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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Blanc T, Abbo O, Vatta F, Grosman J, Marquant F, Elie C, Juricic M, Laraqui S, Broch A, Arnaud A. Transperitoneal Versus Retroperitoneal Robotic-assisted Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Children. A Multicentre, Prospective Study. EUR UROL SUPPL 2022; 41:134-140. [PMID: 35813254 PMCID: PMC9257661 DOI: 10.1016/j.euros.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/27/2022] Open
Abstract
Background Robotic-assisted laparoscopic pyeloplasty (RALP) has been gaining acceptance among paediatric urologists. Objective To compare surgical variables and clinical outcomes, including complications and success rate, with RALP using the transperitoneal (T-RALP) and retroperitoneal (R-RALP) approaches. Design, setting, and participants We performed a multicentre, prospective, cohort study (NCT03274050) between November 2016 and October 2021 in three paediatric urology teaching centres (transperitoneal approach, n = 2; retroperitoneal approach, n = 1). The diagnosis of ureteropelvic junction obstruction (UPJO) was confirmed by renal ultrasound and mercaptoacetyltriglycine-3 renal scan or uro–magnetic resonance imaging with functional evaluation. The exclusion criteria were children <2 yr old, persistent UPJO after failed pyeloplasty, and horseshoe and ectopic kidney. Intervention We performed dismembered pyeloplasty using running monofilament 6-0 absorbable suture. Outcome measurements and statistical analysis We assessed intra- and postoperative morbidity (primary outcome) and success (secondary outcome). Data were expressed as medians and interquartile range (25th and 75th percentiles) for quantitative variables, and analysed comparatively. Results and limitations We operated on 106 children (T-RALP, n = 53; R-RALP, n = 53). Preoperative data were comparable between groups (median age 9.1 [6.2–11.2] yr; median weight 26.8 [21–40] kg). Set-up time (10 vs 31 min), anastomotic time (49 vs 73 min), and console time (97 vs 153 min) were significantly shorter with T-RALP than with R-RALP (p < 0.001). No intraoperative complications occurred. No conversion to open surgery was necessary. The median hospital stay was longer after T-RALP (2 d) than after R-RALP (1 d; p < 0.001). Overall, postoperative complication rates were similar. No failure had occurred at the mean follow-up of 25.4 (15.1–34.7) mo. Conclusions In selected children, RALP is safe and effective using either the transperitoneal or the retroperitoneal approach, with a shorter hospital stay after R-RALP. Patient summary In our multicentre, prospective study, we compared the results and complications of robotic-assisted laparoscopic pyeloplasty (RALP) using the transperitoneal and retroperitoneal approaches. We found that RALP is safe and effective using either approach, with a shorter hospital stay after R-RALP.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Song P, Shu M, Peng Z, Yang L, Zhou M, Wang Z, Lu N, Pei C, Dong Q. Transperitoneal versus retroperitoneal approaches of pyeloplasty in management of ureteropelvic junction obstruction: A meta-analysis. Asian J Surg 2021; 45:1-7. [PMID: 33867239 DOI: 10.1016/j.asjsur.2021.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 02/08/2023] Open
Abstract
The aim of this study was to evaluate the benefits and safety of transperitoneal and retroperitoneal pyeloplasty for ureteropelvic junction obstruction by a meta-analysis. We searched the databases including PubMed, Cochrane Library and Embase database from their inception to December 1st, 2020. Relevant literatures comparing retroperitoneal pyeloplasty with transperitoneal pyeloplasty were identified. A meta-analysis was conducted with Revman 5.3. The main outcomes included success rate, operative time, hospital stay, conversion rate of open surgery, overall complications, and detailed postoperative complications/indicators. 15 studies with 1881 patients were included. The results revealed that there were no significant differences between two approaches in success rate [OR = 1.51, 95%CI (0.94, 2.41), p = 0.09], hospital stay [MD = 0.21, 95%CI (-0.12, 0.54), p = 0.21] and overall complications [OR = 1.07, 95%CI (0.76, 1.50), p = 0.69]. The retroperitoneal approach was associated with longer operative time [MD = -26.91, 95%CI (-40.97, -12.84), p < 0.001], higher conversion rate [OR = 0.23, 95%CI (0.11, 0.47), p < 0.001] than the transperitoneal approach. As for the detailed postoperative complications/indicators, there were no significant differences between two approaches in the urinary leak, mild hematuria, fever, UPJO recurrence, infection and subcutaneous emphysema, as well as split renal function, renal pelvis anteroposterior diameter. The funnel plots showed that there were no obvious publication biases in our analysis. Therefore, we concluded that transperitoneal and retroperitoneal approaches had similar benefits and safety in success rate, hospital stay, overall complications and detailed postoperative complications/indicators. However, retroperitoneal was associated with longer operative time and higher conversion rate than transperitoneal approach. With the limitations of our study, additional high-quality studies are still essential for further evaluation.
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Affiliation(s)
- Pan Song
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Mengxuan Shu
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Zhufeng Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Luchen Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Mingzhen Zhou
- The Second Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Zirui Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Ni Lu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Caixia Pei
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Qiang Dong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rühle A, Arbelaez E, Mattei A, Danuser H. The Watertightness of the Anastomosis After Laparoscopic or Robot-Assisted Pyeloplasty: Is a Drainage Necessary? J Endourol 2017; 31:295-299. [DOI: 10.1089/end.2016.0655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Annika Rühle
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Emilio Arbelaez
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
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Abstract
INTRODUCTION Failure after pyeloplasty is difficult to manage. We report our experience managing pyeloplasty failures. METHODS We retrospectively reviewed the case log of a single surgeon, from August 1996 to August 2014, to identify all patients undergoing a surgical procedure after failed pyeloplasty. We excluded patients without follow-up exceeding 1 year from initial postpyeloplasty procedure. Failure was defined as a need for additional definitive intervention. RESULTS Of 247 laparoscopic pyeloplasties, 68 endopyelotomies and 305 simple laparoscopic nephrectomies reviewed, 41 were performed after previous pyeloplasty and had sufficient follow-up. Laparoscopic nephrectomy was performed in nine patients. All three secondary laparoscopic pyeloplasties were successful. Of 29 secondary endopyelotomies, 10 (34%) were successful. Of the 19 failures after secondary endopyelotomy, 12 patients had tertiary pyeloplasty (5 laparoscopic and 7 open surgical), 5 (26%) underwent tertiary endopyelotomy, and 2 (11%) required nephrectomy. Our overall endopyelotomy success rate was 38% (13/34) vs 100% (11/11) for secondary or tertiary pyeloplasty (4 patients lost to follow-up). Median time to failure was 5 months for endopyelotomy. Median follow-up for patients free from intervention was 40.2 months. CONCLUSIONS Secondary pyeloplasty (including both laparoscopic and open surgical approach) is more than twice as successful as endopyelotomy after failed pyeloplasty. Secondary pyeloplasty is an excellent alternative to endopyelotomy in select patients with failure after initial pyeloplasty.
