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Schäfer FM, Stehr M. Nierenfunktion nach Pyeloplastik im Langzeitverlauf. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01646-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ultrasonographic stabilization of hydronephrosis after pyeloplasty: Key determinant of postoperative follow-up? J Pediatr Urol 2022; 18:662.e1-662.e7. [PMID: 36085189 DOI: 10.1016/j.jpurol.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Although more than 1500 pediatric pyeloplasties are performed in the United States per year, there is a lack of consensus on the adequate imaging modality and timing of follow-up after surgery. OBJECTIVE The aim of this study is to evaluate if ultrasonographic stabilization in the grade of hydronephrosis after pyeloplasty is an adequate parameter to define the optimal length of follow-up after surgery and to detect failed procedures. Secondarily, we want to analyze clinical variables that could impact ultrasonographic stabilization. STUDY DESIGN This is a retrospective chart review of patients who underwent pyeloplasty between 2012 and 2020. Patients were included if they were ≤21 years-old at the time of surgery, had pre and postoperative renal-ultrasounds, had ≥3 months of postoperative follow-up, and had met the criteria for ultrasonographic stabilization after surgery. Ultrasonographic stabilization was defined as 2 consecutive ultrasounds after pyeloplasty, a minimum of 1-month apart, with the same degree of hydronephrosis according to the Society for Fetal Urology (SFU) grading system. Data concerning clinical, surgical, and postoperative variables were collected. RESULTS A total of 143 pyeloplasties met the inclusion criteria. Median age at surgery was 10.5 months with a median post-operative follow-up time of 29 months. Ultrasonographic stabilization was achieved in a mean time of 14.5 months post-operatively. Compared to the preoperative US SFU grade, at ultrasonographic stabilization 127 (88.9%) patients had an improvement of ≥1 grades of hydronephrosis. There were 9 pyeloplasty failures that were diagnosed and surgically corrected in a median of 7.5 months after the initial surgery. No clinical or surgical variables were associated with time to achieve ultrasonographic stabilization. DISCUSSION There is great variability in the length of follow-up after pyeloplasty, ranging from 3-months to 7-years. In our cohort, the bast majority of patients had achieved ultrasonographic stabilization and displayed improvement in their initial grade of hydronephrosis by 14.5 months after surgery. Timeframe in which surgical failures were diagnosed and corrected. There were not clinical or surgical variables associated to time to achieve stabilization. Similar results have been reported in the literature; however, most of them have evaluated as their main outcome resolution and not stabilization of hydronephrosis. CONCLUSION Ultrasonographic stabilization is a suitable and non-invasive parameter for determining the length of follow-up after unilateral pyeloplasty, as it is an adequate timeframe for identifying failed pyeloplasties, observing improvement or stabilization of hydronephrosis, and performing any additional procedure required after the primary repair.
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Jia J, Meng Q, Zhang M, Qi J, Wang D. A comparative study on the Efficacy of Retroperitoneoscopic Pyeloplasty and Open Surgery for Ureteropelvic Junction Obstruction in Children. Pak J Med Sci 2021; 37:1768-1774. [PMID: 34912393 PMCID: PMC8613025 DOI: 10.12669/pjms.37.7.4205] [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: 01/21/2021] [Revised: 06/07/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: To compare the therapeutic effect of retroperitoneoscopic dismembered pyeloplasty and open ureteropelvic junction plasty on the ureteropelvic junction obstruction (UPJO) in children. Methods: After the retrospective analysis of clinical data, 78 children with ureteropelvic junction stenosis treated from January, 2012 to June, 2018 were divided into two groups: OP (open pyeloplasty) group (38 cases) and LP (laparoscopic dismembered pyeloplasty) group (40 cases) according to the surgical methods. The operation time, intraoperative bleeding volume, postoperative length of stay (LOS), postoperative complication rate, postoperative hydronephrosis improvement and other indicators were compared between the two groups. Results: All patients underwent surgery successfully, without conversion to open surgery in LP group. The incidence of postoperative urine leakage and the recovery of hydronephrosis between LP group and OP group 12 months after operation showed no statistically significant difference (P>0.05). The intraoperative bleeding volume, the incidence of postoperative retroperitoneal hematoma, and the postoperative LOS in LP group were lower than those in OP group, while the operation time was longer than that in the OP group, with statistically significant difference (P<0.05). Conclusion: Retroperitoneoscopic dismembered pyeloplasty had similar effect with open dismembered pyeloplasty, but faster recovery and fewer complications, so it has become the preferred treatment method for UPJO in children.
