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Elmaadawy MIA, Kim SW, Kang SK, Han SW, Lee YS. A retrospective analysis of ureteropelvic junction obstructions in patients with horseshoe kidney. Transl Androl Urol 2022; 10:4173-4180. [PMID: 34984183 PMCID: PMC8661266 DOI: 10.21037/tau-21-471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background Ureteropelvic junction obstruction (UPJO) is often encountered in patients with a horseshoe kidney (HSK) and may require surgical intervention. This study retrospectively investigated obstruction causes in HSK patients with UPJOs to determine the most suitable surgical method. Methods Twenty HSK patients with UPJO who underwent pyeloplasty between July 2000 and June 2020 and were followed-up for more than six months in our institution were included in the study. The clinical characteristics, obstruction causes, and surgical outcomes were analyzed. Results The median age at the time of the operation was 4.1 years [interquartile range (IQR): 1.8–10.6]. Hydronephrosis (HN) was found prenatally in 5 patients (25.0%). Pyeloplasty was performed by open, laparoscopic, and robotic techniques in 6, 10, and 4 patients, respectively. Sixteen patients (80.0%) had high ureteral insertion. Twelve patients (60.0%) had crossing vessels, and eight had a high ureteral insertion and crossing vessels. The median follow-up duration was 4.0 years (IQR: 1.8–8.9); no patient required additional surgery. The median differential renal function was 38.0% (IQR: 16.9–43.0%) preoperatively and 38.0% (IQR: 13.3–48.2%) postoperatively. Conclusions UPJOs in HSKs were primarily caused by a high ureteral insertion and crossing vessels. Dismembered pyeloplasty was successfully performed in all surgical modalities such as the open, laparoscopic, and robotic approaches. Attention must be given to patients with HSKs, even in those without HN, to avoid UPJO development.
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Affiliation(s)
- Mohamed Ibrahim Ahmed Elmaadawy
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sang Woon Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Ku Kang
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sang Won Han
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Seung Lee
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Panda SS, Bajpai M, Jana M, Baidya DK, Kumar R. Anderson-Hynes pyeloplasty with isthmotomy and lateropexy in horseshoe kidneys with pelviureteric junction obstruction in children. Indian J Urol 2014; 30:161-3. [PMID: 24744513 PMCID: PMC3989816 DOI: 10.4103/0970-1591.126897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the results of Anderson-Hynes pyeloplasty with isthmotomy and lateropexy in horseshoe kidney with pelviureteric junction obstruction (PUJO). MATERIALS AND METHODS Medical records of patients of horseshoe kidney with PUJO operated in our institute between June 1998 and June 2012 were reviewed. Anderson-Hynes pyeloplasty with isthmotomy and lateropexy was performed in all patients. The surgical outcome was evaluated with emphasis on the changes in degree of hydronephrosis by ultrasonography, renal drainage and function assessed by diuretic renal scans. RESULTS We studied the records of eight children of horseshoe kidney having unilateral PUJO. Obstruction was caused by a crossing lower-pole vessel in two cases, a high ureteral insertion in three and narrowing of the PUJ in three cases. Post-operative follow-up (median 4.4 years, range 18 months to 10 years) revealed improved renal function and good drainage in all cases. Hydronephrosis disappeared in 3, 4 showed Grade 1 and one showed Grade 2 hydronephrosis. All children are doing well and have no symptoms. CONCLUSION Anderson-Hynes pyeloplasty with isthmotomy and lateropexy is a highly effective and safe procedure for treating PUJO in horseshoe kidney in children.
