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Ramos R, Chavali JS, Ferguson E, Soputro N, Geskin A, Rhee A, Kaouk J. Low anterolateral incision for single-port extraperitoneal robot-assisted pyeloplasty: description of technique and initial experience. World J Urol 2024; 42:263. [PMID: 38668859 PMCID: PMC11052816 DOI: 10.1007/s00345-024-04915-4] [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] [Received: 07/05/2023] [Accepted: 09/01/2023] [Indexed: 04/29/2024] Open
Abstract
PURPOSE This study aims to describe the surgical steps for the single-port low anterolateral extraperitoneal approach to pyeloplasty, report its feasibility, and share the initial outcomes of our experience. METHODS We analyzed all consecutive patients who underwent single-port low anterolateral extraperitoneal pyeloplasty due to ureteropelvic junction obstruction (UPJO). The surgical steps included a pure single-port approach through a 3.5 cm low anterolateral incision two fingerbreadths above the superior pubic ramus. The ureter was localized and followed cranially, a dismembered pyeloplasty was performed, and a running ureteropelvic anastomosis was completed. No drains were placed. The urinary catheter was removed upon discharge, and the ureteral stent after 3-5 weeks. RESULTS A total of eight cases (two adults and six children) were completed successfully, without complications or conversions. Median operative time, console time, and estimated blood loss were 208.5 min, 114.5 min, and 10.0 ml, respectively. All patients were discharged within 24 h, except for one that required urinary output observation due to retention. There were no major postoperative complications. The median pain score at discharge was 0/10. Only one patient was prescribed PRN opioids at discharge. The readmission rate was 0.0%. All patients were asymptomatic on their last follow-up with no definitive obstruction on imaging, and no requirement for additional procedures or stents. CONCLUSION Single-port low anterolateral extraperitoneal pyeloplasty is a feasible alternative for surgical treatment of UPJO in adult and pediatric patients with improved recovery outcomes.
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Affiliation(s)
- Roxana Ramos
- Glickman Urologic & Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Jaya S Chavali
- Glickman Urologic & Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Ethan Ferguson
- Glickman Urologic & Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Nicolas Soputro
- Glickman Urologic & Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Albert Geskin
- Glickman Urologic & Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Audrey Rhee
- WakeMed Raleigh Campus, Raleigh, NC, 27610, USA
| | - Jihad Kaouk
- Glickman Urologic & Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
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Beale R, Sicilila S, Riestra P, Albala DM. Are robots the future? A case for robotic pyeloplasty as the gold standard treatment in ureteropelvic junction obstruction. Curr Opin Urol 2022; 32:109-115. [PMID: 34798638 DOI: 10.1097/mou.0000000000000944] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW Robotic pyeloplasty is still a relatively novel procedure. Clinically, early studies have shown high success rates, decreased complication rates, decreased length of hospital stay, and better cosmetic results. This goal of this article is to argue for the use of robotic pyeloplasty as the gold standard of ureteropelvic junction obstruction (UPJO) treatment. Results of studies that have compared robotic pyeloplasty with other procedures currently used are reviewed. RECENT FINDINGS Our study, a comprehensive review of published outcomes of robotic pyeloplasty and alternative therapies, consisted of 666 pediatric patients and 653 adult patients. Our review coincided with the previously established studies that robotic pyeloplasty shows equivalent surgical success rates as previous standard of care treatments. Open pyeloplasty has fallen out of favor as standard of care due to the increased length of hospital stay, increased adverse events, and the undesirable aesthetics. SUMMARY The use of robotic pyeloplasty has shown to have clinical outcomes that are consistent with other intervention for UPJO, with a potential decrease in length of stay and morbidity. More work has to be done to develop ways to decrease cost of the robot to help establish it as the gold standard for UPJO treatment.