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Affiliation(s)
- Jianghua Jia
- Jianghua Jia, Department of Urology, The Second Hospital of Hebei Medical University, NO. 215 Heping Xi road, Shijiazhuang, Hebei, 050000, China
| | - Qingsong Meng
- Qingsong Meng, Department of Urology, The Second Hospital of Hebei Medical University, NO. 215 Heping Xi road, Shijiazhuang, Hebei, 050000, China
| | - Ming Zhang
- Ming Zhang, Department of Urology, The Second Hospital of Hebei Medical University, NO. 215 Heping Xi road, Shijiazhuang, Hebei, 050000, China
| | - Jinchun Qi
- Jinchun Qi, Department of Urology, The Second Hospital of Hebei Medical University, NO. 215 Heping Xi road, Shijiazhuang, Hebei, 050000, China
| | - Dongbin Wang
- Dongbin Wang, Department of Urology, The Second Hospital of Hebei Medical University, NO. 215 Heping Xi road, Shijiazhuang, Hebei, 050000, China
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Chalieopanyarwong V, Attawettayanon W. Renal Cortical Thickness After Pyeloplasty in Pediatric Ureteropelvic Junction Obstruction. Res Rep Urol 2021; 13:699-704. [PMID: 34527607 PMCID: PMC8437387 DOI: 10.2147/rru.s324786] [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: 06/18/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The main goal of pyeloplasty is to maintain or improve renal function. Diuretic renography is the gold standard for evaluating renal function after pyeloplasty. Renal ultrasonography (RUS) is commonly used to determine hydronephrosis in pediatric patients. We hypothesized that the change in the renal parenchymal cortex would predict pyeloplasty success. In this study, we aim to measure renal cortical thickness change after pyeloplasty in ureteropelvic junction obstruction patients. Materials and Methods We retrospectively reviewed 38 patients who underwent pyeloplasty between 2005 and 2019. We divided patients into three age groups and compared the difference of renal parenchymal thickness change by using generalized estimating equations to identify associated factors for renal cortical thickness change after pyeloplasty. Results Thirty-nine kidney units were identified. The median age at the time of surgery was 41.61±40.99 months. Generalized estimating equations showed significant change of renal parenchymal thickness over the period of follow-up (p=0.02). The estimate of thickness change was 0.0373 mm/month. Age at the time of surgery was not associated with significant renal cortical thickness over the period of follow-up. The positive predictive factors for renal cortical thickness were creatinine clearance, pre-operative anteroposterior diameter and pre-operative renal differential function. The negative factors for decrease of renal cortical thickness were body weight, presentation with abdominal mass, and history of infection. Conclusion Renal cortical thickness after pyeloplasty was improved over the period of follow-up. Age at surgery was not associated with improvement of renal parenchymal thickness.
