1
|
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.
Collapse
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
| |
Collapse
|
2
|
Hebert KJ, Linder BJ, Gettman MT, Ubl D, Habermann EB, Lyon TD, Ziegelmann MJ, Viers BR. Contemporary Analysis of Ureteral Reconstruction 30-Day Morbidity Utilizing the National Surgical Quality Improvement Program (NSQIP) Database: Comparison of Minimally Invasive Versus Open Approaches. J Endourol 2021; 36:209-215. [PMID: 34663084 DOI: 10.1089/end.2021.0242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To characterize 30-day morbidity of upper ureteral reconstruction (UUR) and lower ureteral reconstruction (LUR) surgery by comparing open and minimally invasive surgery (MIS) approaches using a national surgical outcomes registry. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent UUR and LUR between 2007-2017. Primary endpoints included 30-day complications, transfusion, readmission, return to operating room (ROR), and prolonged postoperative length of stay (LOS). Multivariable logistic regression was performed to observe the association of MIS approach on 30-day outcomes. RESULTS 3042 patients were identified with 2116 undergoing UUR and 926 undergoing LUR. Of 2116 patients undergoing UUR, 1733 (82%) were performed via MIS approach. On multivariable analysis, open approach for UUR was associated with increased odds of any 30-day complication (odds ratio (OR) 1.6 [1.1-2.4]; p=0.014), major complication (OR 1.8 [1.04-3.0]; p=0.034), transfusion (OR 3.7 [1.2- 11.5]; p=0.025), ROR (OR 2.0 [1.0-3.9]; p=0.047), and prolonged LOS (OR 5.4 [3.9-7.6]; p<0.001). Of the 926 patients undergoing LUR, 458 (49%) were performed via a MIS approach. On multivariable analysis, open approach for LUR was associated with increased odds of any 30-day complication (OR 1.5 [1.1-2.1]; p=0.028), minor complication (OR 1.7 [1.1-2.6]; p=0.02), transfusion (OR 8.1 [2.7-23.7]; p<0.001), and prolonged LOS (OR 4.2 [2.4-7.3]; p<0.001). CONCLUSION Utilization of a national surgical database revealed an open approach was associated with increased 30-day morbidity across multiple postoperative outcome measures. These findings suggest a MIS approach should be considered, when feasible, for upper and lower ureteral reconstruction.
Collapse
Affiliation(s)
- Kevin J Hebert
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian J Linder
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel Ubl
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Department of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Maheshwari PN, Arora AM. Robot-assisted pyeloplasty: The way forward. J Minim Access Surg 2021; 17:274-275. [PMID: 32964878 PMCID: PMC8083731 DOI: 10.4103/jmas.jmas_59_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Amandeep M Arora
- Department of Urology, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| |
Collapse
|
4
|
Uhlig A, Uhlig J, Trojan L, Hinterthaner M, von Hammerstein-Equord A, Strauss A. Surgical approaches for treatment of ureteropelvic junction obstruction - a systematic review and network meta-analysis. BMC Urol 2019; 19:112. [PMID: 31711468 PMCID: PMC6849262 DOI: 10.1186/s12894-019-0544-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 10/24/2019] [Indexed: 12/04/2022] Open
Abstract
Background Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach. Methods A systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques. Results A total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05–0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31–0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41–0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22–0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min–163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min–164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min–151.58 min, p = 0.003). Conclusions Multiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.
Collapse
Affiliation(s)
- Annemarie Uhlig
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany.
