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[Laparoscopic pyeloplasty combined with ultrasonic lithotripsy via nephroscope for treatment of ureteropelvic junction obstruction with renal calculi]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022. [PMID: 35950402 PMCID: PMC9385502 DOI: 10.19723/j.issn.1671-167x.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of laparoscopic pyeloplasty combined with ultrasonic lithotripsy via nephroscope in the treatment of ureteropelvic junction obstruction (UPJO) with renal calculi. METHODS From June 2016 to January 2022, eight patients including five males and three females underwent laparoscopic pyeloplasty combined with ultrasonic lithotripsy via 19.5F(1F≈0.33 mm) nephroscope in Peking University People' s Hospital. The age ranged from 23-51 years (mean: 40.5 years) and the body mass index (BMI) ranged from 18.8-32.4 kg/m2 (mean 27.0 kg/m2). The lesion located on the left side in all of the eight patients. Two patients had solitary kidney and one patient had horseshoe kidney. Solitary stone was seen in one patient and the other seven patients suffered multiple stones, with two patients had staghorn stones. The largest diameter of stones ranged from 0.6-2.5 cm (mean: 1.5 cm). CT or ultrasound showed that moderate nephrosis was seen in five patients and severe nephrosis was seen in three patients. During surgery, after exposure of renal pelvis and proximal ureter, a small incision of 1.5 cm was performed in the anterior wall of the renal pelvis, and a 19.5F nephroscope was introduced into renal pelvis through laparoscopic trocar and renal pelvis incision. Stones were fragmented and sucked out by 3.3 mm ultrasonic probe placed through nephroscope. After stones were removed, modified laparoscopic pyeloplasty was performed. RESULTS Surgery was successfully completed in all of the eight patients without conversion to open surgery. The operation time ranged from 160-254 min (mean 213 min) and the time of nephroscopic management time was 25-40 min (mean: 33 min). The hemoglobin was decreased by 3-21 g/L (mean: 10.3 g/L). The stone-free rate was 75% (6/8 cases), stones were incompletely removed in two patients due to abnormal intrarenal structure. The modified Clavien classification system (MCCS) grade ⅢA complication occurred in one patient postoperatively, which was nephrosis due to intrarenal bleeding, and nephrostomy was performed. With the mean follow-up of 30 months (ranged from 2-68 months), there was no evidence of obstruction in all the patients, and one patient underwent percutaneous nephrolithotomy to treat residual calculi. CONCLUSION Laparoscopic pyeloplasty combined with ultrasonic lithotripsy via 19.5F nephroscope is feasible and safe, and could be a complementary method to treat UPJO and renal calculi.
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Wahyudi I, Tendi W, Rahman F, Situmorang GR, Rodjani A. Minimal Invasive Treatment in Pelvic-Ureteric Junction Obstruction: A Comprehensive Review. Res Rep Urol 2021; 13:573-580. [PMID: 34408990 PMCID: PMC8364382 DOI: 10.2147/rru.s268569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/27/2021] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Irfan Wahyudi
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - William Tendi
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Fakhri Rahman
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Gerhard Reinaldi Situmorang
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Arry Rodjani
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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An L, Xiong L, Chen L, Ye X, Huang X. Concomitant Treatment of Ureteropelvic Junction Obstruction Complicated by Renal Calculi with Laparoscopic Pyeloplasty and Pyelolithotomy via 19.5F Rigid Nephroscope: A Report of 12 Cases. J INVEST SURG 2020; 35:77-82. [PMID: 33302748 DOI: 10.1080/08941939.2020.1824248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To introduce our experience of concomitant laparoscopic pyeloplasty (LP) and pyelolithotomy via 19.5 F rigid nephroscope to treat ureteropelvic junction obstruction (UPJO) complicated with renal calculi. METHODS The data of 42 patients with UPJO who underwent LP from June 2016 to August 2019 were retrospectively reviewed. Twelve patients with ipsilateral renal calculi underwent LP and concomitant pyelolithotomy via 19.5 F rigid nephroscope. Perioperative data of this group were compared with other 12 matched patients without calculi who underwent LP only. RESULTS Of 12 patients with renal calculi, only 4 patients had simple stone and the other 8 patients suffered complex stones. Anatomical solitary kidney was found in 2 patients. The mean diameter of the largest stone was 1.1 cm (ranged from 0.6 to 1.7). The mean operative time was 171 min, the mean time of nephroscopic management was 17.2 min, 7 patients received pyelolithotomy by forceps, 3 patients received pyelolithotomy and ultrasonic lithotripsy, 1 patient received ultrasonic lithotripsy, the mean number of stones retrieved was 8.9 (ranged from 0-53), in one case the calculus was inaccessible because it was located in a narrow neck caliceal diverticulum. Overall stone-free rate was 91.7% (11/12). No difference in operative time, postoperative hemoglobin drop, postoperative hospital stay and incidence of complications was observed between the 2 groups. At the mean follow-up of 17.9 months, no patients had obstruction or recurrent stones. CONCLUSION LP and concomitant pyelolithotomy via 19.5 F rigid nephroscope is a safe and feasible option to treat UPJO with renal calculi, with acceptable success rate and stone-free rate.
