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Xie Q, Wang C, Su C, Shi B, Li Y, Huang J, Chen C. Feasibility and Effectiveness of Repeat Laparoscopic Pyeloplasty for Recurrent Ureteropelvic Junction Obstruction in Pediatric Patients. J Endourol 2024; 38:584-589. [PMID: 38545757 DOI: 10.1089/end.2023.0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Objective: To assess the outcomes of redo laparoscopic pyeloplasty (RLP) in pediatric patients with recurrent ureteropelvic junction obstruction (UPJO) in contrast to redo open pyeloplasty (ROP). In addition, evaluate the feasibility and efficacy of RLP as a treatment modality for recurrent UPJO in children. Materials and Methods: The data of 44 patients from March 2012 to March 2022, who underwent redo pyeloplasty, were retrospectively reviewed. In Group RLP, the children underwent RLP, whereas ROP was attempted in Group ROP. Demographics, clinical manifestations, surgical duration, hospitalization duration, complication rates, and treatment success were examined within the respective groups. Moreover, preoperative and postoperative measurements of anterior-posterior diameter of the renal pelvis (APD), preoperative assessment of differential renal function (DRF), and the percentage of improvement in DRF (PI-DRF) were subject to analysis. Results: The study included 28 patients who underwent RLP (Group RLP), and 16 patients who underwent ROP (Group ROP). In all cases, the Anderson-Hynes technique was employed. There was no significant difference between the two groups regarding age, body mass index, gender distribution, affected side, preoperative APD, postoperative APD, and preoperative DRF. In comparison to Group ROP, Group RLP exhibited a shorter hospitalization duration, a longer surgical procedure duration, and a higher percentage improvement in PI-DRF. The median follow-up period for Group RLP was 25 months, whereas it was 25.5 months for Group ROP. Notably, the success rates were similar between the two groups, with a success rate of 89.2% in RLP and 87.5% in ROP (p = 0.634). Conclusion: RLP has a comparable success rate to ROP and is a safe, effective, and feasible procedure for the treatment of failed pyeloplasty in children.
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Affiliation(s)
- Qike Xie
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Congjun Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Cheng Su
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bo Shi
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yong Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junqiang Huang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chao Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Ordóñez J, Ortiz R, Parente A, Burgos L, Fernández-Bautista B, Pérez-Egido L, Angulo JM. Long Term Outcome of 112 Pediatric Patients With Ureteroplevic Junction Obstruction Treated by Endourologic Retrograde Balloon Dilatation. Front Pediatr 2022; 10:863625. [PMID: 35547531 PMCID: PMC9084922 DOI: 10.3389/fped.2022.863625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To analyze the effectiveness, complications and long-term outcome of the patients with ureteropelvic junction obstruction (UPJO) treated by endoscopic retrograde balloon dilatation (ERBD) in the largest series reported. MATERIALS AND METHODS Between years 2004 and 2018, 112 patients with primary unilateral UPJO were treated by ERBD. Endoscopic treatment consisted on a retrograde balloon dilatation of the ureteropelvic junction (UPJ), through cystoscopy and under fluoroscopic guidance, using high-pressure balloon catheters. In case of persistence in the balloon notch, a Cutting Balloon™ catheter was used. Double-J stent was placed after dilatation. RESULTS Mean age at surgery was 13.1 ± 21.3 months, 92 cases being younger than 18 months. Mean operative time was 24.4 ± 10.3 min; hospital stay was 1 day in 82% of patients. No intraoperative complications occurred. UPJ was calibrated at time of stent removal with cystoscopy 39.1 ± 13.7 days after dilatation. ERBD was not possible in 11 cases. An additional procedure was needed in 24 cases: second ERBD (n = 11, seven during the stent withdrawal), a third dilatation (n = 3) due to persistent hydronephrosis, and percutaneous endopyelotomy (n = 3) or open pyeloplasty (n = 7) in cases of technical failure. Significant improvement in postoperative ultrasound measures were observed (p < 0.05, T-test). Long-term success rate was 76.8% after one dilatation, and 86.6% in those who required up to 2 dilatations. Mean follow-up was 66.7 ± 37.5 months. CONCLUSIONS ERBD is a feasible and safe option for the minimally invasive treatment of UPJ obstruction in infants. Long-term outcome is acceptable with a very low complication rate.