| | - Johannes Uhlig
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.,Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Lutz Trojan
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Goettingen, Goettingen, Germany
| | | | - Arne Strauss
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| |
Collapse
|
5
|
Li BY, Urish KL, Jacobs BL, He C, Borza T, Qin Y, Min HS, Dupree JM, Ellimoottil C, Hollenbeck BK, Lavieri MS, Helm JE, Skolarus TA. Inaugural Readmission Penalties for Total Hip and Total Knee Arthroplasty Procedures Under the Hospital Readmissions Reduction Program. JAMA Netw Open 2019; 2:e1916008. [PMID: 31755949 PMCID: PMC6902819 DOI: 10.1001/jamanetworkopen.2019.16008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE The Hospital Readmissions Reduction Program (HRRP) is a Centers for Medicare and Medicaid Services policy that levies hospital reimbursement penalties based on excess readmissions of patients with 4 medical conditions and 3 surgical procedures. A greater understanding of factors associated with the 3 surgical reimbursement penalties is needed for clinicians in surgical practice. OBJECTIVE To investigate the first year of HRRP readmission penalties applied to 2 surgical procedures-elective total hip arthroplasty (THA) and total knee arthroplasty (TKA)-in the context of hospital and patient characteristics. DESIGN, SETTING, AND PARTICIPANTS Fiscal year 2015 HRRP penalization data from Hospital Compare were linked with the American Hospital Association Annual Survey and with the Healthcare Cost and Utilization Project State Inpatient Database for hospitals in the state of Florida. By using a case-control framework, those hospitals were separated based on HRRP penalty severity, as measured with the HRRP THA and TKA excess readmission ratio, and compared according to orthopedic volume as well as hospital-level and patient-level characteristics. The first year of HRRP readmission penalties applied to surgery in Florida Medicare subsection (d) hospitals was examined, identifying 60 663 Medicare patients who underwent elective THA or TKA in 143 Florida hospitals. The data analysis was conducted from February 2016 to January 2017. EXPOSURES Annual hospital THA and TKA volume, other hospital-level characteristics, and patient factors used in HRRP risk adjustment. MAIN OUTCOMES AND MEASURES The HRRP penalties with HRRP excess readmission ratios were measured, and their association with annual THA and TKA volume, a common measure of surgical quality, was evaluated. The HRRP penalties for surgical care according to hospital and readmitted patient characteristics were then examined. RESULTS Among 143 Florida hospitals, 2991 of 60 663 Medicare patients (4.9%) who underwent THA or TKA were readmitted within 30 days. Annual hospital arthroplasty volume seemed to follow an inverse association with both unadjusted readmission rates (r = -0.16, P = .06) and HRRP risk-adjusted readmission penalties (r = -0.12, P = .14), but these associations were not statistically significant. Other hospital characteristics and readmitted patient characteristics were similar across HRRP orthopedic penalty severity. CONCLUSIONS AND RELEVANCE This study's findings suggest that higher-volume hospitals had less severe, but not significantly different, rates of readmission and HRRP penalties, without systematic differences across readmitted patients.
Collapse
MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Case-Control Studies
- Centers for Medicare and Medicaid Services, U.S./economics
- Centers for Medicare and Medicaid Services, U.S./standards
- Female
- Florida
- Humans
- Male
- Patient Readmission/economics
- Patient Readmission/statistics & numerical data
- Reimbursement Mechanisms/economics
- Reimbursement Mechanisms/organization & administration
- Risk Adjustment
- United States
Collapse
Affiliation(s)
- Benjamin Y. Li
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Kenneth L. Urish
- Magee Bone and Joint Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bruce L. Jacobs
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chang He
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, University of Michigan, Ann Arbor
| | - Tudor Borza
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
- Department of Urology, University of Wisconsin, Madison
| | - Yongmei Qin
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Hye Sung Min
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - James M. Dupree
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Chad Ellimoottil
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Brent K. Hollenbeck
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Mariel S. Lavieri
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor
| | - Jonathan E. Helm
- Operations and Decision Technologies, Indiana University Kelley School of Business, Bloomington
| | - Ted A. Skolarus
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor
- Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| |
Collapse
|
6
|
Jacobs BL, Seelam R, Lai JC, Hanley JM, Wolf JS, Hollenbeck BK, Hollingsworth JM, Dick AW, Setodji CM, Saigal CS. Cost Analysis of Treatments for Ureteropelvic Junction Obstruction. J Endourol 2017; 31:204-209. [PMID: 27927021 DOI: 10.1089/end.2016.0722] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Ureteropelvic junction obstruction is a common urologic condition that accounts for approximately $12 million in inpatient spending annually. Few studies have assessed the costs related to treatment. We sought to examine the cost of care for patients treated for ureteropelvic junction obstruction. PATIENTS AND METHODS We used the MarketScan® database to identify adults from 18 to 64 years old treated with minimally invasive pyeloplasty, open pyeloplasty, and endopyelotomy for ureteropelvic junction obstruction between 2002 and 2010. Our primary outcome was total expenditures related to the surgical episode, defined as the period from 30 days prior until 30 days after the index surgery. We fit a multinomial linear regression model to evaluate cost of the surgical episode, adjusting for age, gender, comorbidity, benefit plan type, and region of residence. RESULTS We identified 1251 endopyelotomies, 717 open pyeloplasties, and 1048 minimally invasive pyeloplasties. The adjusted mean costs were $16,379 for endopyelotomy, $22,421 for open pyeloplasty, and $22,843 for minimally invasive pyeloplasty (p < 0.0001, ANCOVA). Both open and minimally invasive pyeloplasties were more costly than endopyelotomy (both p < 0.0001, comparison between groups). However, the cost of open and minimally invasive pyeloplasties was similar (p = 0.57, comparison between groups). CONCLUSIONS Among the three treatments, endopyelotomy was the least expensive in the immediate perioperative period. Open and minimally invasive pyeloplasties were similar in cost, but both more expensive than endopyelotomies. The similar cost between the two pyeloplasty approaches provides additional evidence that minimally invasive pyeloplasty should be considered the standard treatment for ureteropelvic junction obstruction.