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Affiliation(s)
- Lizhe An
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University, Applied Lithotripsy Institute, Beijing, China
| | - Liulin Xiong
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University, Applied Lithotripsy Institute, Beijing, China
| | - Liang Chen
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University, Applied Lithotripsy Institute, Beijing, China
| | - Xiongjun Ye
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University, Applied Lithotripsy Institute, Beijing, China
| | - Xiaobo Huang
- Urology and Lithotripsy Center, Peking University People's Hospital, Beijing, China.,Peking University, Applied Lithotripsy Institute, Beijing, China
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Kartal I, Çimen S, Karakoyunlu N, Sandıkçı F, Eraslan A, Yalçınkaya F. Factors affecting the effectiveness and success of retrograde holmium laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction in adults. Urologia 2020; 88:34-40. [PMID: 32048558 DOI: 10.1177/0391560320904259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the factors affecting the effectiveness, safety, and success of retrograde holmium:yttrium-aluminum-garnet laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction in adults. METHODS Adult patients who underwent retrograde holmium:yttrium-aluminum-garnet laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction between January 2012 and June 2016 at our clinic were retrospectively analyzed. Success was defined as the relief of symptoms and the resolution of obstruction, as assessed via radiography. Factors affecting success were analyzed, such as the clinical characteristics, procedural outcomes, complications, and the type of ureteroscopy used in the procedure. RESULTS Procedural success was achieved in 29 (74.4%) out of 39 patients, with a mean age of 38.3 ± 12.3 years during a median follow-up duration of 44 (33-65) months. Failure occurred at a median of 4.5 (3-22) months. It was detected that the presence of primary obstruction, ipsilateral kidney function being >30% of normal, and the length of obstruction being <1 cm positively affected procedural success (p = 0.009, p = 0.011, and p = 0.019, respectively). In the postoperative period, two Grade I and four Grade II complications were observed according to the Clavien-Dindo classification. There was a difference only in the operation time between semirigid (24) and flexible ureteroscopes (15), with the operation time being shorter with the use of a semirigid ureteroscope than with the use of a flexible uteroscope (p < 0.001). CONCLUSION Retrograde holmium:yttrium-aluminum-garnet laser endopyelotomy is a minimally invasive method that can be used effectively and safely as the primary treatment of patients with ureteropelvic obstruction, when long-term results are also taken into consideration. The decision of performing laser endopyelotomy should be made after a detailed evaluation of the characteristics of the patient as well as of the obstruction.
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Affiliation(s)
- Ibrahim Kartal
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Sertaç Çimen
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Fatih Sandıkçı
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Aşır Eraslan
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Fatih Yalçınkaya
- Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Elmussareh M, Traxer O, Somani BK, Biyani CS. Laser Endopyelotomy in the Management of Pelviureteric Junction Obstruction in Adults: A Systematic Review of the Literature. Urology 2017; 107:11-22. [PMID: 28438625 DOI: 10.1016/j.urology.2017.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/10/2017] [Accepted: 04/14/2017] [Indexed: 11/29/2022]
Abstract
Laser endopyelotomy (LEP) is considered as an option for the treatment of pelviureteric junction obstruction in adults. A comprehensive systematic search of the published literature was performed to assess the success rate and perioperative complications of LEP in the treatment of primary and secondary pelviureteric junction obstruction and to identify the factors that may have an impact on the success of LEP. The evidence available has significant limitations in terms of the heterogeneous study design and the definitions of outcomes. The average overall success rate of the pooled data was 75% with a mean follow-up of 29 months. Complications were predominately minor with an average rate of 12.5%.