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Affiliation(s)
- Ryan Swearingen
- Department of Urology, University of Michigan , Ann Arbor, Michigan
| | - Sapan Ambani
- Department of Urology, University of Michigan , Ann Arbor, Michigan
| | - Gary J Faerber
- Department of Urology, University of Michigan , Ann Arbor, Michigan
| | - David A Bloom
- Department of Urology, University of Michigan , Ann Arbor, Michigan
| | - J Stuart Wolf
- Department of Urology, University of Michigan , Ann Arbor, Michigan
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Singh V, Sinha RJ, Gupta DK, Kumar V, Pandey M, Akhtar A. Prospective randomized comparison between transperitoneal laparoscopic pyeloplasty and retroperitoneoscopic pyeloplasty for primary ureteropelvic junction obstruction. JSLS 2016; 18:JSLS-D-13-00366. [PMID: 25392671 PMCID: PMC4208907 DOI: 10.4293/jsls.2014.00366] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: To compare laparoscopic transperitoneal versus retroperitoneoscopic pyeloplasty for primary ureteropelvic junction obstruction in a prospective randomized manner and assess overall results with long-term follow-up. Methods: In this prospective study, from 2008 to 2012, 112 cases of primary ureteropelvic junction obstruction were randomized in a 1:1 ratio into 2 groups. Group I included patients who underwent transperitoneal laparoscopic pyeloplasty, and group II consisted of patients who underwent retroperitoneoscopic laparoscopic pyeloplasty. Demographic and clinical characteristics and postoperative and operative data were collected and analyzed. The statistical analysis was performed with the Fisher exact test, χ2 test, and Mann-Whitney U test for independent groups, and P < .05 was considered statistically significant. Results: The total operative time and intracorporeal suturing time were significantly higher in group II than in group I (P < .001). The visual analog scale score for pain on postoperative day 1 and the requirement for tramadol were significantly higher in group I than in group II (P = .004). The hospital stay and the rate of temporary ileus were significantly greater (P < .036 and P < .02, respectively) in group I than in group II. The success rate of transperitoneal laparoscopic pyeloplasty versus retroperitoneoscopic laparoscopic pyeloplasty was 96.4% versus 96.6% with a mean follow-up period of 30.75 ± 4.85 months versus 30.99 ± 5.59 months (P < .88). Conclusion: Transperitoneal laparoscopic pyeloplasty is associated with significantly greater postoperative pain, a higher tramadol dose, a higher rate of ileus, and a longer hospital stay in comparison with retroperitoneoscopic laparoscopic pyeloplasty. Although the operative time for retroperitoneoscopic laparoscopic pyeloplasty is significantly longer, the success rate remains the same for both procedures.
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Affiliation(s)
- Vishwajeet Singh
- Department of Urology, King George's Medical University, Lucknow, India
| | - Rahul Janak Sinha
- Department of Urology, King George's Medical University, Lucknow, India
| | | | - Vikas Kumar
- Department of Urology, King George's Medical University, Lucknow, India
| | - Mohit Pandey
- Department of Radiodiagnosis, King George's Medical University, Lucknow, India
| | - Asif Akhtar
- Department of Psychiatry, King George's Medical University, Lucknow, India
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Donati-Bourne J, Husaini MI, Pillai P, Mathias SJ, Fernando H, Luscombe C, Golash A. A drain- and catheter-free enhanced recovery protocol to achieve discharge within 23 hours of laparoscopic pyeloplasty surgery: Is this feasible and safe? Journal of Clinical Urology 2016. [DOI: 10.1177/2051415815626321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The objective of this article is to review the outcomes of our updated single-centre extended experience of an innovative enhanced recovery pathway to perform catheter- and drain-free laparoscopic pyeloplasties, achieving safe discharge within 23 hours of surgery. Patients and methods: We conducted a retrospective review of patients who underwent a standard trans-peritoneal laparoscopic pyeloplasty repair over an antegrade stent in our centre by a single surgeon, between 1 September 2007 and 1 February 2015. Patients who had a urinary catheter and/or peri-nephric drain inserted intraoperatively and were not planned for day-case discharge were excluded. Data were collected for duration of in-patient stay, readmission rates and reasons for these. Successful outcome was deemed both in subjective improvement of patient symptoms and/or objective improvement in post-operative MAG-3 renogram curve. Results: Fifty-eight patients were included. A total of 74% ( n = 43) were successfully discharged as day-case, and four of these were readmitted. Fifteen patients required in-patient stay, of whom two were readmitted. Successful outcome was recorded in 93% ( n = 54). Conclusion: The insertion of a drain and catheter are not essential in laparoscopic pyeloplasty. Avoidance of unnecessary tubes facilitates day-case surgery with no adverse effect on outcome. At our institute all patients are now offered the enhanced recovery protocol for laparoscopic pyeloplasty with resulting benefits both to patients and the local health economy.
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Affiliation(s)
| | | | - Praveen Pillai
- Department of Urology, Royal Stoke University Hospital, UK
| | | | | | | | - Anurag Golash
- Department of Urology, Royal Stoke University Hospital, UK
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Rivas JG, Gregorio SAY, Sánchez LC, Portella PF, Gómez ÁT, Ledo JC, Sebastián JD, Barthel JJDLP. Evolution in the treatment of the ureteropelvic junction obstruction syndrome. Laparoscopic versus open pyeloplasty. Cent European J Urol 2015; 68:384-8. [PMID: 26568887 PMCID: PMC4643695 DOI: 10.5173/ceju.2015.536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 01/29/2015] [Accepted: 05/12/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The treatment of ureteropelvic junction has evolved considerably over the past 20 years, resulting in new surgical techniques, but traditional open surgery remains the gold standard treatment. Currently, less invasive techniques are used for the treatment of ureteropelvic junction obstruction. The purpose of our study is to compare the surgical and functional results between laparoscopic and open pyeloplasty performed at our department during the last 12 years. MATERIAL AND METHODS This is a retrospective review of 92 cases performed in a period of 12 years. Two groups were compared: 30 patients were treated with open surgery (OP) and 62 with a laparoscopic approach (LP). Demographics, clinical presentation, functionality of the affected kidney, presence of polar vessels, kidney stones, hospital stay, complications and functional results were statistically analyzed. RESULTS The mean age was 42 years. The most common clinical presentation was kidney or ureteral pain: 60% (OP) vs. 52% (LP). The right side was affected in 59%; presence of crossing vessels was 47% (OP) vs. 58% (LP); presence of kidney stones was 20% (OP) vs. 19% (LP), with an average hospital stay of 5.86 days (OP) vs. 3.36 days (LP) p <0.05. Post-operative complications were observed in 3 (OP) vs. 5 (LP) patients, with a success rate comparable between groups. CONCLUSIONS In our department, we recommend LP as the standard treatment for ureteropelvic junction obstruction because of the equal success rate compared to OP and the benefits of a minimally invasive surgery.