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Affiliation(s)
- Javier Ordóñez
- Pediatric Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rubén Ortiz
- Pediatric Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Laura Burgos
- Pediatric Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Laura Pérez-Egido
- Pediatric Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José María Angulo
- Pediatric Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Ceyhan E, Dogan HS, Tekgul S. Our experience on management of failed pediatric pyeloplasty. Pediatr Surg Int 2020; 36:971-976. [PMID: 32542506 DOI: 10.1007/s00383-020-04699-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of the study was to assess the outcomes of salvage procedures after failed pediatric pyeloplasty. Recurrent ureteropelvic junction obstruction treatment is a difficult course. The salvage surgery is more challenging in the pediatric population. We aimed to assess the outcomes of salvage procedures after failed pediatric pyeloplasty to determine the most efficient surgical intervention. METHODS 40 children with 41 renal units who have been treated for recurrent ureteropelvic junction obstruction after pyeloplasty were analyzed retrospectively. The outcomes of all initial and sequent interventions were assessed including redo pyeloplasty, endopyelotomy and balloon dilatation. RESULTS Children's mean age at initial intervention for failed pyeloplasty was 45.9 (± 46.4) months. Our mean follow-up time after the initial intervention was 46.9 (± 46.6) months. The success rate of our initial treatment methods was 48.7% (20/41). Although redo pyeloplasty was the most successful intervention (83.3%) than DJS placement (45.5%), endopyelotomy (50%) and balloon dilatation (30.8%), the statistical difference was not significant in the initial operations. The overall success rates of redo pyeloplasty, double-J stent placement, endopyelotomy and balloon dilatation were 78.9%, 46.1%, 38.8% and 29.4%, respectively (p < 0.05). CONCLUSIONS Redo pyeloplasty provides the best improvement in recurrent ureteropelvic junction obstruction in children. In selected patients, minimal invasive methods such as endopyelotomy and balloon dilatation offer alternative treatment.
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Affiliation(s)
- Erman Ceyhan
- Faculty of Medicine, Department of Urology, Hacettepe University, Ankara, Turkey. .,Department of Urology, Baskent University Konya Hospital, Konya, Turkey.
| | - Hasan Serkan Dogan
- Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Hacettepe University, Ankara, Turkey
| | - Serdar Tekgul
- Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Hacettepe University, Ankara, Turkey
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He Y, Song H, Liu P, Sun N, Tian J, Li M, Li N, Qu Y, Han W, Feng G, Ni X, Zhang W. Primary laparoscopic pyeloplasty in children: A single-center experience of 279 patients and analysis of possible factors affecting complications. J Pediatr Urol 2020; 16:331.e1-331.e11. [PMID: 32334969 DOI: 10.1016/j.jpurol.2020.03.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 03/31/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Laparoscopic pyeloplasty (LP) has been widely used in the treatment of pediatric ureteropelvic junction obstruction (UPJO). However, no prior reports with a large pediatric series have focused on the analysis of complications and impact factors of the outcomes. We hypothesized there were risk factors of higher Clavien grade postoperative complications. OBJECTIVE To analyze the characteristics of complications and risk factors of high Clavien grade postoperative complications. PATIENTS AND METHODS All children with UPJO treated with primary transperitoneal LP between July 2016 and July 2018 were retrospectively reviewed. The Clavien complication grades in groups with different weight, intraoperative complication (drainage methods), anteroposterior pelvic diameters (APPD), side, gender, title of surgeon, preoperative presentation and obstruction reason were compared. RESULTS Of the 279 children, intraoperative complications in which the placement of double-J stents was not accomplished and conversion to open surgery (Satava grade II) occurred in 17 (6.09%) and 2 (0.72%) patients, respectively. A total of 270 patients (277 kidneys) were included in the analysis of postoperative complications. Postoperative complications occurred in 51 (18.89%) patients. The most frequent postoperative incident was febrile UTI in 27 patients. Of the 13 patients who required reoperations, 6 patients had kidney restenosis and were considered as failure of surgery. All complications with an exact onset time occurred within 10 months after surgery. In the univariate and multivariate analysis, weight <10 kg and having intraoperative complication with nephrostomy tube were risk factors of higher Clavien postoperative complication grade (P<0.05). DISCUSSION Patients who were <10 kg in weight and having intraoperative complication with nephrostomy tube had a greater risk of a higher Clavien grade postoperative complication. To reduce high Clavien grade postoperative complications, asymptomatic patients under 10 kg in weight and having intraoperative complication with nephrostomy tube need close monitoring. In the 26 patients who had an exact time of the postoperative complications, the longest time we found was 10 months. Thus, we recommend the follow-up time required to observe postoperative complications in patients should be at least 10 months after surgery. CONCLUSIONS LP has been proven to be safe and effective in children with a low rate of complications. Weight <10 kg and having intraoperative complications with nephrostomy tube were risk factors of higher Clavien grade postoperative complications. Children with low weight and intraoperative complications need more attention in terms of the occurrence of complications.
