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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.
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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
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Wahyudi I, Tendi W, Rahman F, Situmorang GR, Rodjani A. Minimal Invasive Treatment in Pelvic-Ureteric Junction Obstruction: A Comprehensive Review. Res Rep Urol 2021; 13:573-580. [PMID: 34408990 PMCID: PMC8364382 DOI: 10.2147/rru.s268569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/27/2021] [Indexed: 12/22/2022] Open
Abstract
Pelvic-ureteric junction obstruction (PUJO) is a common condition, and one of the lead causes of hydronephrosis in children. Currently, the gold standard treatment of PUJO is open surgery using the Anderson–Hynes-modified dismembered pyeloplasty technique. However, with the advancement of medical technology, several minimal invasive approaches were developed, including endoscopic, laparoscopic, and robotic approach, from which the best choice of surgical technique was yet to be determined. Considering the advantages and disadvantages of these methods, the recommended option is to tailor the best surgical approach to each individual patient, and to the surgeons’ preference and experience. Considering these recent advances, a new algorithm is proposed to choose the best minimal invasive modalities invasive treatment to treat PUJO.
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Affiliation(s)
- Irfan Wahyudi
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - William Tendi
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Fakhri Rahman
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Gerhard Reinaldi Situmorang
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Arry Rodjani
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Simmons KL, Chandrapal JC, Wolf S, Rice HE, Tracy EE, Fitzgerald T, Pomann GM, Routh JC. Open versus minimally-invasive surgical techniques in pediatric renal tumors: A population-level analysis of in-hospital outcomes. J Pediatr Urol 2021; 17:534.e1-534.e7. [PMID: 33849794 PMCID: PMC8449787 DOI: 10.1016/j.jpurol.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Minimally-invasive surgery (MIS) has been adopted slowly in pediatric oncology. We attempted to describe contemporary national trends in MIS use; we hypothesized that adolescents (who are more likely to have relatively small renal cell carcinomas) would have a higher proportion of MIS than younger children (who are more likely to have relatively large Wilms tumors) and that this relationship would vary by region. OBJECTIVE To explore whether pediatric urologic oncology outcomes vary by patient age or by surgical technique. METHODS We queried the 1998-2014 National Inpatient Sample (NIS) and included encounters in children aged ≤ 18 y, ICD-9 diagnostic code for renal tumor, and procedure code for open or MIS partial or radical nephrectomy. All analyses used weighted descriptive statistics and outcomes are compared based on age group (</>10 y) or surgery type; Wald-Chi square test was used for differences in proportions and unadjusted weighted ANOVA was used to test for differences in means. RESULTS 9259 weighted encounters were included; 91% were <10 years old and 50.7% were female. MIS surgery accounted for 1.8% of encounters; there was a difference in proportions by age group (1% <9 y vs. 9.9% >9 y, p < 0.01). The proportion of surgery type was similar across regions within age groups, however. Complications occurred in 13.3% of encounters; mean inpatient length of stay was 8.9 days (SD: 0.3); mean cost was $ 34,457.68 (SD: $1197.00). There was no evidence of a difference between surgery type and proportion of post-operative complications, mean inpatient length of stay or mean inpatient cost. DISCUSSION The admission-based, retrospective design of NIS left us unable to assess long-term outcomes, repeated admissions, or to track a particular patient across time; this is particularly relevant for oncologic variables on interest such as tumor stage or event-free survival. We were similarly limited in evaluating the effect of pre-surgical referral patterns on patient distributions. CONCLUSION In this preliminary descriptive analysis, MIS techniques were infrequently used in children, but there was a higher proportion of MIS use among adolescents. There were similar proportions of surgery type across geographic regions within the United States. Whether this infrequent usage is appropriate is as yet unclear given the lack of Level I evidence regarding the relative merits of MIS and open surgery for pediatric and adolescent renal tumors.
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Affiliation(s)
- Kirsten L Simmons
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jason C Chandrapal
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Steven Wolf
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Henry E Rice
- Division of Pediatric Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Elisabeth E Tracy
- Division of Pediatric Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Tamara Fitzgerald
- Division of Pediatric Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Gina-Maria Pomann
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC, USA; Surgical Center for Outcomes Research, Duke University School of Medicine, Durham, NC, USA.
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Chow AK, Rosenberg BJ, Capoccia EM, Cherullo EE. Risk Factors and Management Options for the Adult Failed Ureteropelvic Junction Obstruction Repair in the Era of Minimally Invasive and Robotic Approaches: A Comprehensive Literature Review. J Endourol 2020; 34:1112-1119. [PMID: 32024376 DOI: 10.1089/end.2019.0737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Guidelines for the management of pyeloplasty failure remain elusive given the rarity of this condition and the difficulty of integrating and analyzing reported outcomes given the varying definition of failures. In this article, we aim to review the existing literature on risk factors that may influence the surgical outcomes of reconstructive pyeloplasty for ureteropelvic junction obstruction. Furthermore, we discuss management options and review success outcomes of treatment options for patients with pyeloplasty failure.
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Affiliation(s)
- Alexander K Chow
- Division of Urology, Department of General Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bryan J Rosenberg
- Division of Urology, Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward M Capoccia
- Division of Urology, Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward E Cherullo
- Division of Urology, Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Simforoosh N, Ansari Djafari A, Shemshaki H, Shakiba B, Golshan A, Bonakdar M. Mini-Laparoscopic Management of Ureteropelvic Junction Obstruction in Adults and Children: A High-Volume Case Series. J Laparoendosc Adv Surg Tech A 2019; 29:747-751. [DOI: 10.1089/lap.2018.0470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nasser Simforoosh
- Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Ansari Djafari
- Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Shemshaki
- Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Shakiba
- Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Golshan
- Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Milad Bonakdar
- Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran
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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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W-type suture in Anderson-Hynes laparoscopic pyeloplasty: a novel approach to an old technique. Wideochir Inne Tech Maloinwazyjne 2018; 13:512-517. [PMID: 30524623 PMCID: PMC6280094 DOI: 10.5114/wiitm.2018.76087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/12/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Anderson-Hynes (A-H) dismembered pyeloplasty has remained nearly unchanged since its introduction in 1949. The authors present a modification of the uretero-pelvic anastomosis as described by Anderson and Hynes. The new approach, called the W-type suture, is thought to be more watertight and associated with fewer complications than the original. Aim To assess the effectiveness of the modification of Anderson-Hynes dismembered pyeloplasty named the W-type suture. Material and methods The research is a retrospective study of 99 patients who underwent laparoscopic A-H pyeloplasty. In 49 patients unmodified laparoscopic A-H pyeloplasty was carried out. Fifty patients underwent laparoscopic A-H pyeloplasty with the anastomosis made using the aforementioned W-type suture. To assess the effectiveness of the W-type suture, we compared urine leakage duration – a direct indicator of anastomosis tightness – and frequency of postoperative complications. Results The mean duration of urinary leakage was 3 ±1.16 days for the W-type suture anastomosis group and 3.57 ±1.14 days for the unmodified A-H pyeloplasty group (p < 0.05). The frequency of post-operative complications did not statistically significantly differ between the groups except for fever (18.4% vs. 4%; p < 0.05). Conclusions The analysis of the collected data showed that the W-type suture might be a promising alternative to a traditional approach of performing the ureteropelvic anastomosis. Further research should be done to minimize biases present in this study, which might have influenced our results.
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