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Affiliation(s)
- Robert Beale
- SUNY Downstate Health Sciences University, New York
| | | | - Paola Riestra
- Associated Medical Professionals, Syracuse, New York, USA
| | - David M Albala
- SUNY Downstate Health Sciences University, New York
- Associated Medical Professionals, Syracuse, New York, USA
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Sizonov VV, Shidaev AHA, Mayr JM, Kogan MI, Kagantsov IM, Rostovskaya VV. Transposition and fixation of lower pole crossing vessel in children with ureteropelvic junction obstruction: A STROBE-compliant study. Medicine (Baltimore) 2021; 100:e28235. [PMID: 34941091 PMCID: PMC8701445 DOI: 10.1097/md.0000000000028235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 11/24/2021] [Indexed: 01/05/2023] Open
Abstract
Chapman and Hellstrom techniques are typically employed to transpose renal lower pole crossing vessels (LPCVs). Both procedures have certain limitations. We investigated the midterm outcomes in pediatric patients in whom LPCV-induced ureteropelvic junction obstruction was treated with either dismembered Anderson-Hynes pyeloplasty or upward transposition coupled with a new technique to fix the LPCV.We retrospectively compared Anderson-Hynes pyeloplasty to the new technique in terms of outcome. LPCV transposition was considered feasible in patients in whom the diuretic loading test revealed a decrease in the pelvic volume after correction of vascular compression as well as absence of structural changes in the ureteropelvic junction (UPJ) and hemodynamic compromise of the lower renal pole. The fascial flap was passed below the LPCV to form a "hammock". The free edge of the flap was sutured to its base.Group 1 consisted of 102 (69.9%) patients (median age: 7.9 years) undergoing dismembered Anderson-Hynes pyeloplasty, while group 2 included 44 (30.1%) patients (median age: 8.4 years) treated with upward transposition and the new technique to fix the LPCV. No intra-operative complications or conversions occurred in either group. Redo-pyeloplasty was performed in 3 (2.9%) children of group 1 and 1 (2.3%) child of group 2. Renal ultrasonography conducted 12 months after surgery revealed similar anteroposterior diameters of the renal pelvis in groups 1 (7.9 ± 8.1 mm) and 2 (6.0 ± 2.9 mm). Patients in both groups showed a non-significant median increase in differential renal function at follow-up after at least 1 year after surgery (group 1: 36% [33.3; 40.5] vs 36.5% [35.3; 41.0]; group 2: 41% [37.5; 46.0] vs 43% [39; 46]).In our patients, the new technique for laparoscopic or open fixation of the obstructing vessel after transposition was effective, reproducible, and devoid of limitations typical for the Chapman and Hellstrom techniques. We recommend Anderson-Hynes pyeloplasty in children with a history of hydronephrosis diagnosed antenatally, recurrent abdominal pain, intra-operative absence of peristalsis across the UPJ, high location of the UPJ at the renal pelvis, or intra-operative absence of volume reduction of the renal pelvis upon furosemide testing.
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Affiliation(s)
| | - Askhab H.-A. Shidaev
- Rostov State Medical University, Department of Urology and Human Reproductive Health, Rostov-on-Don, Russia
| | - Johannes M. Mayr
- University Children's Hospital Basel, Spitalstrasse 33, Basel, Switzerland
| | | | - Ilya M. Kagantsov
- Research Institute of Surgery of Congenital and Hereditary Pathology Institute of Perinatology and Pediatrics, Federal State Budgetary Institution “Almazov National Medical Research Center”, Saint Petersburg, Russia
| | - Vera V. Rostovskaya
- First Moscow State Medical University, Department of Pediatric Surgery and Urology-Andrology, Moscow, Russia
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Ebert KM, Nicassio L, Alpert SA, Ching CB, Dajusta DG, Fuchs ME, McLeod DJ, Jayanthi VR. Surgical outcomes are equivalent after pure laparoscopic and robotic-assisted pyeloplasty for ureteropelvic junction obstruction. J Pediatr Urol 2020; 16:845.e1-845.e6. [PMID: 33060019 DOI: 10.1016/j.jpurol.2020.09.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/17/2020] [Accepted: 09/21/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Minimally invasive (robotic and pure laparoscopic) pyeloplasty has been increasingly used for treatment of ureteropelvic junction obstruction (UPJO). However, few large-scale studies have compared these two modalities directly. METHODS We performed a retrospective single-center review of all patients who underwent pure laparoscopic (LP) or robotic pyeloplasty (RALP) between 2007 and 2018. Patients were excluded if the initial surgery at our institution was a redo pyeloplasty or if they lacked follow-up information. Outcomes of interest included operative time, length of stay, and complication rates, including rates of secondary procedures. We compared these outcomes between groups using Student's t test for continuous variables and a Chi-square for categorical variables. RESULTS A total of 282 patients were identified. Forty-eight were excluded based on study criteria; therefore, our total study cohort was 234 patients: 119 RALP and 115 LP cases. Overall mean postoperative follow-up time was 20.8 months, with no significant differences between groups. Mean operative time was shorter in the LP group when compared the RALP group (3 h 7 min vs. 3 h 41 min, p < 0.001). There were no significant differences between groups in length of stay (1.22 days vs 1.50 days, p = 0.095). Complications occurred in 52 patients (22.2% of overall cohort) with no difference in incidence between groups. Twenty-five patients (14 in the RALP group and 11 in the LP group) underwent unplanned secondary procedures; 19 of these patients (9 in the RALP group and 10 in the LP group) needed a procedure to address secondary obstruction. CONCLUSION We demonstrated no significant differences between RALP and LP in regards to complication rates. Surgeons performing RALP and LP have the potential to offer the same level of care for the surgical management of UPJO, especially in countries where robotic technology may not be readily available.