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Affiliation(s)
- Muhammad Elmussareh
- St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - Olivier Traxer
- Department of Urology, GRC Lithiase Université Paris 6, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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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] [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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Chen Z, Zhou P, Yang ZQ, Li Y, Luo YC, He Y, Li NN, Xie CQ, Lai C, Fang XL, Chen X. Transperitoneal mini-laparoscopic pyeloplasty and concomitant ureteroscopy-assisted pyelolithotomy for ureteropelvic junction obstruction complicated by renal caliceal stones. PLoS One 2013; 8:e55026. [PMID: 23326607 PMCID: PMC3541340 DOI: 10.1371/journal.pone.0055026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/17/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To present our experience of combining transperitoneal mini-laparoscopic pyeloplasty (mini-LP) and concomitant ureteroscopy-assisted pyelolithotomy (U-P) for ureteropelvic junction obstruction (UPJO) complicated by renal caliceal stones in the same session. METHODS Between May 2007 and December 2011, mini-LP and concomitant U-P was performed in nine patients with UPJO and ipsilateral renal caliceal stones. Stone location and burden were preoperatively assessed. After pyelotomy with appropriate length (about 4 mm), a 16-Fr catheter sheath replaced the uppermost or lowermost laparoscopic trocar and was introduced directly into the renal pelvis under the guidance of a guide wire and laparoscopic vision. A 7.5F rigid ureteroscopy passed through the catheter sheath into the plevis. Intracorporeal lithotripsy and/or pressure irrigation via a pump was used for caliceal stone removal. Subsequently, laparoscopic pyeloplasty was performed in a standard fashion. Postoperative imaging was assessed. RESULTS The calculi sizes ranged from 2 to 11 mm (mean, 7.1 mm) and an average of 3 stones per patient was removed (range, 1 to 6 stones). Complete stone clearance confirmed by postoperative imaging was achieved in all patients. Mean operative time was 210 minutes, and estimated blood loss was 20 mL. Mean hospital stay was 5 days (4-7). Stent was removed after 4-8 weeks. No intraoperative or postoperative complications were noted during a mean follow-up of 18.5 months (range, 6 to 24 months). CONCLUSIONS Mini-LP and concomitant U-P are simple and effective alternatives for the simultaneous management of UPJO complicated by coexisting ipsilateral renal caliceal stones.
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Affiliation(s)
- Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Peng Zhou
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhong-Qing Yang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan-Cheng Luo
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Nan-Nan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chao-Qun Xie
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chen Lai
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao-Long Fang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Singh P, Jain P, Dharaskar A, Mandhani A, Dubey D, Kapoor R, Kumar A, Srivastava A. Minimal invasive treatment of ureteropelvic junction obstruction in low volume pelvis: A comparative study of endopyelotomy and laparoscopic nondismembered pyeloplasty. Indian J Urol 2011; 25:68-71. [PMID: 19468432 PMCID: PMC2684309 DOI: 10.4103/0970-1591.45540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the role of nondismembered laparoscopic pyeloplasty and percutaneous endopyelotomy for ureteropelvic junction obstruction (UPJO) with low volume renal pelvis. MATERIAL AND METHODS Retrospective acquired data of 34 patients of laparoscopic nondismembered pyeloplasty was compared with 26 patients of UPJO with pelvic volume less than 50 ml undergoing antegrade endopyelotomy and analyzed for clinical parameters, operative outcomes and success of procedures. All patients were followed up clinically and with diuretic renogram at regular intervals. RESULTS Mean age, renal pelvic volume and preoperative glomerular filtration rate (GFR) was 25 years, 43.6 ml and 42.5 ml/min, respectively in endopyelotomy group and 21 years, 34.4 ml and 39.9 ml/min, respectively in laparoscopic pyeloplasty group. Mean operative time, postoperative analgesic requirement and mean hospital stay was 100min, 250 mg and 4 days, respectively in endopyelotomy group and 210 min, 300 mg and 4 days, respectively in laparoscopic pyeloplasty group. Only operative time was significantly different between two groups (P < 0.05). Mean follow-up was 36 and 39 months and success rates were 91.2% and 88.8% in laparoscopy and endopyelotomy group, respectively (P < 0.05). No significant complication was seen in endopyelotomy group while two patients had hematuria (one requiring blood transfusion) and three had increased drain output for more than 3 days in laparoscopy group. CONCLUSION Percutaneous endopyelotomy is associated with significantly less operative time and postoperative complication rate and provides equivalent success in comparison to nondismembered laparoscopic pyeloplasty in patients with UPJO and low volume pelvis. It can be a preferred minimally invasive treatment modality for such patients.