Collapse
Affiliation(s)
- Bruce L Jacobs
- 1 Department of Urology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Rachana Seelam
- 2 University of California , Los Angeles, and RAND Corporation, Santa Monica, California
| | - Julie C Lai
- 2 University of California , Los Angeles, and RAND Corporation, Santa Monica, California
| | - Janet M Hanley
- 2 University of California , Los Angeles, and RAND Corporation, Santa Monica, California
| | - J Stuart Wolf
- 3 Dell Medical School of the University of Texas , Austin, Texas
| | - Brent K Hollenbeck
- 4 Department of Urology, Division of Health Services Research, University of Michigan , Ann Arbor, Michigan.,5 Department of Urology, Division of Oncology, University of Michigan , Ann Arbor, Michigan
| | - John M Hollingsworth
- 4 Department of Urology, Division of Health Services Research, University of Michigan , Ann Arbor, Michigan.,6 Department of Urology, Division of Endourology, University of Michigan , Ann Arbor, Michigan
| | - Andrew W Dick
- 2 University of California , Los Angeles, and RAND Corporation, Santa Monica, California
| | - Claude M Setodji
- 2 University of California , Los Angeles, and RAND Corporation, Santa Monica, California
| | - Christopher S Saigal
- 2 University of California , Los Angeles, and RAND Corporation, Santa Monica, California.,7 Department of Urology, David Geffen School of Medicine , Santa Monica, California
| |
Collapse
|
7
|
Jacobs BL, Lai JC, Seelam R, Hanley JM, Wolf JS, Hollenbeck BK, Hollingsworth JM, Dick AW, Setodji CM, Saigal CS. Variation in the Use of Open Pyeloplasty, Minimally Invasive Pyeloplasty, and Endopyelotomy for the Treatment of Ureteropelvic Junction Obstruction in Adults. J Endourol 2017; 31:210-215. [PMID: 27936909 DOI: 10.1089/end.2016.0688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Ureteropelvic junction obstruction is a common condition that can be treated with open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy. While all these treatments are effective, the extent to which they are used is unclear. We sought to examine the dissemination of these treatments. PATIENTS AND METHODS Using the MarketScan® database, we identified adults 18 to 64 years old who underwent treatment for ureteropelvic junction obstruction between 2002 and 2010. Our primary outcome was ureteropelvic junction obstruction treatment (i.e., open pyeloplasty, minimally invasive pyeloplasty, endopyelotomy). We fit a multilevel multinomial logistic regression model accounting for patients nested within providers to examine several factors associated with treatment. RESULTS Rates of minimally invasive pyeloplasty increased 10-fold, while rates of open pyeloplasty decreased by over 40%, and rates of endopyelotomy were relatively stable. Factors associated with receiving an open vs a minimally invasive pyeloplasty were largely similar. Compared with endopyelotomy, patients receiving minimally invasive pyeloplasty were less likely to be older (odds ratio [OR] 0.96; 95% confidence interval [CI], 0.95, 0.97) and live in the south (OR 0.52; 95% CI, 0.33, 0.81) and west regions (OR 0.57; 95% CI 0.33, 0.98) compared with the northeast and were more likely to live in metropolitan statistical areas (OR 1.52; 95% CI 1.08, 2.13). CONCLUSIONS Over this 9-year period, the landscape of ureteropelvic junction obstruction treatment has changed dramatically. Further research is needed to understand why geographic factors were associated with receiving a minimally invasive pyeloplasty or an endopyelotomy.