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Affiliation(s)
- Kristin M Ebert
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Lauren Nicassio
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, USA
| | - Seth A Alpert
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, USA
| | - Christina B Ching
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, USA
| | - Daniel G Dajusta
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, USA
| | - Molly E Fuchs
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, USA
| | - Daryl J McLeod
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, USA
| | - Venkata R Jayanthi
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, USA
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Silay MS, Danacioglu O, Ozel K, Karaman MI, Caskurlu T. Laparoscopy versus robotic-assisted pyeloplasty in children: preliminary results of a pilot prospective randomized controlled trial. World J Urol 2019; 38:1841-1848. [PMID: 31435732 DOI: 10.1007/s00345-019-02910-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/09/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The aim of this randomized controlled trial (RCT) is to compare the outcomes of conventional laparoscopic pyeloplasty (LP) versus robotic-assisted laparoscopic pyeloplasty (RALP) in the treatment of ureteropelvic junction obstruction (UPJO) in children. METHODS A total of 53 patients with UPJO were randomized as LP (Group 1, n: 27) and RALP (Group 2, n: 26). Redo cases and patients with anatomical abnormalities were excluded. Urinary ultrasound was performed at postoperative 3, 6 and 12 months; whereas, diuretic renal scintigraphy was performed at 1 year. Failure was defined as progressive hydronephrosis on ultrasound, decline in renal function, or symptom relapse. All parameters were statistically compared. RESULTS The mean age of the patients was 55.53 ± 57.25 months. There were no statistical differences between the groups in terms of patient gender, body mass index, laterality, preoperative renal function, renal pelvis antero-posterior diameter and presence of crossing vessel. Mean total operative time in LP group was longer than RALP (139 min vs 105 min, respectively, p = 0.001). The hospital stay was similar between the two groups. After a mean follow-up of 12.43 ± 5.34 months, the complication and success rates were found comparable. Only two patients required re-do pyeloplasty in LP group. The mean total cost of RALP procedure was approximately four times higher than LP. CONCLUSIONS This is the first RCT comparing LP and RALP in pediatric population. Both LP and RALP are safe and effective in children with comparable success and complication rates. Operative time was longer for LP; whereas, total cost was higher for RALP.