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Affiliation(s)
- Virote Chalieopanyarwong
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Worapat Attawettayanon
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
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Chatterjee US, Basu AK, Mitra D, Chatterjee SK. Factors Accountable for Unabated Obstruction Following Pyeloplasty. J Indian Assoc Pediatr Surg 2021; 26:27-31. [PMID: 33953509 PMCID: PMC8074819 DOI: 10.4103/jiaps.jiaps_202_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/07/2020] [Accepted: 09/06/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: Split renal function (SFR) and frusemide washout (FWO) are assessed by the DTPA renogram to measure the renal parenchymal functions as well as the evidence of obstruction, both for diagnosis and to treat the pelviureteric junction obstruction. In good number of renal units, both these parameters remain unaltered even after surgery and cause anguish to parents and referring physicians and are usually attributed toward “defective pyeloplasty.” In this study, we have tried to single out the bona fide responsible factor for the bad outcome; either the nonreversible kidney or the restenosis of pyeloplasty. Patients and Methods: We studied file of 69 patients in whom a double “J” (DJ) stent was left in situ for internal drainage for a duration of 8 weeks in the postoperative period. DTPA scans were performed preoperative, at 8 weeks with a stent in place, and at 12 and 24 months postremoval of the stent to assess renal function. Results: In our study, 45 patients (65.2%) showed improvement either in SRF or in FWO or in both after 8 weeks following pyeloplasty and 24 of 69 units (34.8%) did not show any change in renal function with DJ stent in place. Only in six units (8.7%), out of 69 units had deterioration of renal function after removal of DJ stent. Conclusions: In our opinion, no improvement of renal function found in 24 units (34.8%) even with internal drainage with DJ indicates irreversible renal damage. In 45 units (65.2%), renal function reversed after pyeloplasty and DJ stent. However, after the removal of the DJ, functions deteriorated in six units (8.7%) due to restenosis following pyeloplasties.
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Affiliation(s)
- Uday Sankar Chatterjee
- Visiting Pediatric Surgeons, Department of Pediatric Surgery, Park Clinic, Kolkata, West Bengal, India
| | - Ashoke Kumar Basu
- Visiting Pediatric Surgeons, Department of Pediatric Surgery, Park Clinic, Kolkata, West Bengal, India
| | - Debashis Mitra
- Visiting Pediatric Surgeons, Department of Pediatric Surgery, Park Clinic, Kolkata, West Bengal, India
| | - Subir Kumar Chatterjee
- Visiting Pediatric Surgeons, Department of Pediatric Surgery, Park Clinic, Kolkata, West Bengal, India
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Lima JCS, Rocha HAL, Mesquita FJC, Araújo DABS, Silveira RAD, Borges GC. Simulated training model of ureteropyelic anastomosis in laparoscopic pyeloplasty. Acta Cir Bras 2020; 35:e351108. [PMID: 33331458 PMCID: PMC7748080 DOI: 10.1590/acb351108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose: To develop a model for simulated training of ureteropyelic anastomosis in laparoscopicpyeloplasty. Methods: Longitudinal and experimental study, with 16 participants. A synthetic instrument was produced to simulate the renal pelvis and the proximal portion of the ureter positioned on a platform within laparoscopic simulators, thereby resulting in the realistic simulation of the ureteropelvic anastomosis. A step-by-step guide was also developed for the accomplishment of the ureteropelvic anastomosis training model. Results: In the evaluation of all participants’ suture training, a decrease was found in the time needed to perform the anastomosis, with a median of 17.83 min in the 1st step and 14.21 min in the last one (p = 0.01). Regarding the knots, in the 1st step, 5% of them were considered firm, with an evolution to 30% in the last step (p = 0.011). Conclusion: We noticed improvement in the ability to perform the ureteropelvic anastomosis by participants with no experience with it. Therefore, even unexperienced participants can improve their skills with this training. Moreover, we observed the effectiveness of the model use, confirmed by the participants’ opinion and its validation by expert surgeons.
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Kohno M, Ogawa T, Kojima Y, Sakoda A, Johnin K, Sugita Y, Nakane A, Noguchi M, Moriya K, Hattori M, Hayashi Y, Kubota M. Pediatric congenital hydronephrosis (ureteropelvic junction obstruction): Medical management guide. Int J Urol 2020; 27:369-376. [PMID: 32162424 DOI: 10.1111/iju.14207] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/27/2020] [Indexed: 02/07/2023]
Abstract
The prevalence of asymptomatic hydronephrosis, now detected by ultrasonography, has increased. However, definitive management guidelines for the management of congenital hydronephrosis have not been established. The Japanese Society of Pediatric Urology created a "medical management guide" based on new findings for physicians practicing pediatric urology. We developed a medical management guide focused on congenital hydronephrosis caused by ureteropelvic junction obstruction. This medical management guide consists of the definition, pathophysiology, epidemiology, diagnosis, classification, treatment using a clinical management algorithm of hydronephrosis and the long-term course of the disease. The aim of hydronephrosis management is to determine whether surgery should be carried out to avoid renal dysfunction, as there is a possibility for improvement without intervention. Ultrasonography is essential to make treatment decisions. Management is determined by a comprehensive assessment, including the degree of hydronephrosis, anterior-posterior diameter of the renal pelvis and, if necessary, a nuclear medicine evaluation of the status of urine drainage and renal function.