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Affiliation(s)
- Pratipal Singh
- Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Samarasekera D, Chew BH. Endopyelotomy still has an important role in the management of ureteropelvic junction obstruction. Can Urol Assoc J 2011; 5:134-6. [PMID: 21470541 DOI: 10.5489/cuaj.11032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dinesh Samarasekera
- Department of Urologic Sciences, University of British Columbia, Level 6-2775 Laurel St., Vancouver, BC
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Kapoor A, Allard CB. Laparoscopic pyeloplasty: the standard of care for ureteropelvic junction obstruction. Can Urol Assoc J 2011; 5:136-8. [PMID: 21470542 DOI: 10.5489/cuaj.11036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Anil Kapoor
- McMaster Institute of Urology, Division of Urology, Department of Surgery McMaster University, Hamilton, ON
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Yong D, Albala DM. Endopyelotomy in the age of laparoscopic and robotic-assisted pyeloplasty. Curr Urol Rep 2010; 11:74-9. [PMID: 20425093 DOI: 10.1007/s11934-010-0090-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ureteropelvic junction obstructixon (UPJO) management has undergone significant changes in the past few years. The aim of this review is to establish the role of endopyelotomy in the age of laparoscopic and robot-assisted laparoscopic pyeloplasty (RALP). Open pyeloplasty (OP) has been the gold standard of care for UPJO for the past six decades. Due to lower long-term efficacy, endopyelotomy has failed to replace OP. However, laparoscopic pyeloplasty (LP) has been able to reproduce the high success rates of OP, while also achieving minimal morbidity. Unfortunately, the steep learning curve and technical difficulties have hindered its use. Recently, robot-assisted systems have enabled LP to overcome its disadvantages, and this may render endopyelotomy obsolete. Although LP and RALP are emerging as the gold standard of treatment for UPJO, endopyelotomy could carve out a niche area as a salvage procedure. Endopyelotomy will continue to have a role in the management of UPJO, albeit a smaller one.
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Affiliation(s)
- Daniel Yong
- Division of Urology, Department of Surgery, Duke University Medical Center, Room 1112, Green Zone, DUMC #3457, Durham, NC, 27710, USA
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Stilling NM, Jung H, Nørby B, Osther SS, Osther PJS. Retrograde ureteroscopic holmium laser endopyelotomy in a selected population of patients with ureteropelvic junction obstruction. ACTA ACUST UNITED AC 2009; 43:68-72. [PMID: 18949631 DOI: 10.1080/00365590802473164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Significant controversy remains concerning the best way to treat ureteropelvic junction obstruction (UPJO). This study evaluates subjective and objective outcomes of retrograde holmium laser endopyelotomy in a selected population with UPJO. MATERIAL AND METHODS Forty-seven patients with UPJO were referred to retrograde endopyelotomy between April 2004 and March 2007. Patients with a very large pelvis, a high insertion of the ureter, a renal split function below 20% or a long (>2 cm) stenosed ureteropelvic segment, and patients younger than 18 years were not selected for endopyelotomy, but subjected to laparoscopic pyeloplasty. Renal function was estimated on renal diuretic scan before and after surgery with a mean renographic follow-up of 35 weeks. Subjective results were based on questionnaires which were returned from 44 patients with primary (n=37) or secondary (n=7) obstruction (mean follow-up 110 weeks). Success criteria were defined as symptom relief and improved or preserved renal function. RESULTS Twenty-nine patients (66%) experienced complete symptom resolution and 10 patients (23%) had significant symptom improvement (i.e. no need for pain-killing medication). Five patients (11%) had unchanged symptoms. No difference in postoperative renal function was observed between these three groups of patients. The differences between preoperative and postoperative renal function were non-significant in each group. No major complications were observed. Five patients (11%) were referred to retreatment owing to unchanged symptoms. CONCLUSION Retrograde ureteroscopic endopyelotomy is a safe and effective treatment option in patients with primary and secondary UPJO when selected properly.