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Affiliation(s)
- Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Badawy H, Zoaier A, Ghoneim T, Hanno A. Transperitoneal versus retroperitoneal laparoscopic pyeloplasty in children: Randomized clinical trial. J Pediatr Urol 2015; 11:122.e1-6. [PMID: 25979219 DOI: 10.1016/j.jpurol.2014.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 11/26/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Laparoscopic pyeloplasty achieves good cosmetic and functional outcomes. Both transperitoneal and retroperitoneal approaches are used. No single study to date has compared the two approaches in a prospective randomized design. OBJECTIVE We present a prospective randomized comparison between both approaches in children in a trial to define which technique is better with regard to multiple factors including operative time, hospital stay, recovery of bowel movement, analgesic requirement and complication rate. STUDY DESIGN In the period from June 2010 to September 2012, 38 children (25 boys and 13 girls) were operated laparoscopically. Children were randomized into Group I (19 children) operated by the transperitoneal approach, and Group II (19 children) operated by the retroperitoneal approach. Both groups were compared as regards to the operative time, anesthetic changes, and postoperative recovery. A minimum sample size required was calculated to be 19 for each arm based on previous studies of laparoscopic pyeloplasty, using a mean difference in operative time = 40 min, effect size = 0.95, an alpha of 0.05 and power 80% and an online sample size calculator. Statistical analysis was performed using SPSS software using the Fischer exact test, chi square test and Mann-Whitney U test. The operative time was the primary endpoint for comparison between both approaches. DISCUSSION Our series is the first in the literature that compares in a prospective randomized design the transperitoneal and retroperitoneal laparoscopic pyeloplasty in children. Shouma et al. is the only prospective randomized study to compare both techniques in adult pyeloplasty. They had a significantly shorter operative time in the transperitoneal group however, the author in the discussion mentioned that he was at the start of the learning curve for retroperitonoscopic pyeloplasty when he conducted his study, which affected the result of the operative time. Hence, as mentioned above, we stressed the importance of a single surgeon with adequate equal experience in both techniques. The recovery of the intestinal motility and start of oral feeding were significantly faster in the retroperitoneal group compared to the transperitoneal group. In our opinion this can be explained by the absence of intraperitoneal manipulations and urine leakage in the peritoneal space. In their series of retroperitoneal pyeloplasty, El Ghoneimi et al. reported feeding after a mean of 1.4 days, however, in our series there was even earlier oral feeding. Shouma et al. reported no significant difference in the start of oral feeding in their adult series. The limitations of our study are: the choice of the 40 min difference created a statistically significant difference in operative time between the groups which might not be considered a truly clinically important difference. In addition, the single author operating for both approaches, which might create a bias, however the author has sufficient experience in both approaches. Moreover, although there were significant differences in hospital stay and intestinal movement between the two groups, it is not clear if these were of clinical significance. CONCLUSION Both transperitoneal and retroperitoneal approaches have high success rate. The shorter operative time, shorter hospital stay, rapid recovery of intestinal movement and early resumption of oral feeding are in favor with the retroperitoneal approach.
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Affiliation(s)
- Haytham Badawy
- Unit of Pediatric Urology, Department of Urology, University of Alexandria, Egypt.
| | - Amr Zoaier
- Unit of Pediatric Urology, Department of Urology, Sporting Children Insurance Hospital, Egypt
| | - Tamer Ghoneim
- Department of Anaesthesia, University of Alexandria, Egypt
| | - Ahmed Hanno
- Department of Urology, University of Alexandria, Egypt
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Yang K, Yao L, Li X, Zhang C, Wang T, Zhang L, Fang D, He Z, Zhou L. A modified suture technique for transperitoneal laparoscopic dismembered pyeloplasty of pelviureteric junction obstruction. Urology 2015; 85:263-7. [PMID: 25530399 DOI: 10.1016/j.urology.2014.09.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/12/2014] [Accepted: 09/23/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe a modified suture technique for transperitoneal laparoscopic dismembered pyeloplasty (TPLDP) that can be consistently replicated. METHODS Between June 2010 and April 2014, 21 men and 7 women with primary pelviureteric junction obstruction underwent our modified TPLDP suture technique performed by the same surgeon. In our method, the dismembering should be performed after performing half of anastomosis to achieve the maintenance of correct orientation and the prevention of torsion of anastomosis. We defined the success criteria as complete clinical resolution of flank pain for the patients with flank pain and complete radiologic resolution for the asymptomatic patients. RESULTS The mean overall operative time for our technique was 137.3 minutes. The mean operative time for procedures on the left side was longer than on the right side (P = .02). The mean suture time was 37.2 minutes. The mean estimated blood loss was 29.4 mL, and the crossing vessel was found in 7 of 28 patients (25.0%). No open conversion was required. The mean follow-up time was 21.0 months. Only 1 patient still had frequent and intolerable flank pain after surgery whose treatment was unsuccessful. The rest of the patients got complete clinical or radiologic resolution. The success rate was 27 of 28 (96.4%). CONCLUSION Our modified TPLDP suture technique is feasible and seems to be safe and to allow high success rate for the treatment of pelviureteric junction obstruction. Sizable sample and further analysis about technique will be completed in the future.