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Affiliation(s)
- Miyuki Kohno
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Tetsushi Ogawa
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatrics, Toranomon Hospital, Tokyo, Japan
| | - Yoshiyuki Kojima
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Sakoda
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuyoshi Johnin
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshifumi Sugita
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Akihiro Nakane
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Mitsuru Noguchi
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Saga Medical School Faculty of Medicine, Saga University, Saga, Japan
| | - Kimihiko Moriya
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Motoshi Hattori
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yutaro Hayashi
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Masayuki Kubota
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Verma S, Saxena P, Singh SK, Khandpur S, Deswal S, Kumar N, Singh A. To evaluate the minimum number of renal scans required to follow pediatric patient postpyeloplasty. World J Nucl Med 2020; 19:106-110. [PMID: 32939196 PMCID: PMC7478307 DOI: 10.4103/wjnm.wjnm_3_19] [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: 01/09/2019] [Accepted: 04/05/2019] [Indexed: 11/16/2022] Open
Abstract
The aim of the study is to evaluate the minimum number of renal scans required to follow pediatric patients postpyeloplasty. We prospectively reviewed the renal scans of 145 children with unilateral pelvi-ureteric junction obstruction who underwent dismembered pyeloplasty. Patients were then divided into four groups based on preoperative split renal function. All patients were followed with renal scan and ultrasound for minimum of 4 years. Renal scan and ultrasound were done after stent removal at 3, 6, and 12 months and then yearly after surgery. Drainage pattern (T1/2) was seen in all groups, except in patients where there was no comment on drainage pattern. Statistical analysis was performed using the Friedman ANOVA and Wilcoxon signed-ranks test as a post hoc test with Bonferroni correction and Kruskal–Wallis test with Mann–Whitney U-test as a post hoc test with Bonferroni correction. On comparison of the pattern of drainage with time in Groups 1–4, it was found that there was no significant difference with time in Group 1. Then, further, using Wilcoxon signed-rank test as post hoc test for Friedman ANOVA, Group 2 showed statistically significant difference in drainage pattern in scans between 6 months and 1 year, Group 3 showed statistically significant difference in drainage pattern in scans between 3 months and 1 year, and Group 4 showed statistically significant difference in drainage pattern in scans done between 3 and 6 months (P < 0.05). Minimum of three renal scans were required for paediatric patients post pyeloplasty at 3 months, 6 months and 1 year in the follow up period.
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Affiliation(s)
- Shashwat Verma
- Department of Nuclear Medicine, Chandan Hospital, Lucknow, Uttar Pradesh, India
| | - Payal Saxena
- Department of Obstetrics and Gynaecology, Chandan Hospital, Lucknow, Uttar Pradesh, India
| | | | - Sukhanshi Khandpur
- Department of Statistics, Lucknow University, Lucknow, Uttar Pradesh, India
| | - Satyawati Deswal
- Department of Nuclear Medicine, Chandan Hospital, Lucknow, Uttar Pradesh, India
| | - Narvesh Kumar
- Department of Nuclear Medicine, Apollo Medics, Lucknow, Uttar Pradesh, India
| | - Anjana Singh
- Department of Pathology, Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
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Kadihasanoglu M, Yucetas U, Karabay E, Sonmezay E. Comparison of the outcomes of laparoscopic pyeloplasty with and without concomitant pyelolithotomy. Int Braz J Urol 2019; 45:965-973. [PMID: 31626519 PMCID: PMC6844342 DOI: 10.1590/s1677-5538.ibju.2018.0781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/06/2019] [Indexed: 12/22/2022] Open
Abstract
Objective We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy. Materials and Methods We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups. Results The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88). Conclusions Laparoscopic pyeloplasty with concomitant pyelolithotomy is a safe and effective intervention with associated good cosmetic results and high stone-free rates without significant increase in operative time or complications.