Collapse
Affiliation(s)
- Bruce L Jacobs
- 1 Department of Urology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Julie C Lai
- 2 RAND Corporation , Santa Monica, California
| | | | | | - J Stuart Wolf
- 3 Dell Medical School of the University of Texas , Austin, Texas
| | - Brent K Hollenbeck
- 4 Department of Urology, Division of Health Services Research, University of Michigan , Ann Arbor, Michigan.,5 Department of Urology, Division of Oncology, University of Michigan , Ann Arbor, Michigan
| | - John M Hollingsworth
- 4 Department of Urology, Division of Health Services Research, University of Michigan , Ann Arbor, Michigan.,6 Department of Urology, Division of Endourology, University of Michigan , Ann Arbor, Michigan
| | | | | | - Christopher S Saigal
- 2 RAND Corporation , Santa Monica, California.,7 Department of Urology, David Geffen School of Medicine, University of California , Los Angeles, California
| |
Collapse
|
8
|
Lai WR, Stewart CA, Thomas R. Technology Based Treatment for UreteroPelvic Junction Obstruction. J Endourol 2016; 31:S59-S63. [PMID: 27549028 DOI: 10.1089/end.2016.0592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Surgical management of ureteropelvic junction obstruction (UPJO) has historically been performed with open pyeloplasty. With the advent of endourology, laparoscopy, and robotics, minimally-invasive techniques have been described and accepted as alternatives to open surgery. Each of these approaches has its own advantages and disadvantages, equipment needs, degree of invasiveness, and experience of the treating urologist. Advocates and critics have their own say as to their preferred technique. In this article, we review the chronological evolution of these techniques and discuss their current role in the management of UPJO.
Collapse
Affiliation(s)
- Weil R Lai
- Department of Urology, Tulane University School of Medicine , New Orleans, Louisiana
| | - Carrie A Stewart
- Department of Urology, Tulane University School of Medicine , New Orleans, Louisiana
| | - Raju Thomas
- Department of Urology, Tulane University School of Medicine , New Orleans, Louisiana
| |
Collapse
|
9
|
Schiavina R, Zaramella S, Chessa F, Pultrone CV, Borghesi M, Minervini A, Cocci A, Chindemi A, Antonelli A, Simeone C, Pagliarulo V, Parma P, Samuelli A, Celia A, De Concilio B, Rocco B, De Lorenzis E, La Manna G, Terrone C, Falsaperla M, Dente D, Porreca A. Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up. J Robot Surg 2016; 10:323-330. [PMID: 27209477 DOI: 10.1007/s11701-016-0601-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Abstract
The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n = 36) and robotic (n = 26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center's protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2 ± 71.9 cc for the laparoscopic and 47.2 ± 32.3 cc for the robotic, respectively (p = 0.004). Mean days of hospitalization were 5.9 ± 2.4 for the laparoscopic group and 7.6 ± 3.4 for the robotic group (p = 0.006). No differences were found in terms of operative time and post-operative complications. After a median follow-up of 27 months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p = 0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence.
Collapse
Affiliation(s)
- Riccardo Schiavina
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy
| | - Stefano Zaramella
- Department Of Urology, University of Eastern Piedmont Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy
| | - Francesco Chessa
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy.