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Parente Hernández A, Angulo Madero JM, Romero Ruiz RM, Rivas Vila S, Laín Fernández A, Fanjul Gómez M. Resultados a medio plazo del tratamiento endourológico retrógrado con balón de la estenosis pieloureteral en niños menores de 1 año. Actas Urol Esp 2009; 33:422-8. [DOI: 10.1016/s0210-4806(09)74169-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gulur DM, Young JG, Painter DJ, Keeley FX, Timoney AG. How successful is the conservative management of pelvi-ureteric junction obstruction in adults? BJU Int 2008; 103:1414-6; discussion 1416. [PMID: 19040533 DOI: 10.1111/j.1464-410x.2008.08192.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the conservative management of pelvi-ureteric junction obstruction (PUJO), according to severity, accepted in paediatric urology but rarely reported in adults. PATIENTS AND METHODS A series of 23 patients (median age 58 years, 17 men and six women) with asymptomatic or minimally symptomatic PUJO were managed conservatively. The patients' age, preference and comorbidities were considered. The diagnosis of PUJO was based on intravenous urography and isotopic renography. After stringently reviewing the renograms based on relative renal function (RRF) and output efficiency (OE), 15 patients had an OE consistent with definitive PUJO. One patient had no further imaging due to associated comorbidities. Ten patients had right PUJO, three left and one with bilateral PUJO, with unilateral conservative management. The follow-up included annual renography and clinical consultation. Laparoscopic pyeloplasty was considered for patients with a >10% loss of RRF and/or <40% RRF during the follow-up. RESULTS Overall, 14 of 15 patients had renograms during the follow-up. The mean RRF of the affected kidney at diagnosis was 48.6% which marginally decreased to 46.7% after a median (range) follow-up of 44 (23-75) months. The RRF of 11 patients remained stable and in three decreased significantly (median 11% RRF), requiring pyeloplasty. None of the patients became symptomatic throughout the follow-up. CONCLUSION In asymptomatic adults the conservative management of PUJO appears to be safe during a short- to medium-term follow-up. We recommend that patients are regularly followed with renography and seen promptly should they become symptomatic. A longer follow-up is needed in a larger group to confirm these findings.
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Affiliation(s)
- Dev M Gulur
- Bristol Urological Institute, Southmead Hospital, Westbury on Trym, Bristol, UK.
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Savoie PH, Lechevallier E, Crochet P, Saïdi A, Breton X, Delaporte V, Coulange C. [Retrograde endopyelotomy using Holmium-Yag laser for uretero-pelvic junction obstruction]. Prog Urol 2008; 19:27-32. [PMID: 19135639 DOI: 10.1016/j.purol.2008.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 07/02/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate our results of retrograde laser endopyelotomy for uretero-pelvic junction obstruction. MATERIAL AND METHODS Retrospective study of 27 consecutive retrograde laser endopyelotomies performed on 24 patients over a six years period (June 1999 to July 2005). Sixteen stenoses were primary. The level of obstruction was severe in 13 patients and moderate in 14 patients. A polar pedicle was diagnosed by pre-operative CT-angiography in seven cases. Balloon dilatation was performed in 17 procedures. A double J ureteral stent remained in place for six weeks mean. We evaluated results by a clinical examination and an excretory urography (at 1 and 6 months then annually). Mean follow-up was 35+/-22.7 months. RESULTS Mean operating time and mean length of hospital stay were 49.8+/-17.9min and four days (range: 2-10 days). Two cases of pyelonephritis were observed. The overall success was 70%. In the eight unresolved cases, the failure appeared at 2.7+/-1 month mean. Success criteria were moderate level of obstruction and primary junction. Here, patients so selected have 100% of success. CONCLUSION Study confirmed retrograde laser endopyelotomy was safety with a short length of hospital stay. This minimally invasive procedure should be reserved to primary moderate stenoses without polar pedicle.