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Affiliation(s)
- Yuzhu He
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hongcheng Song
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Pei Liu
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Ning Sun
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jun Tian
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Minglei Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Ning Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yanchao Qu
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wenwen Han
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Guoshuang Feng
- Center for Clinical Epidemiology & Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xin Ni
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Weiping Zhang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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Baek M, Silay MS, Au JK, Huang GO, Elizondo RA, Puttmann K, Janzen NK, Seth A, Roth DR, Koh CJ. Quantifying the Additional Difficulty of Pediatric Robot-Assisted Laparoscopic Re-Do Pyeloplasty: A Comparison of Primary and Re-Do Procedures. J Laparoendosc Adv Surg Tech A 2018; 28:610-616. [PMID: 29406807 DOI: 10.1089/lap.2016.0691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Re-do pyeloplasty after failed open or laparoscopic ureteropelvic junction (UPJ) obstruction correction can be a challenging procedure because of scar formation at the previous anastomosis site and decreased vascularity of the ureter. This study compared the perioperative parameters for pediatric robot-assisted laparoscopic (RAL) primary and re-do pyeloplasties with an emphasis on the intra-operative parameters. MATERIALS AND METHODS We compared the perioperative parameters of pediatric RAL procedures performed by a single surgeon at a tertiary care children's hospital for both primary ureteropelvic junction obstruction (UPJO) and recurrent UPJO after a previous open or laparoscopic procedure over 2013-2015. The operative time was subdivided as total operative time, console time, port placement time, dissection time to UPJ, and anastomosis time. RESULTS A total of 65 pediatric RAL pyeloplasty procedures for UPJO were performed (55 primary and 10 re-do pyeloplasties) during the study period. The console times were 43.3% longer for re-do pyeloplasties than for primary pyeloplasties (133.0 ± 30.7 versus 92.8 ± 24.0 minutes, respectively, P < .01). The re-do cases had longer operative times, especially for UPJ exposure (52.2 ± 21.0 versus 28.0 ± 14.0 minutes, P < .01). There were no conversions to open surgery or significant perioperative complications. There was no difference in hospital pain medication usage and hospital length of stay between the 2 groups. The treatment success rates were 98.2% (54/55) and 100% (10/10), respectively. CONCLUSIONS RAL re-do pyeloplasty is associated with significantly longer operative times as compared with primary pyeloplasties, especially during the exposure of the UPJ, but it is overall a safe and effective surgical modality for persistent/recurrent UPJO in children. As surgeons are increasingly asked for more accurate predictions of operative time lengths when scheduling cases, this information can be helpful for surgeons when scheduling these cases and with counseling families.