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Kim C. Robotic Urologic Surgery in Infants: Results and Complications. Front Pediatr 2019; 7:187. [PMID: 31139606 PMCID: PMC6527797 DOI: 10.3389/fped.2019.00187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/23/2019] [Indexed: 12/23/2022] Open
Abstract
Over the last 30 years, robotic surgery has evolved into the preferred surgical approach for many operative cases. Robotics has been associated with lower pain scales, shorter hospitalizations, and improved cosmesis (1, 2). However, its acceptance in pediatrics have been hampered by longer operative times, smaller working space, and limited fine surgical instruments. Many find these challenges even more pronounced when performing robotic surgery in infants (i.e., children <1 year old). Although the data in infants is less robust, many studies have shown benefits similar to the adult population. Specifically, multiple reports of robotic surgery in infants have shown lower postoperative analgesic use. Additionally, hospital stays are shorter, which may lead to quicker return to work for parents and guardians. Multiple reports have shown low complication rates of robotic surgery in infants. When complications have occurred, they are usually Clavien Grade 1 and 2, with occasional grade 3. Often the complications are not from the robotic technique, but are linked to other factors such as the ureteral stents (3, 4). Most importantly, the success rates of surgery are comparable to open surgery. This chapter will review indications for the most common urologic robotic surgeries performed in infants. Also, we will review reported results and complications of robotic surgery in children, with specific attention to the infant population. However, data focused only on infants is limited. Many studies have some infant patients, but their results are often mixed with all pediatric patients.
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Affiliation(s)
- Christina Kim
- Department of Urology, University of Wisconsin-Madison, Madison, AL, United States
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Skinner TAA, Witherspoon L, Dergham A, Warren JE, Watterson J, Blew B. Laparoscopic pyeloplasty practice patterns in Canada. Can Urol Assoc J 2019; 13:E268-E278. [PMID: 30763231 DOI: 10.5489/cuaj.5675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ureteropelvic junction obstruction (UPJO) is a condition characterized by partial or complete obstruction of urine transport from the renal pelvis to the ureter and can present with intermittent flank pain, recurrent urinary tract infections, renal stones, or renal dysfunction. While historically, open pyeloplasty was the gold standard for surgical management, laparoscopic methods to repair UPJO have largely taken over as the preferred approach for adolescent and adult patients. Despite near universal adoption of laparoscopic pyeloplasty among Canadian urologists, it remains a technically complex procedure and considerable variability exists in the procedural steps performed. METHODS An online survey was distributed to all urologists registered with the Canadian Urology Association (CUA). Participants were asked to describe their training background, comfort level with laparoscopic pyeloplasty, positioning preferences, procedural steps, and stenting practices. RESULTS A total of 100 board-certified urologists completed our survey, with approximately half from a community setting and half with academic affiliations (56% and 43%, respectively). The vast majority (98%) reported preferring the Anderson-Hynes (dismembered) pyeloplasty technique. Other technical steps of the procedure were variable among respondents, with no discernable pattern. Those who felt most comfortable with the procedure tended to perform a larger volume of laparoscopic pyeloplasties annually or work at higher-volume institutions. CONCLUSIONS Laparoscopic pyeloplasty remains a technically challenging procedure that many Canadian urologists are uncomfortable performing. With this publication, we hope to create discussion among urologists and to reveal procedural tips that may improve comfort in tackling these complex cases.
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Affiliation(s)
- Thomas A A Skinner
- Division of Urology, Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Luke Witherspoon
- Division of Urology, Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Ali Dergham
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jeffrey E Warren
- Division of Urology, Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - James Watterson
- Division of Urology, Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Brian Blew
- Division of Urology, Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
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Morales-López RA, Pérez-Marchán M, Pérez Brayfield M. Current Concepts in Pediatric Robotic Assisted Pyeloplasty. Front Pediatr 2019; 7:4. [PMID: 30733937 PMCID: PMC6353791 DOI: 10.3389/fped.2019.00004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
Robotic surgery in pediatric urology has been gaining popularity since its introduction almost two decades ago. Robotic assisted pyeloplasty is the most common robotic procedure performed in pediatric urology. Advances in robotic technology, instrumentation, patient care and surgical expertise have allowed the correction of ureteropelvic junction (UPJ) obstruction in most patients using this minimally invasive technique. The excellent experience with robotic assisted pyeloplasty has challenged other approaches as a new standard for the treatment of UPJ obstruction. In this review, we will describe the technique as it relates to the different robotic platforms, review the surgical experience and compare its results to other surgical approaches. Also, we will discuss patient and parent satisfaction, cost and financial considerations, along with evaluating the future of robotic surgery in the treatment of UPJ obstruction.