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Oberlin DT, McGuire BB, Pilecki M, Rambachan A, Kim JY, Perry KT, Nadler RB. Contemporary National Surgical Outcomes in the Treatment of Ureteropelvic Junction Obstruction. Urology 2015; 85:363-7. [DOI: 10.1016/j.urology.2014.07.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/12/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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Garg M, Singh V, Sinha RJ, Sankhwar SN. Prospective Randomized Comparison of Retroperitoneoscopic vs Open Pyeloplasty With Minimal Incision: Subjective and Objective Assessment in Adults. Urology 2014; 83:805-11. [DOI: 10.1016/j.urology.2013.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/09/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
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Khoder WY, Waidelich R, Becker AJ, Karl A, Haseke N, Bauer RM, Stief CG, Bachmann A, Ebinger Mundorff N. Patients' Perception of Surgical Outcomes and Quality of Life after Retroperitoneoscopic and Open Pyeloplasty. Urol Int 2014; 92:74-82. [DOI: 10.1159/000352055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 05/02/2013] [Indexed: 11/19/2022]
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Vannahme M, Mathur S, Davenport K, Timoney AG, Keeley FX. The management of secondary pelvi-ureteric junction obstruction - a comparison of pyeloplasty and endopyelotomy. BJU Int 2013; 113:108-12. [DOI: 10.1111/bju.12454] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Milena Vannahme
- The Bristol Urological Institute; Southmead Hospital; North Bristol NHS Trust; Bristol Gloucestershire UK
| | - Sunil Mathur
- The Bristol Urological Institute; Southmead Hospital; North Bristol NHS Trust; Bristol Gloucestershire UK
| | - Kim Davenport
- Cheltenham General Hospital; Gloucestershire Hospitals NHS Foundation Trust; Cheltenham Gloucestershire UK
| | - Anthony G. Timoney
- The Bristol Urological Institute; Southmead Hospital; North Bristol NHS Trust; Bristol Gloucestershire UK
| | - Francis X. Keeley
- The Bristol Urological Institute; Southmead Hospital; North Bristol NHS Trust; Bristol Gloucestershire UK
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Ou Z, Qi L, Yang J, Chen X, Cao Z, Zu X, Liu L, Wang L. Preliminary Experience and Learning Curve for Laparoendoscopic Single-Site Retroperitoneal Pyeloplasty. J Laparoendosc Adv Surg Tech A 2013; 23:765-70. [PMID: 23789708 DOI: 10.1089/lap.2013.0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zhenyu Ou
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jinrui Yang
- Department of Urology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhenzhen Cao
- Department of Gynecologic Oncology, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Longfei Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Long Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Iwamura M, Nishi M, Soh S, Ikeda M, Matsumoto K, Fujita T, Baba S. Efficacy and late complications of laparoscopic pyeloplasty: experience involving 125 consecutive ureters. Asian J Endosc Surg 2013. [PMID: 23206265 DOI: 10.1111/ases.12007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Laparoscopic pyeloplasty is now widely recognized as a minimally invasive alternative for the surgical management of ureteropelvic junction obstruction. However, there have been insufficient reports describing the long-term outcomes and the stability of the results. In addition, late complications have not been thoroughly discussed. METHODS Between October 1999 and December 2010, we performed laparoscopic pyeloplasty on 125 consecutive ureters in 119 patients with an obstruction of the ureteropelvic junction. We performed dismembered Anderson-Hynes pyeloplasty, Fenger plasty and Y-V flap in 108 (86.4%), 15 (12.0%), and 2 ureters (1.6%), respectively. RESULTS All procedures were completed successfully. Median operative time was 200 min (range, 80-775 min) and median estimated blood loss was 20 mL (range, 20-250 mL). Intraoperative and postoperative complications categorized as Clavien grade II and III occurred in 11 (8.9%) procedures. Among them, three were observed after 12 months postoperative and all involved renal stones in the collapsed pelvis. In 120 (96%) ureters, hydronephrosis improved and/or obstructive pattern on diuretic renography disappeared during a median follow-up period of 45 months (range, 5-146 months). The degree of hydronephrosis steadily improved for more than 2 years, and re-obstruction was never observed after 1 year postoperative. CONCLUSION The efficacy of laparoscopic pyeloplasty seems to be durable over 2 years postoperatively. Because obstruction recurrence was not observed after 12 months postoperative, patients with complete disappearance of hydronephrosis may unnecessarily be followed longer than 2 years. However, cases with persisting hydronephrosis should be regularly monitored because of the remaining possibility of stone formation.
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Affiliation(s)
- Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan.
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Tugcu V, Ilbey YO, Sonmezay E, Aras B, Tasci AI. Laparoendoscopic single-site versus conventional transperitoneal laparoscopic pyeloplasty: a prospective randomized study. Int J Urol 2013; 20:1112-7. [PMID: 23441754 DOI: 10.1111/iju.12126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/27/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the potential benefits of laparoendoscopic single-site pyeloplasty over conventional laparoscopic pyeloplasty. METHODS Between October 2009 and January 2012, 39 patients were enrolled in a prospective study and randomized to undergo a laparoendoscopic single-site pyeloplasty (n = 19) or conventional laparoscopic pyeloplasty (n = 20). The outcomes in the two groups were compared by using Mann-Whitney U-test and χ(2) -test, and considering a P-value less than 0.05 as statistically significant. RESULTS There was no difference in blood loss (55.67 ± 6.71 vs 45.84 ± 5.22 mL, P = 0.60), transfusion rates (0% for both) and hospitalization time (2.12 ± 0.23 vs 2.06 ± 0.34 days, P = 0.72) between the laparoendoscopic single-site pyeloplasty and conventional laparoscopic pyeloplasty groups. The time to return to normal activities was shorter (8.65 ± 1.25 vs 11.53 ± 1.28 days, P = 0.01), and median operative time (195.21 ± 12.15 vs 145.62 ± 15.34 min, P = 0.001) was longer in the laparoendoscopic single-site pyeloplasty group compared with the conventional laparoscopic pyeloplasty group. No significant intraoperative or postoperative complications occurred in either group. Compared with conventional laparoscopic pyeloplasty, laparoendoscopic single-site pyeloplasty yielded better cosmetic results and patient satisfaction. The mean follow-up period was 19.7 months (4-28 months). The success rate was 95% in both the groups. Both the visual analog scale and the postoperative use of analgesics were significantly lower in patients who underwent laparoendoscopic single-site pyeloplasty. CONCLUSIONS Our findings suggest that laparoendoscopic single-site pyeloplasty can offer faster recovery and higher patient satisfaction than conventional laparoscopic pyeloplasty. Thus, this novel technique promises to become the treatment of choice in minimally-invasive management of ureteropelvic junction obstruction.