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Affiliation(s)
- Minki Baek
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas.,3 Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Mesrur Selcuk Silay
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas.,4 Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University , Istanbul, Turkey
| | - Jason K Au
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Gene O Huang
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Rodolfo A Elizondo
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Kathleen Puttmann
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Nicolette K Janzen
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Abhishek Seth
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - David R Roth
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
| | - Chester J Koh
- 1 Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital , Houston, Texas.,2 Scott Department of Urology, Baylor College of Medicine , Houston, Texas
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Moscardi PRM, Barbosa JABA, Andrade HS, Mello MF, Cezarino BN, Oliveira LM, Srougi M, Dénes FT, Lopes RI. Reoperative Laparoscopic Ureteropelvic Junction Obstruction Repair in Children: Safety and Efficacy of the Technique. J Urol 2016; 197:798-804. [PMID: 27789217 DOI: 10.1016/j.juro.2016.10.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Failure after pyeloplasty for ureteropelvic junction obstruction in children may occur in up to 10% of cases. Therapeutic options include Double-J® stent placement, endoscopic treatment and reoperation. Laparoscopic and robotic reoperative modalities seem safe and efficacious, although pediatric series are limited in the literature. We report the largest known series of reoperative laparoscopic ureteropelvic junction obstruction repair in children and compare this approach to primary laparoscopic pyeloplasty. MATERIALS AND METHODS We reviewed all children undergoing laparoscopic pyeloplasty at a single institution from 2004 to 2015. Reoperative laparoscopic ureteropelvic junction obstruction repair was compared to primary pyeloplasty. Groups were analyzed regarding demographics, operative time, complications, length of hospital stay and success, defined by improvement of symptoms, ultrasound and renogram. RESULTS We identified 11 cases of reoperation (8 redo pyeloplasties and 3 ureterocalycostomies) and 71 primary pyeloplasties. Groups were not different in age, gender or weight. Median followup was 37 months. Median time between primary pyeloplasty and reoperation was 34 months. Median operative time was 205 minutes for the reoperative group and 200 for primary pyeloplasty (p = 0.98). Length of stay was longer in the reoperative group (p = 0.049), although no major complications were recorded in this group. All reoperative cases and 96% of primary pyeloplasty cases remained asymptomatic following surgery (p = 0.99). Postoperative improvement was similar for both groups on ultrasound (90% for reoperation vs 92% for primary pyeloplasty, p = 0.99) and renogram (80% vs 88%, p = 0.6). CONCLUSIONS Laparoscopy seems to be safe and effective for management of failed pyeloplasty in children. Based on our data, reoperation is as safe and effective as primary pyeloplasty.
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Affiliation(s)
| | | | - Hiury Silva Andrade
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | | | - Miguel Srougi
- Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil
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Dy GW, Hsi RS, Holt SK, Lendvay TS, Gore JL, Harper JD. National Trends in Secondary Procedures Following Pediatric Pyeloplasty. J Urol 2016; 195:1209-14. [PMID: 26926543 DOI: 10.1016/j.juro.2015.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE Although reported success rates after pediatric pyeloplasty to correct ureteropelvic junction are high, failure may require intervention. We sought to characterize the incidence and timing of secondary procedures after pediatric pyeloplasty using a national employer based insurance database. MATERIALS AND METHODS Using the MarketScan® database we identified patients 0 to 18 years old who underwent pyeloplasty from 2007 to 2013 with greater than 3 months of postoperative enrollment. Secondary procedures following the index pyeloplasty were identified by CPT codes and classified as stent/drain, endoscopic, pyeloplasty, nephrectomy or transplant. The risk of undergoing a secondary procedure was ascertained using Cox proportional hazards models adjusting for demographic and clinical characteristics. RESULTS We identified 1,976 patients with a mean ± SD followup of 23.9 ± 19.8 months. Overall 226 children (11.4%) had undergone at least 1 post-pyeloplasty procedure. The first procedure was done within 1 year in 87.2% of patients with a mean postoperative interval of 5.9 ± 11.1 months. Stents/drains, endoscopic procedures and pyeloplasties were noted in 116 (5.9%), 34 (1.7%) and 71 patients (3.1%), respectively. Length of stay was associated with undergoing a secondary procedure. Compared with 2 days or less the HR of 3 to 5 and 6 days or greater was 1.65 and 3.94 (p = 0.001 and <0.001, respectively). CONCLUSIONS Following pediatric pyeloplasty 1 of 9 patients undergoes at least 1 secondary procedure with the majority performed within the first year. One of 11 patients undergoes intervention more extensive than placement of a single stent or drain, requiring management strategies that generally signify recurrent or persistent obstruction. Estimates of pyeloplasty success in this national data set are lower than in other published series.