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Affiliation(s)
- Ramphis A Morales-López
- Division of Urology, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, PR, United States.,HIMA-San Pablo Group, Caguas, PR, United States
| | - Marcos Pérez-Marchán
- Division of Urology, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, PR, United States.,HIMA-San Pablo Group, Caguas, PR, United States
| | - Marcos Pérez Brayfield
- Division of Urology, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, PR, United States.,HIMA-San Pablo Group, Caguas, PR, United States
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Nerli RB, Ghagane SC, Dixit NS, Hiremath MB. Traumatic rupture of hydronephrosis secondary to UPJ obstruction in a child: A case report. Urol Case Rep 2018; 23:27-28. [PMID: 30534524 PMCID: PMC6279991 DOI: 10.1016/j.eucr.2018.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- R B Nerli
- Department of Urology, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, 590010, India.,KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Belagavi, 590010, India
| | - Shridhar C Ghagane
- Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Belagavi, 590010, India
| | - Neeraj S Dixit
- Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Belagavi, 590010, India
| | - Murigendra B Hiremath
- Department of Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka, India
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Junejo NN, Vallasciani S, Alshammari A, Aljallad H, Alshahrani S, Abasher A, Almathami A, Alhazmi H. Robotic versus open pyeloplasty in pediatric patients: a single center experience in Saudi Arabia. MINERVA UROL NEFROL 2018; 70:486-493. [DOI: 10.23736/s0393-2249.18.03106-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Colaco M, Hester A, Visser W, Rasper A, Terlecki R. Relative to open surgery, minimally-invasive renal and ureteral pediatric surgery offers no improvement in 30-day complications, yet requires longer operative time: Data from the National Surgical Quality Improvement Program Pediatrics. Investig Clin Urol 2018; 59:200-205. [PMID: 29744478 PMCID: PMC5934283 DOI: 10.4111/icu.2018.59.3.200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/05/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose Performance of minimally-invasive surgery (MIS) is increasing relative to open surgery. We sought to compare the contemporary rates of short-term complications of open versus laparoscopic renal and ureteral surgery in pediatric patients. Materials and Methods A retrospective cross-sectional analysis of the National Surgical Quality Improvement Program Pediatrics database was performed of all cases in 2014 identified using CPT procedure codes for nephrectomy, partial nephrectomy (PN), ureteroneocystostomy (UNC), and pyeloplasty, and reviewed for postoperative complications. Univariate analysis was performed to determine 30-day complications, with comparison between open and MIS approaches. Receiver operator curve (ROC) analysis was performed to determine differences in body surface area (BSA) and age for open versus MIS. Results Review identified 207 nephrectomies, 72 PN, 920 UNC, and 625 pyeloplasties. MIS was associated with older age and larger BSA except for cases of UNC. Apart from PN, operative durations were longer with MIS. However, only PN was associated with significantly longer length of hospital stay (LOS). There was no difference in incidence of all other 30-day complications. When evaluating BSA via ROC, the area under the curve (AUC) was found to be 0.730 and was significant. Children with a BSA greater than 0.408 m2 were more likely to have MIS (sensitivity, 66.9%; specificity, 69.3%). Regarding age, the AUC was 0.732. Children older than 637.5 days were more likely to have MIS (sensitivity, 72.8%; specificity, 63.3%). Conclusions Pediatric MIS is associated with longer operative time for nephrectomy, but shorter LOS following PN. Surgical approach was not associated with difference in short-term complications.