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Affiliation(s)
| | - Ugur Yucetas
- Department of Urology, Istanbul Training & Research Hospital, Istanbul, Turkey
| | - Emre Karabay
- Department of Urology, Istanbul Training & Research Hospital, Istanbul, Turkey
| | - Erkan Sonmezay
- Department of Urology, Istanbul Training & Research Hospital, Istanbul, Turkey
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Robot-assisted laparoscopic pyeloplasty in infants and children: is it superior to conventional laparoscopy? World J Urol 2019; 38:1827-1833. [PMID: 31506749 DOI: 10.1007/s00345-019-02943-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Open pyeloplasty (OP) has been the first-line treatment for ureteropelvic junction obstruction (UPJO) since it was first described by Anderson and Hynes. The use of minimally invasive surgery (MIS) to treat UPJO in the pediatric population has increased in recent years, due to decreased morbidity and shorter recovery times. Recently, robot-assisted laparoscopic pyeloplasty (RALP) has seen a steady expansion. Unlike laparoscopic pyeloplasty (LP), RALP comes with a more manageable learning curve aided by specialized technological advantages such as high-resolution three-dimensional view, tremor filtration with motion scaling, and highly dexterous wrist-like instruments. With this review, we aim to highlight the trend toward robotic pyeloplasty over laparoscopy and current available evidence on outcomes. METHODS We systematically searched the PubMed and EMBASE databases, and we critically reviewed the available literature on the use of laparoscopy and robotic technology in pediatric patients with UPJO. RESULTS Overall, we selected 19 original articles and 5 meta-analyses. The available literature showed that the robotic approach to the UPJO allowed for decreased operative times, shorter length of hospital stay, lower complication rates, with success rates comparable to LP. Conflicting results persist regarding robotic platform and equipment costs. CONCLUSION While laparoscopy requires advanced skills for complex reconstructive procedures, such as pyeloplasty, robot-assisted surgery offers the valuable potential of making MIS more accessible to these types of procedure. Robotic technology has contributed to shortening the learning curve by acting as a bridge between open and endoscopic approach. There is still a strong need for higher quality evidence in the form of prospective observational studies and clinical trials, as well as further cost-effectiveness analyses. As robotic surgical technology spreads, future systems will be developed, offering smaller and more flexible tools, allowing enhanced applications on pediatric patients.
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Elbaset M, Zahran MH, Sharaf M, Elmeniar A, Ezzat O, Elgamal M, Badawy M, Osman Y. Long Term Functional Success After Pyeloplasty for Pelvi-Ureteral Junction Obstruction in Unilateral Poorly Functioning Kidney in Exclusively Adults Population. Urology 2019; 131:234-239. [DOI: 10.1016/j.urology.2019.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
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Predictors of Recurrence and Complications in Pediatric Pyeloplasty. Urology 2019; 126:187-191. [DOI: 10.1016/j.urology.2019.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 11/20/2022]
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Abdrabuh AM, Salih EM, Aboelnasr M, Galal H, El-Emam A, El-Zayat T. Endopyelotomy versus redo pyeoloplasty for management of failed pyeloplasty in children: A single center experience. J Pediatr Surg 2018; 53:2250-2255. [PMID: 29954589 DOI: 10.1016/j.jpedsurg.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/06/2018] [Accepted: 06/03/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE We compared endopyelotomy to redo pyeloplasty for the treatment of failed pyeloplasty in children to identify factors that may have an impact on outcome and favor one procedure over the other. METHODS Of 43 patients with recurrent UPJO, EP was performed in 27 and RP was performed in 16. Age, gender, side, presentation of secondary UPJO, hospital stay, complications and success rates were compared. Success was defined as radiographic relief of obstruction as determined by ultrasound or diuretic renography at latest follow-up. RESULTS Mean (Range) patient age was 7.2 years (range 6 months to 17 years) in EP (group 1) while 7.4 (range 6 months to 17 years) in RP (group 2). EP technique consisted of retrograde cold-knife in 17 patients, retrograde holmium laser in 8 and antegrade cold-knife in 2. RP was performed in 16 patients. All the patients with failed EP had a stricture greater than 15 mm. Mean length of the narrowed ureteral segment was 17.8 mm in the failed EP group vs 10 mm in the successful group (p < 0.001). Mean Hospital stay was 1 day for the EP group and 5 days for the RP group (p < 0.001). Mean follow-up was 17 months (range 12 to 43) after EP and 21 months (12 to 51) after RP. There was no statistical significance between both groups regarding the postoperative degree of hydronephrosis, parenchymal thickness, split renal functions and renal drainage. The overall success was (86%); the success was nonsignificantly higher in RP (93.8%) vs (81.5%) in EP. CONCLUSION In selected children, retrograde endopyelotomy is safe and may give comparable short-term outcomes as open redo pyeloplasty for correction of secondary UPJO after failed pyeloplasty. Narrowed ureteral segment greater than 15 mm and preoperative grade 4 hydronephrosis were factors significantly associated with a poor outcome after EP. A LEVEL-OF-EVIDENCE RATING FOR CLASSIFYING STUDY QUALITY LEVEL III Retrospective comparative study.