| | - Cristian Vincenzo Pultrone
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy
| | - Marco Borghesi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Chindemi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Claudio Simeone
- Department of Urology, University of Brescia, Brescia, Italy
| | | | - Paolo Parma
- Department of Urology, Ospedale "Carlo Poma" Mantova, Mantova, Italy
| | | | - Antonio Celia
- Dept. Of Urology, Ospedale "San Bassiano", Bassano del Grappa, VI, Italy
| | | | - Bernardo Rocco
- Department of Urology, Policlinico Di Milano, Milan, Italy
| | | | - Gaetano La Manna
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Carlo Terrone
- Department Of Urology, University of Eastern Piedmont Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy
| | - Mario Falsaperla
- Department of Urology, Policlinico Vittorio Emanuele, Catania, Italy
| | - Donato Dente
- Department of Urology, Policlinico Di Abano, Abano Terme, PD, Italy
| | - Angelo Porreca
- Department of Urology, Policlinico Di Abano, Abano Terme, PD, Italy
| |
Collapse
|
10
|
|
11
|
Zetlen H, Daratha KB, Harper JD, Wessells H, Roberts KP, Gore JL. Hospital-level Variation in the Quality of Benign Inpatient Urologic Surgery. Urology 2015; 87:82-7. [PMID: 26519000 DOI: 10.1016/j.urology.2015.07.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/14/2015] [Accepted: 07/28/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine hospital-level variation in outcomes following benign urologic surgeries given that hospital-level variation in surgical outcomes can portend quality and appropriateness of care concerns and identify quality improvement opportunities in perioperative care. MATERIALS AND METHODS Using the Washington State Comprehensive Hospital Abstract Reporting System, we identified patients who underwent transurethral resection of the prostate (TURP), percutaneous nephrostolithotomy (PCNL), and pyeloplasty from 2003 to 2008. We classified prolonged postoperative length of stay (LOS) as that exceeding the 75th percentile, and we measured the rate of Agency for Healthcare Quality Patient Safety Indicators, readmissions, and death. We calculated hospital-specific observed-to-expected event rates using random effects multilevel multivariable models adjusted for age and comorbidity. RESULTS We identified 6699 TURP patients at 54 hospitals, 2541 PCNL patients at 45 hospitals, and 584 pyeloplasty patients at 36 hospitals. Complication rates were highest after PCNL (22.9% prolonged LOS vs 17.3% for TURP and 13.9% for pyeloplasty, P < .001; 3.4% 90-day mortality vs 0.6% for TURP and 0% for pyeloplasty). Hospital-level variation was most substantial for LOS after TURP and pyeloplasty (8.1% and 14.3% of variance in prolonged LOS, respectively). CONCLUSION Hospital-level variation is common after benign inpatient urologic surgeries and may relate to difference in perioperative provider practice patterns. The morbidity of PCNL in this study was higher than expected and merits further investigation.
Collapse
Affiliation(s)
- Hilary Zetlen
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Kenn B Daratha
- College of Nursing, Washington State University, Spokane, WA
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Hunter Wessells
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Kenneth P Roberts
- College of Medical Sciences, Washington State University, Spokane, WA
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, WA.
| |
Collapse
|
12
|
Ekin RG, Celik O, Ilbey YO. An up-to-date overview of minimally invasive treatment methods in ureteropelvic junction obstruction. Cent European J Urol 2015; 68:245-51. [PMID: 26251754 PMCID: PMC4526614 DOI: 10.5173/ceju.2015.543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/15/2015] [Accepted: 04/18/2015] [Indexed: 12/20/2022] Open
Abstract
Introduction Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction have been developed and are bcoming more popular. Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, for both the transperitoneal and retroperitoneal approaches. In this review, we aimed to analyze the current status of minimally invasive therapy of ureteropelvic junction obstruction. Material and methods A PubMed database search was conducted to examine minimally invasive treatments of ureteropelvic junction obstruction. Results A large number of cases have been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric populations. A clear advantage, in terms of hospital stay, of minimally invasive over open pyeloplasty was observed only in the adult population. Conclusions Studies have shown that minimally invasive pyeloplasty techniques are a safe, effective, and feasible in adult and pediatric populations.