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Affiliation(s)
- Marc Colaco
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Austin Hester
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - William Visser
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Alison Rasper
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ryan Terlecki
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Chrzan R, Panek W, Kuijper CF, Dik P, Klijn AJ, de Mooij KL, de Jong TP. Short-term Complications After Pyeloplasty in Children With Lower Urinary Tract Anomalies. Urology 2016; 100:198-202. [PMID: 27771423 DOI: 10.1016/j.urology.2016.08.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate whether children with lower urinary tract (LUT) anomalies are at greater risk for postoperative complications after laparoscopic pyeloplasty stented with a double-J catheter (JJC). MATERIALS AND METHODS Prospectively collected data of laparoscopic pyeloplasty (LP) performed between 2006 and 2015 were analyzed. Inclusion criteria are (1) toilet-trained child and (2) unilateral dismembered pyeloplasty stented with a JJC done by the same surgeon. Our pyeloplasty protocol includes cystoscopy and retrograde pyelography. JJC is left in for 3weeks. Asymptomatic patients with infravesical LUT anomalies (a-LUTA) and those with history of LUT symptoms (LUTS) were identified. Any short-term complication was classified according to Clavien-Dindo. Fisher's exact test was used for statistical analysis. RESULTS Fifty-four children (mean 9.8 years) were included. Ten of 54 patients had LUTS. In 4 of those 10, anatomical infravesical anomaly was found during cystoscopy. Accidental urethral anomaly was found in 11 patients (a-LUTA). The control group (CG) consisted of 33 patients. Postoperative hospital stay ranged from 1 to 8 days (mean 2 days). Overall complication rate was 8 of 54 (14%). Grade 1 complications occurred in 3 patients in the CG. Five patients had grade 3 complications (2 needed replacement of bladder catheter, and 3 had diversion of the upper tract). Those problems occurred in 1 of 10 patients with LUTS and 3 of 11 patients with a-LUTA compared to 1 of 33 in the CG. This difference was statistically significant (P < .05). CONCLUSION Careful history should be taken in toilet-trained children before pyeloplasty. If any infravesical abnormality is discovered, internal diversion should probably be avoided. Special attention must be paid to bladder function in the postoperative period.
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Affiliation(s)
- Rafal Chrzan
- Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands.
| | - Wojciech Panek
- Department of Urology, 4th Military Hospital, Wroclaw, Poland
| | - Caroline F Kuijper
- Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands
| | - Peter Dik
- Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands
| | - Aart J Klijn
- Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands
| | - Keetje L de Mooij
- Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands
| | - Tom P de Jong
- Department of Pediatric Urology, University Children's Hospital AMC/EKZ, Amsterdam, The Netherlands; Department of Pediatric Urology, UMC/WKZ, Utrecht, The Netherlands
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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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Silay MS, Spinoit AF, Undre S, Fiala V, Tandogdu Z, Garmanova T, Guttilla A, Sancaktutar AA, Haid B, Waldert M, Goyal A, Serefoglu EC, Baldassarre E, Manzoni G, Radford A, Subramaniam R, Cherian A, Hoebeke P, Jacobs M, Rocco B, Yuriy R, Zattoni F, Kocvara R, Koh CJ. Global minimally invasive pyeloplasty study in children: Results from the Pediatric Urology Expert Group of the European Association of Urology Young Academic Urologists working party. J Pediatr Urol 2016; 12:229.e1-7. [PMID: 27346071 DOI: 10.1016/j.jpurol.2016.04.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/24/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Minimally invasive pyeloplasty (MIP) for ureteropelvic junction (UPJ) obstruction in children has gained popularity over the past decade as an alternative to open surgery. The present study aimed to identify the factors affecting complication rates of MIP in children, and to compare the outcomes of laparoscopic (LP) and robotic-assisted laparoscopic pyeloplasty (RALP). MATERIALS AND METHODS The perioperative data of 783 pediatric patients (<18 years old) from 15 academic centers who underwent either LP or RALP with an Anderson Hynes dismembered pyeloplasty technique were retrospectively evaluated. Redo cases and patients with anatomic renal abnormalities were excluded. Demographics and operative data, including procedural factors, were collected. Complications were classified according to the Satava and modified Clavien systems. Failure was defined as any of the following: obstructive parameters on diuretic renal scintigraphy, decline in renal function, progressive hydronephrosis, or symptom relapse. Univariate and multivariate analysis were applied to identify factors affecting the complication rates. All parameters were compared between LP and RALP. RESULTS A total of 575 children met the inclusion criteria. Laparoscopy, increased operative time, prolonged hospital stay, ureteral stenting technique, and time required for stenting were factors influencing complication rates on univariate analysis. None of those factors remained significant on multivariate analysis. Mean follow-up was 12.8 ± 9.8 months for RALP and 45.2 ± 33.8 months for LP (P = 0.001). Hospital stay and time for stenting were shorter for robotic pyeloplasty (P < 0.05 for both). Success rates were similar between RALP and LP (99.5% vs 97.3%, P = 0.11). The intraoperative complication rate was comparable between RALP and LP (3.8% vs 7.4%, P = 0.06). However, the postoperative complication rate was significantly higher in the LP group (3.2% for RALP and 7.7% for LP, P = 0.02). All complications were of no greater severity than Satava Grade IIa and Clavien Grade IIIb. DISCUSSION This was the largest multicenter series of LP and RALP in the pediatric population. Limitations of the study included the retrospective design and lack of surgical experience as a confounder. CONCLUSIONS Both minimally invasive approaches that were studied were safe and highly effective in treating UPJ obstruction in children in many centers globally. However, shorter hospitalization time and lower postoperative complication rates with RALP were noted. The aims of the study were met.