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Affiliation(s)
- Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Rivas JG, Gregorio SAY, Eastmond MAP, Gómez AT, Ledo JC, Togores LH, Barthel JJDLP. Transperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction. Cent European J Urol 2013; 66:361-6. [PMID: 24707387 PMCID: PMC3974479 DOI: 10.5173/ceju.2013.03.art31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 06/26/2013] [Accepted: 07/05/2013] [Indexed: 11/22/2022] Open
Abstract
Introduction Laparoscopic pyeloplasty was first described by Schuessler. During the last decade, this technique has been developed in order to achieve the same results as open surgery, with lower rates of morbidity and complications. In this study we review our experience using laparoscopic pyeloplasty as the gold standard for the treatment of the ureteropelvic junction obstruction (UPJO). Material and methods We performed a retrospective review of 62 laparoscopic pyeloplasties carried out at our center. In the last 2 years we used 3 mm and 5 mm ports in order to achieve better cosmetics results. Demographic data is described and the functionality of the affected kidney and surgical data, among others were analyzed statistically. In the case of bilateral statistical tests were considered significant as those with p values <0.05. Results The most frequent reason for consultation was ureteral pain. Patients mean age was 40 years and 94% of them had preoperative renogram showing a full or partial obstructive pattern. The right side was affected in 61% of cases and the left in the remaining 39%. The presence of stones was observed in 12 patients and crossing vessels in 58% of cases. The average stay was 3.72 days. Post–surgery complications were observed in two patients. The operative time was 178 minutes. Mean follow–up was 45 months and a success was achieved in 91%. Conclusions The transperitoneal laparoscopic pyeloplasty has become the gold standard for the treatment of ureteropelvic junction stenosis in our center because of high success rate, shorter postoperative stay, and low intra and postoperative complications.
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Affiliation(s)
- Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Zhu H, Shen C, Li X, Xiao X, Chen X, Zhang Q, Wang H, He Z, Zhou L. Laparoscopic Pyeloplasty: A Comparison between the Transperitoneal and Retroperitoneal Approach during the Learning Curve. Urol Int 2013; 90:130-5. [DOI: 10.1159/000343989] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 09/27/2012] [Indexed: 11/19/2022]
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Hao G, Xiao J, Yang P, Shen H. Laparoscopic Retroperitoneal Dismembered Pyeloplasty: Single-Center Experience in China. J Laparoendosc Adv Surg Tech A 2013. [PMID: 23198954 DOI: 10.1089/lap.2012.0360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- GangYue Hao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Xiao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - PeiQian Yang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - HongLiang Shen
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Arap MA, Torricelli FCM, Mitre AI, Chambo JL, Duarte RJ, Srougi M. Lessons from 90 consecutive laparoscopic dismembered pyeloplasties in a residency program. Scand J Urol 2012; 47:323-7. [DOI: 10.3109/00365599.2012.740071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Szydełko T, Kasprzak J, Lewandowski J, Apoznański W, Dembowski J. Dismembered Laparoscopic Anderson-Hynes Pyeloplasty Versus Nondismembered Laparoscopic Y-V Pyeloplasty in the Treatment of Patients with Primary Ureteropelvic Junction Obstruction: A Prospective Study. J Endourol 2012; 26:1165-70. [PMID: 22515336 DOI: 10.1089/end.2011.0642] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tomasz Szydełko
- Department of Urology, Clinical Military Hospital, University of Medicine, Wrocław, Poland
| | - Jarosław Kasprzak
- Department of Urology and Urological Oncology, University of Medicine, Wrocław, Poland
| | - Jarosław Lewandowski
- Department of Urology, Clinical Military Hospital, University of Medicine, Wrocław, Poland
| | - Wojciech Apoznański
- Department of Pediatric Surgery and Urology, University of Medicine, Wrocław, Poland
| | - Janusz Dembowski
- Department of Urology and Urological Oncology, University of Medicine, Wrocław, Poland
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Wu Y, Dong Q, Han P, Liu L, Wang L, Wei Q. Meta-analysis of Transperitoneal Versus Retroperitoneal Approaches of Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction. J Laparoendosc Adv Surg Tech A 2012; 22:658-62. [PMID: 22731801 DOI: 10.1089/lap.2011.0508] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- YunJian Wu
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Dong
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - LiangRen Liu
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Li Wang
- The Chinese Cochrane Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China
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Shadpour P, Nayyeri RK, Daneshvar R, Salimi H, Radfar H. Prospective clinical trial to compare standard colon-reflecting with transmesocolic laparoscopic pyeloplasty. BJU Int 2012; 110:1814-8. [PMID: 22500855 DOI: 10.1111/j.1464-410x.2012.11081.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Laparoscopic pyeloplasty has replaced open pyeloplasty as the new standard of care and we, among others, have even proven its applicability to redo surgery. The focus is now on limiting morbidity. One technical modification to this end is transmesocolic (TM) exposure of the PUJ. This randomized study pinpoints the objective benefits of TM exposure of the PUJ compared with standard colon reflection, and its results showed a 23% conservation in operating time. OBJECTIVE • To compare the efficacy and safety of colon-reflecting (CR) and transmesocolic (TM) laparoscopic pyeloplasty approaches in a prospective randomized non-selective setting. PATIENTS AND METHODS • Excluding only those patients with a history of abdominal surgery, all consenting patients scheduled for laparoscopic pyeloplasty of left-sided pelvi-ureteric junction (PUJ) obstruction between December 2004 and November 2007 were randomized into one of two groups: laparoscopic pyeloplasty using the standard CR approach or laparoscopic pyeloplasty through the TM aperture. • All patients underwent dismembered repair by a single expert and were followed by diuretic renogram and urography at 4 months postoperatively and by annual diuretic renogram thereafter. • Four discrete task phases were timed for comparison: trochar to PUJ, dismembering and spatulation, stenting and anastomosis. RESULTS • Sixty-four patients were randomized into two groups, TM or CR, with 32 patients in each. • The groups were similar, with no significant difference in sex, age, initial renal function or body mass index. Forty-seven patients were ≤ 15 years old. • The mean (sd) operating time was 23% shorter in the TM group, owing mostly to the much shorter trochar to PUJ phase (5.0 [3.2] min in the TM group vs 35.8 [10.3] in the CR group; P < 0.001). The mean hospitalization time was shorter in the TM group than in the CR group (2.9 vs 3.6 days; P < 0.001). • Thirty-one of 32 patients in each group (96.9%) achieved a durable cure. CONCLUSION • Transmesocolic exposure of left-sided PUJ obstruction is superior to standard CR exposure, in that it saves anaesthesia time, hospitalization time and has lower morbidity with no compromise in efficiency, and could be considered as the new standard approach.
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Affiliation(s)
- Pejman Shadpour
- Paediatric Urology and Laparoscopic Surgery Programme, Hasheminejad Kidney Centre, Hospital Management Research Center Tehran University of Medical Sciences, Tehran, Iran.