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Affiliation(s)
- Geolani W Dy
- Department of Urology, University of Washington School of Medicine, Seattle, Washington.
| | - Ryan S Hsi
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Thomas S Lendvay
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
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Leung L, Chan IHY, Chung PHY, Lan LCL, Wong KKY, Tam PKH. Outcomes of Re-Intervention for Laparoscopic Transperitoneal Pyeloplasty in Children. J Laparoendosc Adv Surg Tech A 2016; 26:318-23. [PMID: 26799751 DOI: 10.1089/lap.2015.0095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is no consensus for the management of failed laparoscopic pyeloplasty in pediatric surgical patients, and only limited publications are available. We evaluated here the clinical outcomes of re-intervention for failed laparoscopic transperitoneal pyeloplasty in infants and children. MATERIALS AND METHODS Retrospective review of all children who had undergone laparoscopic transperitoneal dismembered Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction from 2002 to 2013 was performed. Patients' demographics, indications, operative details, and outcomes for primary operation as well as re-intervention were studied. RESULTS There were 42 patients with a median age of 20 months (range, 3-192 months) and a median body weight of 12 kg (range, 6-56 kg) who underwent a total of 46 laparoscopic transperitoneal pyeloplasties during the study period. The median operative time and blood loss were 193 minutes (range, 115-480 minutes) and trace amount (range, trace amount to 400 mL), respectively. No conversion was reported. Ten cases (22%) required re-intervention. No statistically significant risk factor for failed pyeloplasty was identified. Indications for re-intervention included deterioration of differential renal function (n = 6), progressive hydronephrosis (n = 1), urinary ascites (n = 2), and urosepsis (n = 1). Median time of re-intervention was 6.5 ± 38 months postpyeloplasty. Re-intervention was categorized into the redo pyeloplasty group (n = 6) and the urinary diversion group (n = 4) (insertion of double-J ureteral stent or endopyelotomy) with success rates of 50% and 25%, respectively. Among the redo pyeloplasty group, 3 patients underwent redo laparoscopic pyeloplasty, and all of them had drainage restored with a median improvement in differential renal function of 11%. The mean follow-up duration was 77 ± 38 months. CONCLUSIONS Laparoscopic transperitoneal pyeloplasty is safe and feasible in children. Redo pyeloplasty is a more favorable re-intervention compared with urinary diversion in our series. Redo laparoscopic pyeloplasty has been shown to improve differential renal function.
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Affiliation(s)
- Ling Leung
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong
| | - Ivy Hau Yee Chan
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong
| | - Patrick Ho Yu Chung
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong
| | - Lawrence Chuen Leung Lan
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong
| | - Kenneth Kak Yuen Wong
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong
| | - Paul Kwong Hang Tam
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong
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Parente A, Perez-Egido L, Romero RM, Ortiz R, Burgos L, Angulo JM. Retrograde Endopyelotomy with Cutting Balloon™ for Treatment of Ureteropelvic Junction Obstruction in Infants. Front Pediatr 2016; 4:72. [PMID: 27458574 PMCID: PMC4937023 DOI: 10.3389/fped.2016.00072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/30/2016] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The aim of this study is to analyze results of retrograde endopyelotomy with cutting balloon for treatment of ureteropelvic junction obstruction (UPJO) in infants. METHODS We routinely treat patients with UPJO under 18 months of age with retrograde high-pressure balloon dilatation of the pelviureteric junction (PUJ). During the procedure, in these cases where narrowing at the PUJ persists, endopyelotomy with cutting balloon is performed. Endopyelotomy is performed over guidewire with 5-mm Cutting Balloon™ under fluoroscopic control. Double-J stents is left in situ for 4 weeks. We retrospectively analyzed the postoperative, clinical, and radiological outcome infants treated with cutting balloon endopyelotomy between 2007 and 2015. RESULTS Sixteen patients required cutting balloon endopyelotomy to achieve complete resolution of narrowing of the waist observed during high-pressure balloon dilatation of the PUJ. Mean operative time was 35 ± 21 min (mean ± SD) and hospital stay was <24 h in all patients. Complete resolution of the narrowing at the PUJ under fluoroscopy was achieved in all cases, with no perioperative complications. One patient presented with urinary tract infection, postoperatively (Clavien grade II). Preoperatively, all cases had grade IV SFU hydronephrosis with parenchymal thinning. During follow-up, resolution of the hydronephrosis was observed in 11 patients (grade I SFU). In four infants, there was an improvement of the hydronephrosis (grade II SFU) and the renogram curve. In one case, an open pyeloplasty was required due to persistent hydronephrosis and obstructive curve. CONCLUSION We believe that endopyelotomy with cutting balloon could be a valid and safe option in minimally invasive management of UPJO in infants.