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Affiliation(s)
- M S Silay
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey; Department of Urology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - S Undre
- Department of Pediatric Urology, Great Ormond Street Hospital, London, UK
| | - V Fiala
- Department of Urology, General Teaching Hospital in Prague and Charles University, 1st Faculty of Medicine, Prague, Czech Republic
| | - Z Tandogdu
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - T Garmanova
- Department of Urology, Institute of Moscow, Moscow, Russia
| | - A Guttilla
- Department of Urology, University of Padua, Padua, Italy
| | | | - B Haid
- Department of Pediatric Urology, Sisters of the Charity Hospital, Linz, Austria
| | - M Waldert
- Department of Urology, University of Vienna, Vienna, Austria
| | - A Goyal
- Department of Pediatric Urology, University of Manchester, Manchester, UK
| | - E C Serefoglu
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - E Baldassarre
- Department of Urology, Umberto Parini Hospital, Aosta, Italy
| | - G Manzoni
- Department of Urology, Policlinico, Milan, Italy
| | - A Radford
- Department of Pediatric Urology, Leeds Children's Hospital, Leeds, UK
| | - R Subramaniam
- Department of Pediatric Urology, Leeds Children's Hospital, Leeds, UK
| | - A Cherian
- Department of Pediatric Urology, Great Ormond Street Hospital, London, UK
| | - P Hoebeke
- Department of Urology, General Teaching Hospital in Prague and Charles University, 1st Faculty of Medicine, Prague, Czech Republic
| | - M Jacobs
- Department of Pediatric Urology, Children's Medical Center, Dallas, USA
| | - B Rocco
- Department of Urology, Policlinico, Milan, Italy
| | - R Yuriy
- Department of Urology, Institute of Moscow, Moscow, Russia
| | - Fabio Zattoni
- Department of Urology, University of Padua, Padua, Italy
| | - R Kocvara
- Department of Urology, General Teaching Hospital in Prague and Charles University, 1st Faculty of Medicine, Prague, Czech Republic
| | - C J Koh
- Department of Urology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
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Tai S, Wang J, Zhou J, Hao Z, Shi H, Zhang Y, Liang C. The Robotic-Assisted Laparoscopy, Isthmusectomy, and Pyeloplasty in a Patient With Horseshoe Kidney: A Case Report. Medicine (Baltimore) 2016; 95:e2516. [PMID: 26765474 PMCID: PMC4718300 DOI: 10.1097/md.0000000000002516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this case report was to evaluate the results of isthmusectomy and pyeloplasty of horseshoe kidney with the da Vinci robotic-assisted laparoscopy system.This case presented 1 patient with left back pain, associated with lower abdominal pain, and then she underwent the isthmusectomy and dismembered pyeloplasty using robotic-assisted laparoscopy simultaneously. The operation was performed by a transperitoneal approach using 5 ports.We cut the renal isthmus by means of bipolar scissors and then closed the renal parenchyma with 3-0 absorbed stitches. The total operation time was 123 min including simultaneous dismembered pyeloplasty. Blood loss was <50 mL. There were no complications either during or after the procedure. The oral nutrition and mobilization were included on the second day after surgery. The peritoneal drainage was removed on the eighth day. Long-term follow-up after treatment showed good results.The da Vinci robotic-assisted laparoscopy is an alternative to open surgery and laparoscopy, particularly in the correction of congenital defects of the urinary tract. Furthermore, the da Vinci robotic-assisted laparoscopy technique in isthmusectomy and pyeloplasty is safe for patient as shown by our results.
