congenital ureteropelvic junction obstruction (UPJO). Methods Between December 2012 and December 2017, 45 children (< 14 years of age) with congenital UPJO were divided into two groups. In Group A, children underwent conventional “no-suspension fixation” LDP; and in Group B, “4-point suspension fixation” LDP was performed to lower difficulties and shorten operative time. The perioperative clinical data were recorded and analyzed. Results No statistical difference was found between two groups in preoperative characteristics. The duration of surgery, operative time for completion of anastomosis and the length of postoperative hospital stay in Group B was remarkably shortened than that in Group A, respectively (P < 0.05 for all). There was no significant difference between two groups in terms of postoperative renal pelvic diameter (RPD) decreasing, extubation time and success rates of surgery (P > 0.05 for all). In addition, no recurrent stenosis and urine leakage in both groups, and the postoperative RPD remained at the low level in both groups during the period of follow-up. Conclusions Our modification of the 4-point suspension fixation for retroperitoneal LDP is an effective and safe method for children with UPJO. It can simplify the surgical procedures, lower difficulties (especially in precise anastomotic suturing) and shorten the learning curve. This modification might be of particular interest to urologists for improving treatment of children with UPJO.
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Affiliation(s)
- Ke Li
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Cheng Hu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Wentao Huang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Jie Si-Tu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Li Lu
- Department of Urology, The Sixth Affiliated Hospital of Sun Yat-sen University, Yuancun Erheng Road 26, Guangzhou, 510655 Guangdong China
| | - Yunhua Mao
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Huimin Zhang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Jianguang Qiu
- Department of Urology, The Sixth Affiliated Hospital of Sun Yat-sen University, Yuancun Erheng Road 26, Guangzhou, 510655 Guangdong China
| | - Dejuan Wang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
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