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Porpiglia F, Morra I, Bertolo R, Manfredi M, Mele F, Fiori C. Pure Mini-laparoscopic Transperitoneal Pyeloplasty in an Adult Population: Feasibility, Safety, and Functional Results After One Year of Follow-up. Urology 2012; 79:728-32. [DOI: 10.1016/j.urology.2011.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/30/2011] [Accepted: 11/10/2011] [Indexed: 11/25/2022]
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Nour H, Mostafa A, Gobashy S, Elganzoury H, Elkholy A, Riad E. Laparoscopic management of primary pelvi-ureteric junction obstruction: Single-centre experience. Arab J Urol 2011; 9:241-4. [PMID: 26579305 PMCID: PMC4150588 DOI: 10.1016/j.aju.2011.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 10/12/2011] [Accepted: 10/13/2011] [Indexed: 11/26/2022] Open
Abstract
Objective To evaluate the effect and safety of laparoscopic pyeloplasty in the treatment of pelvi-ureteric junction obstruction (PUJO). Patients and methods In 34 patients, laparoscopic dismembered pyeloplasty was used to treat primary PUJO. Information was obtained for symptoms, results of a nuclear scan before and after surgery, intraoperative blood loss, operative duration, stenting method, and hospital stay. Under general anaesthesia and in the flank position, a 10 mm trocar was first placed above the umbilicus; three 5 mm working ports were then placed. The ureter and pelvis were freed from surrounding adhesions. The obstructive pelvi-ureteric segment was then excised, and the opened point of the ureter spatulated. Ureteropyeloplasty between the lower pole, pelvis and spatulated ureter was made using a 4-0 polyglactin suture around a JJ stent. Results The mean (SD) preoperative nuclear scan result was 23.6 (6.4) mL/min, with retention of tracer. The median operative duration was 200 min, and the median blood loss 120 mL. All patients were stented with a JJ stent. The mean hospital stay was 5 days. The final results were assessed at 6 months after surgery, when the mean (SD) nuclear scan result was 30 (7.4) mL/min. Conclusion Laparoscopic pyeloplasty is a safe and effective option which can produce satisfactory results both clinically and radiologically.
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Affiliation(s)
- Hani Nour
- Corresponding author. Tel.: +20 11 11 000191/+20 23 85 80357.
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Chen Z, Chen X, Luo YC. Technical modifications of double-J stenting for retroperitoneal laparoscopic dismembered pyeloplasty in children under 5 years old. PLoS One 2011; 6:e23073. [PMID: 21853069 PMCID: PMC3154918 DOI: 10.1371/journal.pone.0023073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 07/05/2011] [Indexed: 11/18/2022] Open
Abstract
Both antegrade stenting and retrograde stenting for retroperitoneal laparoscopic dismembered pyeloplasty in children have many disadvantages. In this work, we tried using an alternative technique of modified antegrade (MAG) double-J stenting for retroperitoneal laparoscopic dismembered pyeloplasty in children under 5 years old, analyzed our results using the conventional antegrade (CAG) and the MAG techniques of stent insertion for this procedure, and reported our experience with these techniques. Between December 2002 and July 2010, 77 children under 5 years old with ureteropelvic junction obstruction underwent retroperitoneal laparoscopic dismembered pyeloplasty. CAG and MAG double-J stenting were attempted, in the first 36 cases (mean age 27.1 months) and the following 41 cases (mean age 25.4 months), respectively. The stents were removed 4–6 weeks later via cystoscopy. Follow-up studies were performed with ultrasonography and intravenous urography at 3 and 12 months postoperatively. The results showed that successful stent placement without malpositioning was achieved in 31 of 36 (86%) and all 41 (100%) cases, in the CAG and MAG groups, respectively. The common factor of unsuccessful stent was the inability to across the ureterovesical junction. The mean stent insertion time was 10 min 54 s and 12 min 46 s in the CAG and MAG groups, respectively. The mean operating time was 176 min and 185 min in the CAG and MAG groups, respectively. No stent malpositioning occurred in the MAG group; in the CAG group, two children had a malpositioned stent in the distal ureter and one child presented with a severe hematuria. Twelve months follow-up showed no new onset of hydroureteronephrosis and hydronephrosis. Thus we concluded that the MAG double-J stenting seems more reliable than CAG stenting for retroperitoneal laparoscopic dismembered pyeloplasty in children under 5 years old, with greater success and lower complication rates.
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Affiliation(s)
- Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- * E-mail:
| | - Yan-Cheng Luo
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Symons SJ, Palit V, Biyani CS, Cartledge JJ, Browning AJ, Joyce AD. Minimally invasive surgical options for ureteropelvic junction obstruction: A significant step in the right direction. Indian J Urol 2011; 25:27-33. [PMID: 19468425 PMCID: PMC2684299 DOI: 10.4103/0970-1591.45533] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Open pyeloplasty is the gold standard treatment for adult ureteropelvic junction obstruction (UPJO) with published success rates consistently over 90%. In recent years, the management of UPJO has been revolutionized by the introduction of endoscopic procedures and laparoscopic techniques. We analyzed the long-term results of endoscopic and other minimal access approaches for the treatment of UPJO. Early results for endopyelotomy were promising but long-term results were not encouraging. Laparoscopic pyeloplasty technique is well defined and duplicates the surgical principles of conventional open pyeloplasty. With such a large variety of minimally invasive procedures for the treatment of UPJO available, the treatment choice for UPJO must be based on the success and morbidity of the procedures, the surgeon’s experience, the cost of the treatment, and the patient’s choice. We feel that with the technological advances in instrumentation coupled with a decrease in cost and improved training of urological surgeons, laparoscopic pyeloplasty may evolve to be the new “gold” standard for the treatment of UPJO.
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Affiliation(s)
- Stephanie J Symons
- Endourology Society Fellow, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India; Specialist Urology Registrar, London, UK
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Dong J, Wong J, Al-Enezi A, Kapoor A, Whelan JP, Piercey K, Matsumoto ED. Laparoscopic pyeloplasty: the updated McMaster University experience. Can Urol Assoc J 2011; 2:388-91. [PMID: 18781214 DOI: 10.5489/cuaj.806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The open Anderson-Hynes procedure has an overall success rate of 90% for ureteropelvic junction obstruction. Laparoscopic pyeloplasty (LP) was developed to reduce morbidity and hospital stay while preserving the excellent results. We report on the results of our experience with laparoscopic pyeloplasty. METHODS Between January 2001 and May 2006, 77 consecutive patients underwent LP performed by one of 4 surgeons at our institution. Patients were reassessed with ultrasound (U/S) or intravenous pyelogram (IVP) at 6 weeks. Diuretic renal scan and U/S or IVP were performed at 6 months, and subsequent follow-up included a U/S or IVP as well as clinical assessment. Patients were assessed for pain and hydronephrosis on radiologic imaging, clearance on diuretic renal scan (T(1/2)) and differential renal function. RESULTS We evaluated 73 patients. The mean patient age was 38 years (range 16-71 yr), the mean operating time was 218 minutes (range 110-409 min), and the mean blood loss was 57 mL (range 25-250 mL). Mean hospital stay was 3.0 days (range 2-7 d). The success rate was 90.4%, and failures were mainly due to poor function after surgery (3 patients). Pyelolithotomy was performed concomitantly on 6 patients, which on average extended operative time by 36 minutes. CONCLUSION Our success rates are consistent with the LP experience of other centres and are comparable with rates for the open technique. Patients had short hospital stays, and complications were negligible. With experienced surgeons, LP should be the first-line treatment for ureteropelvic junction obstruction.