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Affiliation(s)
- Sheng Tai
- From the Department of Urology, the First Affiliated Hospital of Anhui Medical University (ST, JW, JZ, ZH, HS, YZ, CL); and the Urological Institute of Anhui Medical University, Hefei, Anhui, PR China (ST, JW, JZ, ZH, HS, YZ, CL)
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Chang SJ, Hsu CK, Hsieh CH, Yang SSD. Comparing the efficacy and safety between robotic-assisted versus open pyeloplasty in children: a systemic review and meta-analysis. World J Urol 2015; 33:1855-65. [PMID: 25754944 DOI: 10.1007/s00345-015-1526-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/02/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This manuscript is mainly to systemically review the published reports that compared the efficacy and safety of robotic-assisted (RP) versus open pyeloplasty (OP) in children with ureteropelvic junction obstruction (UPJO). METHODS We did a systemic search in the PubMed(®) for all randomized controlled trials or comparative studies that compared the surgical results of robotic versus open pyeloplasty in children with UPJO. Two of the authors (Hsu and Chang) independently did the literature search, quality assessment, and data extraction. The obtained data were analyzed with Cochrane Collaboration Review Manager (RevMan(®), version 5.3). The end points of the analysis and review included age, operative time, hospital stay, costs, complications, and success rate. RESULTS In total, seven comparative trials and three studies using national database met the criteria that comprised 20,691 (RP:OP = 1956:18,735) patients in the meta-analysis. Most studies reported median value of patient age, operative time, and hospital stay. Only a small proportion of studies could be included for meta-analysis. The enrolled trials revealed that RP was more frequently performed in older children, required longer operative time, and shorter hospital stay. The postoperative success rate was comparable (RR = 0.99, 95 CI 0.94-1.04). Comparing with OP, there was a significant higher complication rate (RR = 1.29, 95 CI 1.10-1.51) and higher costs in the RP group. CONCLUSION Robotic-assisted pyeloplasty may be a promising alternative minimal invasive surgery for UPJO in children if the higher complication rates and higher costs in the RP can be overcome in the near future.
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Affiliation(s)
- Shang-Jen Chang
- Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Chienkuo Road, Xindian, New Taipei City, 231, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chun-Kai Hsu
- Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Chienkuo Road, Xindian, New Taipei City, 231, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Cheng-Hsing Hsieh
- Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Chienkuo Road, Xindian, New Taipei City, 231, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Stephen Shei-Dei Yang
- Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 289 Chienkuo Road, Xindian, New Taipei City, 231, Taiwan.
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
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Abstract
BACKGROUND To survey the effects of one-trocar-assisted pyeloplasty (OTAP) in the treatment of ureteropelvic junction obstruction (UPJO) in kids. MATERIALS AND METHODS Forty-four children (±3.5 years) were submitted to OTAP procedure. A flank incision under the XII rib was made, the Gerota's fascia was achieved and a balloon Hasson trocar with an operative telescope inserted for retroperitoneal access. The renal pelvis and ureter were isolated and exteriorised. Forty-two patients underwent Anderson-Hynes dismembered and one Fenger pyeloplasty . One patient was converted to an open procedure. Two patients presented an aberrant crossing vessel. In all patients, a double J stent was positioned. The operative time and length of stay (LOS) were evaluated. Renal scan and ultrasound (US) were utilised to evaluate the results from 6 to 12 months. RESULTS OTAP was successful in all but 1 patient. Mean operative time and LOS were 128 min and 3,5 days. We had four operative complications (9.09%). The US and a nuclear scan confirmed the resolution of the UPJO in all patients except one with the Fenger pyeloplasty who had an open Anderson-Hynes. CONCLUSIONS The combination of retroperitoneoscopic and open procedures for dismembered pyeloplasty offers a simple, time-saving method in a minimally invasive fashion with low morbidity for patients with UPJO.
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Affiliation(s)
| | - Alfonso Papparella
- Department of Paediatrics and Paediatric Surgery, Second University of Naples, Caserta, Italy
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Reply by Authors. J Urol 2015. [DOI: 10.1016/j.juro.2015.01.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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