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Affiliation(s)
- P-H Savoie
- Service d'urologie et de transplantation rénale, hôpital La Conception, 149, boulevard Baille, 13006 Marseille, France.
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Retrospective Analysis of Long-Term Outcomes of 64 Patients Treated by Endopyelotomy in Two Low-Volume Hospitals: Good and Durable Results. J Endourol 2008; 22:1659-64. [DOI: 10.1089/end.2008.0117] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stein RJ, Gill IS, Desai MM. Comparison of surgical approaches to ureteropelvic junction obstruction: Endopyeloplasty versus endopyelotomy versus laparoscopic pyeloplasty. Curr Urol Rep 2008; 8:140-9. [PMID: 17303020 DOI: 10.1007/s11934-007-0064-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Several minimally invasive approaches to treatment of ureteropelvic junction obstruction are now in the urologist's armamentarium. This review provides in-depth analysis of endopyelotomy, endopyeloplasty, and laparoscopic pyeloplasty and suggests a treatment algorithm for proper patient selection to improve efficacy and minimize morbidity.
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Srivastava A, Singh P, Gupta M, Ansari M, Mandhani A, Kapoor R, Kumar A, Dubey D. Laparoscopic Pyeloplasty with Concomitant Pyelolithotomy – Is It an Effective Mode of Treatment? Urol Int 2008; 80:306-9. [DOI: 10.1159/000127347] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 06/06/2007] [Indexed: 11/19/2022]
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Rassweiler JJ, Subotic S, Feist-Schwenk M, Sugiono M, Schulze M, Teber D, Frede T. Minimally invasive treatment of ureteropelvic junction obstruction: long-term experience with an algorithm for laser endopyelotomy and laparoscopic retroperitoneal pyeloplasty. J Urol 2007; 177:1000-5. [PMID: 17296396 DOI: 10.1016/j.juro.2006.10.049] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Indexed: 11/30/2022]
Abstract
PURPOSE First line treatment of ureteropelvic junction obstruction is still open dismembered pyeloplasty. The development of videoendoscopic techniques like endopyelotomy and laparoscopy offers less invasive alternatives. The long-term outcome of an algorithm selectively using these techniques is presented. MATERIALS AND METHODS From February 1995 to March 2006, 256 patients with ureteropelvic junction obstruction were treated with 113 laser endopyelotomies and 143 laparoscopic retroperitoneal pyeloplasties. According to changing selection criteria, an early group (92 in 1995 to 1999) treated with laser endopyelotomy for extrinsic as well as intrinsic stenoses, and a late group (164 in 2000 to 2006) treated with laser endopyelotomy for intrinsic stenosis, were evaluated. In the late group extrinsic ureteropelvic junction obstruction was treated with nondismembered pyeloplasty in cases of anteriorly and by dismembered pyeloplasty in cases of posteriorly crossing vessels or a redundant renal pelvis. RESULTS Operating time of laser endopyelotomy averaged 34 (range 10 to 90) minutes with a complication rate of 5.3% and a success rate of 72.6% (intrinsic 85.7% vs extrinsic 51.4%). Operating time of laparoscopic retroperitoneal pyeloplasty averaged 124 (range 37 to 368) minutes with a 6.3% complication rate and an overall success rate of 94.4% (intrinsic 100% vs extrinsic 93.8%). In the late group the LAP success rate was 98.3% with no significant differences related to the cause of ureteropelvic junction obstruction (intrinsic 100% vs extrinsic 98.1%) or the type of pyeloplasty (YV plasty 97.0% vs Anderson-Hynes 97.7%). CONCLUSIONS Laparoscopic retroperitoneal pyeloplasty yields an efficacy similar to that of open surgery. The inferior success of laser endopyelotomy even in optimally selected cases and the increasing expertise with endoscopic suturing may favor laparoscopic pyeloplasty with or without robotic assistance in the future.