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Juliano RV, Mendonça RR, Meyer F, Rubinstein M, Lasmar MTC, Korkes F, Tavares A, Pompeo ACL, Tobias-Machado M. Long-Term Outcome of Laparoscopic Pyeloplasty: Multicentric Comparative Study of Techniques and Accesses. J Laparoendosc Adv Surg Tech A 2011; 21:399-403. [DOI: 10.1089/lap.2010.0281] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Marco Túlio Coelho Lasmar
- Laparoscopic Division of Hospital Felício Rocho, Belo Horizonte, Minas Gerais, Brazil
- Division of Laparoscopic Urology, ABC Medical School, Santo André, Sao Paulo, Brazil
| | - Fernando Korkes
- Division of Urology, ABC Medical School, Santo André, Sao Paulo, Brazil
| | | | | | - Marcos Tobias-Machado
- Section of Minimally Invasive Surgery, Department of Urology, ABC Medical School, Santo André, Sao Paulo, Brazil
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Szydełko T, Kasprzak J, Apoznański W, Tupikowski K, Pupka A, Janczak D, Zdrojowy R. Clavien Classification of Complications After 150 Laparoscopic Pyeloplasties. Urology 2011; 77:1359-64. [DOI: 10.1016/j.urology.2010.12.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 12/13/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
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Martina GR, Verze P, Giummelli P, Scuzzarella S, Cantoni F, Caruso G, Remotti M, Mirone VG. A Single Institute's Experience in Retroperitoneal Laparoscopic Dismembered Pyeloplasty: Results with 86 Consecutive Patients. J Endourol 2011; 25:999-1003. [DOI: 10.1089/end.2010.0683] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giorgio R. Martina
- Department of Urology, Azienda Ospedaliera Valtellina e Valchiavenna, Ospedale di Sondalo, Sondalo, Italy
| | - Paolo Verze
- Department of Urology, University Federico II of Naples, Naples, Italy
| | - Pierluigi Giummelli
- Department of Urology, Azienda Ospedaliera Valtellina e Valchiavenna, Ospedale di Sondalo, Sondalo, Italy
| | - Salvatore Scuzzarella
- Department of Urology, Azienda Ospedaliera Valtellina e Valchiavenna, Ospedale di Sondalo, Sondalo, Italy
| | - Federico Cantoni
- Department of Urology, Azienda Ospedaliera Valtellina e Valchiavenna, Ospedale di Sondalo, Sondalo, Italy
| | - Giacomo Caruso
- Department of Urology, Azienda Ospedaliera Valtellina e Valchiavenna, Ospedale di Sondalo, Sondalo, Italy
| | - Marco Remotti
- Department of Urology, Azienda Ospedaliera Valtellina e Valchiavenna, Ospedale di Sondalo, Sondalo, Italy
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Mei H, Pu J, Yang C, Zhang H, Zheng L, Tong Q. Laparoscopic Versus Open Pyeloplasty for Ureteropelvic Junction Obstruction in Children: A Systematic Review and Meta-Analysis. J Endourol 2011; 25:727-36. [PMID: 21476861 DOI: 10.1089/end.2010.0544] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Hong Mei
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiarui Pu
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunlei Yang
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huanyu Zhang
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liduan Zheng
- Department of Pathology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiangsong Tong
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
Reported success rates for laparoscopic pyeloplasty exceed 90% despite no standard definition of success. Objective: To assess our success rate for laparoscopic pyeloplasty using various definitions reported in the literature. Method: Data for 52 patients undergoing transperitoneal laparoscopic pyeloplasty were retrospectively analysed. We define success as improvement in pain plus preservation of differential function on MAG3 renogram. Other case series were identified in the literature and their definitions of success used to reassess our data. Results: Full data were available on 47/52 patients. Defining success as improvement in pain plus preservation of differential function on MAG3 renogram, our success rate was 85.1%. By entering our data into others' definitions of success, our success rate ranged from 77% to 98%. Conclusion: We have demonstrated the impact of various definitions on the reported success rate in laparoscopic pyeloplasty. There is a need for consensus in defining success so that meaningful comparison of results can be made. We propose that our definition should be adopted in future assessments of this procedure.
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Chow K, Adeyoju, Section of Endourology of AA. National Practice and Outcomes of Laparoscopic Pyeloplasty in the United Kingdom. J Endourol 2011; 25:657-62. [DOI: 10.1089/end.2010.0505] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karyee Chow
- Department of Urology, University Hospital of South Manchester, Manchester, United Kingdom
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Tugcu V, Ilbey YO, Polat H, Tasci AI. Early experience with laparoendoscopic single-site pyeloplasty in children. J Pediatr Urol 2011; 7:187-91. [PMID: 21131232 DOI: 10.1016/j.jpurol.2010.10.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 10/08/2010] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To present our initial clinical experience with laparoendoscopic single-site surgery (LESS) for ureteropelvic junction obstruction (UPJO) in the pediatric age group. MATERIAL AND METHODS Between January and December 2009, 11 consecutive pediatric patients underwent treatment of primary UPJO via a laparoscopic approach. All patients underwent LESS-pyeloplasty. Radiographic success was defined as improvement of hydronephrosis with a patent UPJ on intravenous urography, or improved drainage on diuretic renal scan. RESULTS The mean age of patients was 10 (2-17) years. Crossing lower pole vessel and severe adhesion were found in three (27%) and eight (73%) cases, respectively. The mean operating-room time was 182.5 (160-300) min, and the mean estimated blood loss, including urine, was 97.3 (80-160) mL. Mean hospital stay was 2 (1-3) days. Wound infection at port site and urinary infection occurred in one case each. All parents seem extremely satisfied with postoperative cosmetic outcome. The success rate was 100%. CONCLUSION Preliminary experience with LESS-pyeloplasty in children suggests that outcomes are comparable to conventional laparoscopic surgery but with improved cosmesis; however, a larger study is necessary to confirm these findings and to determine if there are any benefits in postoperative pain or recovery.