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Affiliation(s)
| | - Elsayed M Salih
- Department of urology, Al-Azhar university Hospitals, Cairo, Egypt
| | | | - Hussein Galal
- Department of urology, Al-Azhar university Hospitals, Cairo, Egypt
| | | | - Tarek El-Zayat
- Department of urology, Al-Azhar university Hospitals, Cairo, Egypt; Department of Radiodiagnosis, Al-Azhar university Hospitals, Cairo, Egypt
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Li B, Chu D. Screening for and Management of Chronic Kidney Disease for Children with Congenital Abnormalities of the Kidney and Urinary Tract. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Light A, Karthikeyan S, Maruthan S, Elhage O, Danuser H, Dasgupta P. Peri-operative outcomes and complications after laparoscopic vs robot-assisted dismembered pyeloplasty: a systematic review and meta-analysis. BJU Int 2018; 122:181-194. [DOI: 10.1111/bju.14170] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Alexander Light
- GKT School of Medical Education; King's College London, Guy's Campus; London UK
| | - Sandeep Karthikeyan
- GKT School of Medical Education; King's College London, Guy's Campus; London UK
| | - Sachan Maruthan
- GKT School of Medical Education; King's College London, Guy's Campus; London UK
| | - Oussama Elhage
- Department of Urology; Guy's and St Thomas' NHS Foundation Trust; London UK
| | | | - Prokar Dasgupta
- Department of Urology; Guy's and St Thomas' NHS Foundation Trust; London UK
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16
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Tam YH, Pang KKY, Wong YS, Chan KW, Lee KH. From Laparoscopic Pyeloplasty to Robot-Assisted Laparoscopic Pyeloplasty in Primary and Reoperative Repairs for Ureteropelvic Junction Obstruction in Children. J Laparoendosc Adv Surg Tech A 2018; 28:1012-1018. [PMID: 29641368 DOI: 10.1089/lap.2017.0561] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) are both minimally invasive surgical options to correct ureteropelvic junction obstruction in children. There are limited data reporting surgeons' experience of switching from LP to RALP and comparing the outcomes of the two procedures. METHODS We conducted a retrospective study on 63 consecutive children who underwent either LP or RALP by the same surgeon in a tertiary center from January 2008 to November 2016. LP had been the standard practice until January 2014 when it was replaced by RALP in short transition. RESULTS Thirty-seven LP and 26 RALP were successfully performed in children aged 2 months to 16 years. There was no difference between the two groups in age, body weight, laterality, clinical presentations, preoperative imagings, primary/reoperative repairs. The overall success rates were 34/37 (91.9%) and 25/26 (96.2%) for LP and RALP, respectively (P > .05). RALP was associated with shorter length of stay (3.1 days versus 4.0 days; P = .03). Surgeon-in-training participation was greater in RALP group (P < .001). There was no difference in operative time, complication rates, and analgesic requirement between the two groups. CONCLUSIONS Surgeons proficient in LP can adapt quickly to RALP, achieving comparable outcomes. Robotic technology may facilitate training on minimally invasive pyeloplasty.
