Posterior One-Trocar-Assisted Pyeloplasty

Minimal Invasive Treatment in Pelvic-Ureteric Junction Obstruction: A Comprehensive Review

Pelvic-ureteric junction obstruction (PUJO) is a common condition, and one of the lead causes of hydronephrosis in children. Currently, the gold standard treatment of PUJO is open surgery using the Anderson–Hynes-modified dismembered pyeloplasty technique. However, with the advancement of medical technology, several minimal invasive approaches were developed, including endoscopic, laparoscopic, and robotic approach, from which the best choice of surgical technique was yet to be determined. Considering the advantages and disadvantages of these methods, the recommended option is to tailor the best surgical approach to each individual patient, and to the surgeons’ preference and experience. Considering these recent advances, a new algorithm is proposed to choose the best minimal invasive modalities invasive treatment to treat PUJO.

Hybrid Retroperitoneoscopic Pyeloplasty for Congenital Ureteropelvic Junction Obstruction in Infants Weighing Less than 10 kg

Introduction: Success rate of laparoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO) in children is comparable with open pyeloplasty. Prolonged ileus and injury to adjacent viscera more often occurred in transperitoneal approach; however, longer operation time is noted in retroperitoneal approach. Purpose: This study presented a hybrid retroperitoneoscopic pyeloplasty (HRP), for congenital UPJO in infants weighing <10 kg. Materials and Methods: From February 2017 to June 2020, 10 HRP procedures were performed in 9 patients by 1 surgeon. Retroperitoneal dissection of the renal pelvis and the upper third ureter was first performed, followed by extracorporeal suturing for pyeloureterostomy. Results: Mean operative age and body weight were 4.23 ± 3.69 months and 6.18 ± 1.57 kg. Operative, CO₂ inflation, and extracorporeal suture time were 147.9 ± 39.5, 40.6 ± 11.2, and 62.9 ± 26.1 minutes, respectively. Surgical outcome was confirmed by renal ultrasound and diuretic renogram. Postoperative follow-up duration was 15.2 ± 7.7 months. Three patients had postoperative febrile urinary tract infection and recovered after antibiotic treatment. Conclusion: In infants or smaller children with UPJO, the HRP procedure may be considered as an effective and minimally invasive alternative with shorter learning curve for inexperienced surgeons.