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Affiliation(s)
- Shasanka Shekhar Panda
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi India
| | - Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi India
| | - Dalim Kumar Baidya
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi India
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Faddegon S, Granberg C, Tan YK, Gargollo PC, Cadeddu JA. Minimally Invasive Pyeloplasty in Horseshoe Kidneys with Ureteropelvic Junction obstruction: A case series. Int Braz J Urol 2013; 39:195-202. [DOI: 10.1590/s1677-5538.ibju.2013.02.07] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 12/21/2012] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | - Yung K Tan
- University of Texas Southwestern Medical Center, USA
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Seguimiento a largo plazo de la endopielotomía anterógrada. factores que influyen en el resultado. Actas Urol Esp 2009; 33:64-8. [DOI: 10.1016/s0210-4806(09)74004-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Pühse G, Piechota H, Scheffold C, Kloska S, Hertle L, Wülfing C. Multiorgan Failure 17 Years after Initial Stone Therapy: Forgotten Ureteral Stent in a Horseshoe Kidney: Part 2. Eur Urol 2008. [DOI: 10.1016/j.eururo.2007.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
PURPOSE OF REVIEW Congenital abnormities in urology are very common. Horseshoe, malrotated and ectopic kidneys, as well as duplex systems, are the most frequent in this respect. The combination of both abnormalities and stones is of clinical importance. The question is asked if standard procedures for stones apply also to stones in abnormal kidneys. RECENT FINDINGS In general, open surgery, extracorporeal shock-wave lithotripsy, percutaneous procedures, endoscopic procedures and laparoscopy are possible procedures in both normal and abnormal kidneys. The importance of ureteric pelvic junction obstruction has to be taken into account and a metabolic work-up remains important. SUMMARY The trend for treatment of stones in abnormal kidneys goes towards endoscopical and laparoscopical procedures, whereas a combination of both seems to be appropriate in many cases.
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Chammas M, Feuillu B, Coissard A, Hubert J. Laparoscopic robotic-assisted management of pelvi-ureteric junction obstruction in patients with horseshoe kidneys: technique and 1-year follow-up. BJU Int 2006; 97:579-83. [PMID: 16469030 DOI: 10.1111/j.1464-410x.2006.05967.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report our experience with laparoscopic robotic-assisted management of pelvi-ureteric junction obstruction (PUJO) in patients with horseshoe kidneys. PATIENTS AND METHODS Between January 2002 and May 2003, two men and a woman with horseshoe kidneys (mean age 44.6 years) had laparoscopic dismembered pyeloplasty with robotic assistance for PUJO with no division of the isthmus. Two patients had renal stones which were extracted during surgery. None of the patients had had previous abdominal surgery. RESULTS The mean operative duration was 148.3 min, the mean estimated blood loss was <100 mL and the mean hospital stay was 7.6 days. Renal function was preserved in all three patients during the immediate and long-term follow-up as measured by intravenous urography. The three patients had durable clinical and radiographic success during a mean follow-up of 21 months. One patient needed complementary extracorporeal shockwave lithotripsy, and one had an episode of pyelonephritis, which was treated successfully. There were no other significant complications before or after surgery. CONCLUSION Laparoscopic robotic-assisted pyeloplasty for horseshoe kidney is safe and feasible, offering the advantages of minimally invasive surgical procedures with enhanced laparoscopic skills related to the use of the robot.
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Affiliation(s)
- Mario Chammas
- Urology Department, CHU Nancy - Brabois, Vandoeuvre-les-Nancy, France
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Abstract
PURPOSE Horseshoe kidneys are the most common renal fusion anomalies. Ureteropelvic junction obstruction, urolithiasis and renal malignancies are the most common complications that occur in this patient population. Endourological management of these complications has decreased perioperative morbidity. We identified the applications of minimally invasive surgery for treating complications secondary to horseshoe kidney. MATERIALS AND METHODS A comprehensive literature review of the different endourological approaches in the management of complications secondary to horseshoe kidney was performed using MEDLINE. RESULTS Ureteropelvic junction obstruction can be managed by percutaneous endopyelotomy or laparoscopic pyeloplasty with good results. Small stones associated with horseshoe kidney are best managed by shock wave lithotripsy, while stones that have failed management by shock wave lithotripsy or are greater than 2 cm. are best managed percutaneously. All patients should undergo metabolic evaluation. Ureteroscopy or shock wave lithotripsy is associated with a higher residual stone rate than the percutaneous approach. Laparoscopic nephrectomy is a safe and feasible option for benign and malignant horseshoe kidney diseases. CONCLUSIONS Endourological techniques can be safe and effective for treating complications secondary to horseshoe kidney.
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Nakada SY, Ono Y. Controversial cases in endourology. J Endourol 2001; 15:247-50. [PMID: 11339389 DOI: 10.1089/089277901750161692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Y Nakada
- Department of Surgery, University of Wisconsin Medical School, Clinical Science Center, Madison 53792, USA.