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Affiliation(s)
- Yuk Him Tam
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong, China
| | - Kristine Kit Yi Pang
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong, China
| | - Yuen Shan Wong
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong, China
| | - Kin Wai Chan
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong, China
| | - Kim Hung Lee
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong , Hong Kong, China
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Abstract
Laparoscopic pyeloplasty (LP) is more beneficial than open procedures. However, studies on laparoscopic management of cases with secondary ureteropelvic junction obstruction (SUPJO) after previous failed pyeloplasty in the pediatric population are lacking. This meta-analysis aimed to assess the difference between redo LP (RLP) and redo open pyeloplasty (ROP) for children with SUPJO, focusing on certain criteria. All recent studies on RLP and ROP in children with SUPJO were searched. Search engines such as Medline, PubMed, and The Cochrane Library of Systematic Reviews were used. Sixty citations were specified. Two reviewers extracted data independently, screened the titles, and assessed the quality of each citation. Continuous data reported as a weighted mean difference (WMD) (95% confidence interval) and dichotomous data reported as relative risk were used. We measured the length of hospital stay (LOS) and operative time using weighted mean and success and complication rates using risk difference and odds ratio (OR). A random effects model was used to pool OR that was tested for heterogeneity. We specified six publications that minutely met our eligibility standards. Meta-analysis of given data resulted in the following: ROP showed reduction in operative time by 12 min (WMD: 12.7 min; P = 0.14). RLP had shorter LOS than ROP (WMD: 0.6 days; P < 0.01). No difference was observed in complication and success rates (OR: 0.8; P = 0.50 and OR: 1.2; P = 0.51, respectively). In conclusion, RLP seems to be better than ROP in terms of LOS reduction; however, both are comparable with respect to success and complication rates, especially postoperative urine leakage.
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Affiliation(s)
- Hamdan Hammad Alhazmi
- Department of Surgery, Division of Urology, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
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18
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Polok M, Apoznański W. Anderson-Hynes pyeloplasty in children - long-term outcomes, how long follow up is necessary? Cent European J Urol 2017; 70:434-438. [PMID: 29410899 PMCID: PMC5791399 DOI: 10.5173/ceju.2017.1431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/20/2017] [Accepted: 09/01/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Pyeloplasty is commonly conducted in children with uretero-pelvic junction obstruction. Standard post-operational procedure involves only a short period of time after the surgery. What is the real number of complications, including those in the long-term? What is the function of the operated kidney? The aims of this study are to assess the effectiveness of pyeloplasty and to assess the suitability of conducting long term follow-up after pyeloplasty. Material and methods 35 of 137 patients after open pyeloplasty between 1992–2006 responded to the invitation and returned for a control appointment. The median age was 8 years (range 1 month – 19 years). In 26 kidney units the disease proceeded with symptoms and in 10 cases it proceeded without symptoms. The predominant symptom was abdominal pain (n = 21). In each child both the control ultrasound and the diuretic renal scintigraphy of the kidneys were conducted. Results Regression of symptoms after the operation was obtained in 19 kidney units (73%). Improvement in scintigraphy was observed in 23 kidney units (82.1%), improvement in ultrasound was obtained in 32 (91%) kidney units. Complications which required surgical intervention occurred in 4 (11.1%) patients. One patient required operative removal of a pyelostomy tube, 2 patients (11.1%) required repeated pyleoplasty (23 and 27 months after the operation), one child required nephrectomy due to nephrogenic arterial hypertension (after 4 years). Conclusions Statistically, there are improvements of scintigraphic function of the kidney, improvements in ultrasound examinations, and the remission of symptoms after pyeoplasty. Most complications occur within 2 years after the surgery. Long-term follow up should be continued.