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Affiliation(s)
- Alberto Parente
- Paediatric Urology, Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Laura Perez-Egido
- Paediatric Urology, Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Rosa Maria Romero
- Paediatric Urology, Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Ruben Ortiz
- Paediatric Urology, Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Laura Burgos
- Paediatric Urology, Hospital General Universitario Gregorio Marañón , Madrid , Spain
| | - Jose Maria Angulo
- Paediatric Urology, Hospital General Universitario Gregorio Marañón , Madrid , Spain
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10
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Outcomes of endopyelotomy for pelviureteric junction obstruction in the paediatric population: A systematic review. J Pediatr Urol 2015; 11:328-36. [PMID: 26553288 DOI: 10.1016/j.jpurol.2015.08.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/11/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Dismembered pyeloplasty is the gold standard treatment for pelviureteric obstruction (PUJO) although endourological techniques are also employed. Outcomes and success rates for paediatric endopyelotomy are variably reported. OBJECTIVE The study aimed to systematically analyse published literature to give an overall success rate for endopyelotomy in children. STUDY DESIGN Medline and Embase databases were searched using relevant key terms to identify reports of paediatric endoplyelotomy. Literature reviews, case reports, series of <3 children and adult studies (age >20 years) were excluded. Primary and secondary procedures were considered separately. The procedure was considered successful if [a] the author reported success AND [b] there was no immediate conversion to open pyeloplasty OR a subsequent procedure to the PUJ 3 or more weeks after endopyelotomy. RESULTS One hundred and fourteen studies were assessed, 15 were included in the final review. Overall, 220 endopyelotomies were performed in 216 patients; 128 had primary PUJO, 92 underwent secondary endopyelotomy. Median success rate was 71% (range 46-100) in the primary group and 75% (25-100) in the secondary group. Previously undetected crossing vessels were found at subsequent open pyeloplasty in 12 failures (11 primary = 31% of failed primary endopyelotomies). Complications were reported in 14.8% of primary and 14.1% of secondary procedures. DISCUSSION This study is limited by the data given in the individual series: varied criteria used for patient selection and outcome as well as inconsistent pre and post operative imaging data precluded a meta-analysis. Designating procedures as failures if there were subsequent procedures to the PUJ lowered success rates from author-given figures for some studies. Complications rates after endopyelotomy are higher than those for open and minimally invasive pyeloplasty. Success rates for endoplyelotomy do not compare favourably with pyeloplasty and crossing vessels should be excluded before considering the procedure.
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Wang Z, Liu B, Gao X, Bao Y, Wang Y, Ye H, Sun Y, Wang L. Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction after failed endoscopic intervention: A technical report. Asian J Urol 2015; 2:238-243. [PMID: 29264152 PMCID: PMC5730735 DOI: 10.1016/j.ajur.2015.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/17/2015] [Accepted: 08/27/2015] [Indexed: 12/16/2022] Open
Abstract
Objective Complex ureteral obstruction is refractory to conventional urological intervention. This report describes a case of laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction. Methods Right-side multiple ureteral stones and complicating ureteral obstruction failed an initial attempt of ureteroscopy lithotripsy with simultaneous percutaneous nephroscopy in a 23-year-old male. Laparoscopic ureterolysis with ureteroscopy and percutaneous nephroscopy was used simultaneously to dissect the periureteral adhesions with the patient placed in the Galdakao-modified supine Valdivia position. The ureter was incised to allow the insertion of a ureteral catheter through the twisted ureter, and a guide wire was advanced into the pelvis using ureteroscopy. A double-J stent was placed into the right-side ureter using antegrade percutaneous nephroscopy. Results The laparoendoscopic procedure lasted 330 min with an estimated bleeding volume of 100 mL. The patient underwent an uneventful postoperative course, and postoperative follow-up radiography confirmed good positioning of the double-J stent. The double-J stent was removed 3 months after operation. The patient remained asymptomatic within a 13-month follow-up period. Conclusion Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy is an effective and safe treatment option for complex ureteral obstruction.