Collapse
Affiliation(s)
- Rahmi Gokhan Ekin
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Orcun Celik
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Yusuf Ozlem Ilbey
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| |
Collapse
|
13
|
Comparison of 30-day perioperative outcomes in adults undergoing open versus minimally invasive pyeloplasty for ureteropelvic junction obstruction: analysis of 593 patients in a prospective national database. World J Urol 2015; 33:2107-13. [DOI: 10.1007/s00345-015-1586-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/28/2015] [Indexed: 11/25/2022] Open
|
14
|
Ozayar A, Friedlander JI, Shakir NA, Gahan JC, Cadeddu JA, Morgan MS. Equivocal Ureteropelvic Junction Obstruction on Diuretic Renogram—Should Minimally Invasive Pyeloplasty be Offered to Symptomatic Patients? J Urol 2015; 193:1278-82. [PMID: 25444983 DOI: 10.1016/j.juro.2014.10.100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Asim Ozayar
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Justin I. Friedlander
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nabeel A. Shakir
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey C. Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A. Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Monica S.C. Morgan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
15
|
Prompt Management of Anastomotic Leak or Acute Obstruction after Minimally Invasive Pyeloplasty with Percutaneous Nephrostomy Preserves Outcomes. J Urol 2014; 192:1716-9. [DOI: 10.1016/j.juro.2014.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2014] [Indexed: 11/20/2022]
|
16
|
Fedelini P, Verze P, Meccariello C, Arcaniolo D, Taglialatela D, Mirone VG. Intraoperative and postoperative complications of laparoscopic pyeloplasty: a single surgical team experience with 236 cases. J Endourol 2013; 27:1224-9. [PMID: 23829573 DOI: 10.1089/end.2013.0301] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To describe and analyze a single surgical team's experience with intraoperative and postoperative complications arising from the Anderson-Hynes transperitoneal laparoscopic pyeloplasty (LP) procedure in the treatment of patients with ureteropelvic junction obstruction (UPJO). PATIENTS AND METHODS There were 236 consecutive patients who underwent transperitoneal LP over a period of 8 years (2004-2012). These patients' records were retrospectively analyzed for intraoperative and postoperative complications. Of the 236 patients, 111 (47.0%) were males and 125 (53%) were females. In 226 patients, surgical indication was primary UPJO, and in 10 patients, recurrent obstruction. Two hundred and eleven patients (89.4%) were symptomatic. RESULTS Mean operative time was 96.5 minutes (range 45-360 min). The mean blood loss was 20 mL (range 5-500 mL), and no blood transfusions were necessary. The overall success rate was 97% (229 patients) with a mean follow-up of 38 months (range 6-84 mos). In 86 of the 94 patients who presented with a crossing vessel (91.5%), the anomalous crossing vessel was transposed to the ureteropelvic junction (UPJ) dorsally because of evident obstruction. The mean postoperative hospital stay was 4.2 days (range 3-14 days). All 211 preoperative symptomatic patients reported a complete resolution of symptoms after the procedure. Intraoperative incidents occurred in nine (3.8%) patients, while postoperative complications occurred in 32 (13.5%) patients. CONCLUSIONS Our retrospective analysis confirms that LP is an efficacious and safe procedure resulting in a reported success rate of 97% and a concomitant low level of intraoperative (3.8%) and postoperative complications (13.6%). Major complications necessitating active management occur in a low percentage of cases (5.9% of patients). The most frequent and severe intraoperative complications are related to the Double-J stent insertion. The most common postoperative complication is urine leakage.
Collapse
Affiliation(s)
- Paolo Fedelini
- 1 Urology Unit, AORN Cardarelli Hospital , Naples, Italy
| | | | | | | | | | | |
Collapse
|
17
|
Autorino R, Eden C, El-Ghoneimi A, Guazzoni G, Buffi N, Peters CA, Stein RJ, Gettman M. Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis. Eur Urol 2013; 65:430-52. [PMID: 23856037 DOI: 10.1016/j.eururo.2013.06.053] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/26/2013] [Indexed: 12/15/2022]
Abstract
CONTEXT Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized. OBJECTIVE To critically analyze the current status of laparoscopic and robotic repair of UPJO. EVIDENCE ACQUISITION A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. EVIDENCE SYNTHESIS Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population. CONCLUSIONS Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.
Collapse
Affiliation(s)
- Riccardo Autorino
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Service, Second University of Naples, Naples, Italy.
| | - Christopher Eden
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Hôpital Robert Debré, Assistance Publique-Hopitaux de Paris, University of Paris Diderot, Paris, France
| | - Giorgio Guazzoni
- Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy
| | - Nicolòmaria Buffi
- Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy
| | - Craig A Peters
- Department of Pediatric Surgery, Children's National Medical Center, Washington, DC, USA
| | - Robert J Stein
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | |
Collapse
|