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Dewan PA, Clark S, Condron S, Henning P. Point of technique: Ureterocalycostomy in the management of pelvi-ureteric junction obstruction in the horseshoe kidney. BJU Int 1999; 84:366-8. [PMID: 10468740 DOI: 10.1046/j.1464-410x.1999.00087.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- P A Dewan
- Department of Surgery, Royal Children's Hospital, Melbourne, Australia
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Jabbour ME, Goldfischer ER, Stravodimos KG, Klima WJ, Smith AD. Endopyelotomy for horseshoe and ectopic kidneys. J Urol 1998; 160:694-7. [PMID: 9720523 DOI: 10.1016/s0022-5347(01)62760-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We report our experience with endopyelotomy for horseshoe and ectopic kidneys in the largest series to date to our knowledge, and discuss the technical modifications adopted to perform successfully percutaneous antegrade endopyelotomy. MATERIALS AND METHODS From September 1987 to April 1996, 4 patients with horseshoe and 5 with ectopic kidney underwent percutaneous antegrade endopyelotomy for symptomatic ureteropelvic junction obstruction. The percutaneous puncture was made more posteromedial and the ureteropelvic junction was incised lateral. A retrograde percutaneous access tract was created under laparoscopic guidance in pelvic kidneys. RESULTS The operative procedure was performed uneventfully in all patients with no major bleeding, pleural effusion or visceral perforation. The stents were removed at 6 weeks, and an excretory urogram was performed at 2 weeks, 6 months and yearly thereafter. In 2 patients (22%) with severe hydronephrosis, poor renal function and a long ureteral stricture surgical treatment failed immediately. The remaining 7 patients (78%) had long lasting clinical and radiographic success with a mean followup of 62 months. CONCLUSIONS Percutaneous antegrade endopyelotomy, with a few technical modifications, is a safe and effective treatment for ureteropelvic junction obstruction associated with horseshoe and ectopic kidneys.
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Affiliation(s)
- M E Jabbour
- Department of Urology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York, USA
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Jabbour ME, Goldfischer ER, Stravodimos KG, Klima WJ, Smith AD. Endopyelotomy for horseshoe and ectopic kidneys. J Urol 1998; 160:694-7. [PMID: 9720523 DOI: 10.1097/00005392-199809010-00016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We report our experience with endopyelotomy for horseshoe and ectopic kidneys in the largest series to date to our knowledge, and discuss the technical modifications adopted to perform successfully percutaneous antegrade endopyelotomy. MATERIALS AND METHODS From September 1987 to April 1996, 4 patients with horseshoe and 5 with ectopic kidney underwent percutaneous antegrade endopyelotomy for symptomatic ureteropelvic junction obstruction. The percutaneous puncture was made more posteromedial and the ureteropelvic junction was incised lateral. A retrograde percutaneous access tract was created under laparoscopic guidance in pelvic kidneys. RESULTS The operative procedure was performed uneventfully in all patients with no major bleeding, pleural effusion or visceral perforation. The stents were removed at 6 weeks, and an excretory urogram was performed at 2 weeks, 6 months and yearly thereafter. In 2 patients (22%) with severe hydronephrosis, poor renal function and a long ureteral stricture surgical treatment failed immediately. The remaining 7 patients (78%) had long lasting clinical and radiographic success with a mean followup of 62 months. CONCLUSIONS Percutaneous antegrade endopyelotomy, with a few technical modifications, is a safe and effective treatment for ureteropelvic junction obstruction associated with horseshoe and ectopic kidneys.
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Affiliation(s)
- M E Jabbour
- Department of Urology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York, USA
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Abstract
UPJ obstructions occurring in anomalous kidneys require special consideration. Many anomalous kidneys are dysmorphic with extrarenal pelves, making the distinction between obstructed and nonobstructed hydronephrosis crucial. The radiographic evaluation must be thorough because there are often other associated anomalies of the ipsilateral or contralateral kidney. Operative intervention must be tailored to the specifics of the case. Although most UPJ obstructions in anomalous kidneys can be reconstructed successfully with dismembered pyeloplasty or treated with newer minimally invasive techniques, issues regarding access, operative detail, and adjunct procedures make these cases challenging for the urologic surgeon.
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Affiliation(s)
- J H Ross
- Section of Pediatric Urology, Cleveland Clinic Foundation, Ohio, USA
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15
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Abstract
We report a patient with ureteropelvic junction obstruction in a horseshoe kidney who was successfully managed with an antegrade endopyelotomy. Follow-up at 1 year confirmed a good result. Special considerations are necessary for the successful performance of an endopyelotomy in a horseshoe kidney. Recommendations will be made regarding percutaneous access and orientation of the incision as well as a review of the literature.
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Affiliation(s)
- G C Bellman
- Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California 90027, USA
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