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Affiliation(s)
- Zhixiang Wang
- Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bing Liu
- Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiaofeng Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yi Bao
- Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yang Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Huamao Ye
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Linhui Wang
- Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Parente A, Angulo J, Burgos L, Romero R, Rivas S, Ortiz R. Percutaneous Endopyelotomy over High Pressure Balloon for Recurrent Ureteropelvic Junction Obstruction in Children. J Urol 2015; 194:184-9. [DOI: 10.1016/j.juro.2015.01.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 11/16/2022]
Affiliation(s)
- A. Parente
- Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - J.M. Angulo
- Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - L. Burgos
- Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - R.M. Romero
- Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - S. Rivas
- Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - R. Ortiz
- Pediatric Urology Department, Gregorio Marañón University Hospital, Madrid, Spain
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Emiliani E, Breda A. Laser endoureterotomy and endopyelotomy: an update. World J Urol 2014; 33:583-7. [PMID: 25246158 DOI: 10.1007/s00345-014-1405-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Although minimally invasive approach is one of the first-line treatment choices for ureteral strictures, there are still controversies on the ideal method to treat this entity. The objective of this update was to define the level of evidence around endoscopic treatment of ureteropelvic junction (UPJ) and ureteral strictures. METHODS We reviewed the current available literature on the PubMed database from the last decade up to May 2014 on laser endoureterotomy and endopyelotomy. RESULTS The level of evidence for the endoscopic treatment of UPJ and ureteral strictures is low. Despite this, it appears that endoureterotomy and endopyelotomy performed mainly with Ho:YAG laser achieve good success rates with minimal perioperative morbidity. CONCLUSIONS Laser endoureterotomy and endopyelotomy should be considered a reasonable treatment option in selected patients.
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Affiliation(s)
- Esteban Emiliani
- Fundación Puigvert, Universitat Autonoma de Barcelona, Carrer Cartagena 340-350, 08025, Barcelona, Spain,
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Sukumar S, Roghmann F, Sood A, Abdo A, Menon M, Sammon JD, Sun M, Varda B, Trinh QD, Elder JS. Correction of ureteropelvic junction obstruction in children: national trends and comparative effectiveness in operative outcomes. J Endourol 2014; 28:592-8. [PMID: 24372348 DOI: 10.1089/end.2013.0618] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the national trends and comparative effectiveness of the various treatments for pediatric ureteropelvic junction obstruction (UPJO). PATIENTS AND METHODS Within the Nationwide Inpatient Sample, a weighted estimate of 35,275 pediatric patients (<19 years; 1998-2010) with UPJO underwent open pyeloplasty (OP), laparoscopic pyeloplasty (LP), robot-assisted pyeloplasty (RP, ≥October 2008) or endopyelotomy (EP). National trends in utilization and comparative effectiveness were evaluated. RESULTS Minimally invasive pyeloplasty (RP+LP, MIP) utilization began to increase in 2007; MIP accounted for 16.9% of cases (2008-2010). EP accounted for 1.4% of all cases from 1998 to 2010. On individual multivariate models (relative to OP): (a) no significant differences were noted between groups for intraoperative complications; (b) RP and LP had equivalent risks of postoperative complications developing (vs OP), but EP had a significantly higher risk of postoperative complications; (c) RP and EP had significantly higher risks of necessitating transfusions; (d) RP, LP, and EP had higher overall risks of greater hospital charges; (e) RP had a lower risk of greater length of stay, while EP had a higher risk (LP and OP were equivalent). CONCLUSIONS OP continues to be the predominant treatment for patients with UPJO. RP was the most common MIP modality in every age group. Compared with OP patients, RP patients had equivalent risk for intraoperative and postoperative complications, lower risk for greater length-of-stay, but higher risks for transfusions and greater hospital charges. LP patients had higher overall hospital charges, but no mitigating benefits relative to OP. EP fared poorly on most outcomes.
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Affiliation(s)
- Shyam Sukumar
- 1 Department of Urology, University of Minnesota , Minneapolis, Minnesota
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Reply. Urology 2013. [DOI: 10.1016/j.urology.2013.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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