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Affiliation(s)
- Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey.
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Abstract
OBJECTIVE • To report our experience with retroperitoneal laparoscopic dismembered pyeloplasty for pelvi-ureteric junction (PUJ) obstruction in children. PATIENTS AND METHODS • Between March 2007 and December 2009, 38 children with PUJ obstruction (mean age 8.3 years, range 3-14) underwent retroperitoneal laparoscopic dismembered pyeloplasty. • A ureteric catheter was inserted into the mid-ureter cystoscopically. During pyeloplasty, the proximal end of the ureteric catheter was extracorporeally sutured to the distal end of the JJ stent with silk. • The ureteric catheter was then pulled down and the stent was pulled antegrade into the ureter and bladder. RESULTS • The approach was retroperitoneal in all patients except one who required open conversion. The overall mean operative time was 162 min (range 145-210 min) and this appeared to decrease with experience. Mean hospital stay was 4 days (range 3-7 days). • Mean follow-up was 20.2 months (range 6-32 months). Satisfactory drainage with decreased hydronephrosis was documented in all patients on ultrasonography and intravenous urography. CONCLUSION • Our study shows that retroperitoneal laparoscopic dismembered pyeloplasty is a feasible and effective alternative to open pyeloplasty with a relatively minimal complication rate in children 3 years of age and older, but it should be undertaken by experienced laparoscopic surgeons.
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Affiliation(s)
- Jianhua Yu
- Department of Urology, Hubei Provincial Corps Hospital, Chinese People's Armed Police Forces, Wuhan, HuBei, China
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Affiliation(s)
- Subhasis K. Giri
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| | - Declan Murphy
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| | - Anthony J. Costello
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
| | - Daniel A. Moon
- The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
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Wu Z, Yu J, Qi F, Xu Y, Li Z, Qi L. Novel Method for Double-J Stenting in Retroperitoneal Laparoscopic Dismembered Pyeloplasty. Urology 2011; 77:354-6. [DOI: 10.1016/j.urology.2010.03.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 03/21/2010] [Accepted: 03/29/2010] [Indexed: 11/15/2022]
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Tugcu V, Sönmezay E, Ilbey YO, Polat H, Tasci AI. Transperitoneal Laparoendoscopic Single-Site Pyeloplasty: Initial Experiences. J Endourol 2010; 24:2023-7. [DOI: 10.1089/end.2010.0083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Erkan Sönmezay
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Ozlem Ilbey
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hakan Polat
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ali Ihsan Tasci
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Abuanz S, Gamé X, Roche JB, Guillotreau J, Mouzin M, Sallusto F, Chaabane W, Malavaud B, Rischmann P. Laparoscopic Pyeloplasty: Comparison Between Retroperitoneoscopic and Transperitoneal Approach. Urology 2010; 76:877-81. [DOI: 10.1016/j.urology.2009.11.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 10/20/2009] [Accepted: 11/24/2009] [Indexed: 10/19/2022]
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Singh O, Gupta SS, Hastir A, Arvind NK. Laparoscopic Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction: Experience with 142 Cases in a High-Volume Center. J Endourol 2010; 24:1431-4. [DOI: 10.1089/end.2010.0002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Onkar Singh
- Department of Urology, Bhopal Memorial Hospital and Research Centre, Bhopal, India
| | - Shilpi Singh Gupta
- Department of Urology, Bhopal Memorial Hospital and Research Centre, Bhopal, India
| | - Ankur Hastir
- Department of Surgery, MGM Medical College and Hospital, Navi Mumbai, Kamothe, India
| | - Nand Kishore Arvind
- Department of Urology, Bhopal Memorial Hospital and Research Centre, Bhopal, India
- Department of Urology, BGS Apollo Hospital, Kuvempu Nagar, Mysoor, Karnataka, India
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El-Feel AS, Abdel-Hakim MA, Abouel-Fettouh HI, Abdel-Hakim AM. Antegrade Ureteral Stenting During Laparoscopic Dismembered Pyeloplasty: Intraoperative Findings and Long-Term Outcome. J Endourol 2010; 24:551-5. [DOI: 10.1089/end.2009.0427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Pouliot F, Lebel MH, Audet JF, Dujardin T. Determination of Success by Objective Scintigraphic Criteria After Laparoscopic Pyeloplasty. J Endourol 2010; 24:299-304. [DOI: 10.1089/end.2009.0134] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frédéric Pouliot
- Centre Hospitalier Universitaire de Québec and Université Laval Québec, Québec, Canada
| | - Michel Hugues Lebel
- Centre Hospitalier Universitaire de Québec and Université Laval Québec, Québec, Canada
| | - Jean-François Audet
- Centre Hospitalier Universitaire de Québec and Université Laval Québec, Québec, Canada
| | - Thierry Dujardin
- Centre Hospitalier Universitaire de Québec and Université Laval Québec, Québec, Canada
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Abstract
The aim of this review is to critically compare the different procedures performed for the treatment of ureteropelvic junction obstruction (UPJO) in order to identify, currently, the best treatment that a urologist should propose to patients with this condition. Three different types of procedures were assessed: open pyeloplasty (OP), endopyelotomy, and laparoscopic pyeloplasty (LP). Regarding efficacy, success rates of 94.1, 62-83, and 95.9-97.2% were reported for OP, endopyelotomy, and LP, respectively. Concerning operative time and length of hospital stay, no extensive data are available in the literature, although endopyelotomy seems to provide shorter times with respect to those reported after OP and LP. Regarding the complication rate, it was very similar after the different techniques and due to the respective approaches. Overall, our data support the conclusion that LP provided a balance between the highly successful technique reported by OP and the quick postoperative recovery provided by the endoscopic approach. Anyway, in spite of these clear advantages, the reproducibility of LP is still strongly limited by the challenge of the learning curve. The da Vinci robot (Intuitive Surgical, Inc., Sunnyvale, CA), providing an extraordinary vision and precision of surgical movement, appears to be changing this scenario, allowing naïve surgeons to achieve very good results after few procedures. In this setting, robot-assisted pyeloplasty seems to be emerging as the new standard of care in the patients with UPJO, which will further take place over the other techniques once its costs decrease.
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Affiliation(s)
- Fabrizio Gallo
- Department of Surgery, Division of Urology, San Paolo Hospital, Via Genova 38 17100 Savona, Italy.
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