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Affiliation(s)
- Jens J Rassweiler
- Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany.
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el-Nahas AR. Retrograde endopyelotomy: a comparison between laser and Acucise balloon cutting catheter. Curr Urol Rep 2007; 8:122-7. [PMID: 17303017 DOI: 10.1007/s11934-007-0061-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Endopyelotomy and laparoscopic pyeloplasty are the preferred modalities for treatment of ureteropelvic junction obstruction because of their minimally invasive nature. There are continuous efforts for improving endopyelotomy techniques and outcome. Retrograde access represents the natural evolution of endopyelotomy. The Acucise cutting balloon catheter (Applied Medical Resources Corp., Laguna Hills, CA) and ureteroscopic endopyelotomy using holmium laser are the most widely accepted techniques. The Acucise catheter was developed to simplify retrograde endopyelotomy and made it possible for all urologists, regardless of their endourologic skills. The Acucise catheter depends on incision and dilatation of the ureteropelvic junction under fluoroscopic guidance, whereas ureteroscopy allows visual control of the site, depth, and extent of the incision; the holmium laser is a perfect method for a clean precise incision. Review of the English literature showed that the Acucise technique was more widely performed, though laser had better (but not statistically significant) safety and efficacy profiles.
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Affiliation(s)
- Ahmed R el-Nahas
- Urology and Nephrology Center, Mansoura University, El-Gomhoria Street, PO: 35516, Mansoura, Egypt.
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Ko R, Duvdevani M, Denstedt JD. Antegrade percutaneous endopyelotomy. Curr Urol Rep 2007; 8:128-33. [PMID: 17303018 DOI: 10.1007/s11934-007-0062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ureteropelvic junction obstruction (UPJO) is a well-known pathologic condition with several potential associated urologic complications. The treatment for UPJO has evolved dramatically during the past two decades with the advent of minimally invasive treatment options. This has resulted in shorter hospital stays, reduced postoperative pain, and quicker convalescence compared with the gold standard, open pyeloplasty. Antegrade (percutaneous) endopyelotomy is one of the many minimally invasive treatment options for this disorder. In this article, we review the technical aspects, outcomes, and current role of antegrade endopyelotomy in the treatment of UPJO.
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Abstract
The term ureteropelvic junction (UPJ) obstruction covers different morbid entities, and the old aphorism, "A UPJ is not a UPJ" remains true. Hydronephrosis is readily seen on antenatal ultrasonography but does not necessarily imply obstruction. Although most cases will resolve spontaneously, the probability of a significant pathology is related to the degree of pyelectasis, as seen on the third trimester study. Criteria of obstruction are difficult to define with precision, but two that are well-accepted are size of the renal pelvis (> 15 mm) and relative renal function, as determined by adequate isotopic studies. A new therapeutic standard has been established, and minimally invasive surgery has finally dethroned its open rival. Possibly facilitated by robotic assistance, laparoscopic dismembered pyeloplasty is the present gold standard, albeit endopyelotomy remains the least invasive with similar results in carefully selected patients.
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Affiliation(s)
- Paul J Van Cangh
- Department of Urology, Univerité Catholique de Louvain, Cliniques Universitaires St Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium.
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Singh P, Kapoor R, Suri A, Singh KJ, Mandhani A, Dubey D, Srivastava A, Kumar A. Comparison of endopyelotomy and laparoscopic pyeloplasty for poorly functioning kidneys with ureteropelvic junction obstruction. Indian J Urol 2007; 23:9-12. [PMID: 19675751 PMCID: PMC2721514 DOI: 10.4103/0970-1591.30255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Endopyelotomy and laparoscopic pyeloplasty are established procedures for ureteropelvic junction obstruction (UPJO) and historically a high failure rate has been observed in poorly functioning units with UPJ obstruction. The aim of this study is to compare the results of laparoscopic pyeloplasty with endopyelotomy in poorly functioning renal units, i.e., GFR under 25 ml/min.
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Affiliation(s)
- Pratipal Singh
- Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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