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Affiliation(s)
- Marcin Polok
- Department of Pediatric Surgery and Urology, Medical University of Wrocław, Wrocław, Poland
| | - Wojciech Apoznański
- Department of Pediatric Surgery and Urology, Medical University of Wrocław, Wrocław, Poland
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19
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Rickard M, Lorenzo AJ, Braga LH, Munoz C. Parenchyma-to-hydronephrosis Area Ratio Is a Promising Outcome Measure to Quantify Upper Tract Changes in Infants With High-grade Prenatal Hydronephrosis. Urology 2017; 104:166-171. [PMID: 28111223 DOI: 10.1016/j.urology.2017.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/08/2017] [Accepted: 01/11/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To explore the value of renal parenchyma-to-hydronephrosis area ratio (PHAR) in detecting trends of hydronephrosis (HN) improvement or worsening and response to surgical intervention. METHODS Initial and follow-up sagittal renal ultrasound images of patients entered into a prenatal HN database from 2008 to 2016, with baseline Society for Fetal Urology (SFU) grades III and IV HN and without vesicoureteral reflux, were evaluated using National Institutes of Health-sponsored image-processing software. Renal parenchymal area, hydronephrosis area (HA), PHAR, anteroposterior diameter (APd), and SFU grade were captured at baseline and most recent visit. Data were analyzed based on the need for surgical intervention to address obstruction. RESULTS Out of 193 infants (159 boys; 135 left side), 58 (30%) underwent surgery. Patients managed surgically compared with those managed nonsurgically had worse baseline HN severity markers: SFU grade (3.6 ± 0.5 vs 3.1 ± 0.4; P <.001), urinary tract dilation classification (2.7 ± 0.5 vs 2.2 ± 0.4; P <.001), APd (20.3 ± 10.1 vs 12.8 ± 8.0; P <.001), HA (10.0 ± 6.6 vs 4.7 ± 2.8; P <.001), and PHAR (1.3 ± 1.0 vs 3.0 ± 2.9; P <.001); but both patient groups had similar renal parenchymal area (9.4 ± 3.5 vs 9.7 ± 2.8; P = .5). At last follow-up, the following discrepancies persisted: SFU grade (2.3 ± 1.0 vs 1.7 ± 1.0; P <.001), urinary tract dilation classification (1.5 ± 0.7 vs 1.0 ± 0.7; P <.001), APd (11.7 ± 8.0 vs 7.7 ± 5.7; P <.001), and HA (6.4 ± 5.1 vs 3.6 ± 2.7; P <.001); however, PHAR was equalized for both groups (7.2 ± 14.0 vs 7.1 ± 6.1; P = .9). CONCLUSION By concurrently considering changes in renal parenchyma and degree of HN, we found that PHAR appears to be a promising parameter that reflects similarities between patients managed surgically and those managed nonsurgically, despite initial discrepancies. Our data suggest that this variable may provide reassurance and a more objective assessment of improvement after surgery compared with other traditional ultrasound outcome measures.
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Affiliation(s)
- Mandy Rickard
- Department of Surgery and McMaster Pediatric Surgery Research Collaborative, McMaster University, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Canada
| | - Armando J Lorenzo
- Division of Pediatric Urology, Department of Surgery, Hospital for Sick Children and University of Toronto, Canada.
| | - Luis H Braga
- Department of Surgery and McMaster Pediatric Surgery Research Collaborative, McMaster University, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Canada
| | - Caroline Munoz
- Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Canada
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20
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Wadskier Gutierrez LA. Comentario editorial a “Experiencia en pieloplastia laparoscópica durante 5 años”. Rev Urol 2017. [DOI: 10.1016/j.uroco.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bansal UK, Dangle PP, Stephany H, Durrani A, Cannon G, Schneck FX, Ost MC. Optimal Length of Follow-up for the Detection of Unsuccessful Pediatric Pyeloplasty: A Single-Center Experience. Front Pediatr 2017; 5:126. [PMID: 28620596 PMCID: PMC5451493 DOI: 10.3389/fped.2017.00126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/12/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the optimal length of follow-up for patients undergoing both open and minimally invasive pyeloplasties to ensure prompt detection of a recurrent obstruction. There are no standard guidelines on ideal follow-up and imaging post-pediatric pyeloplasty currently. METHODS A retrospective chart review identified 264 patients (<18 years old) who underwent pyeloplasty for ureteropelvic junction obstruction between April 2002 and December 2014. Ultrasound was obtained every 3-4 months for the first year following pyeloplasty and thereafter at discretion of treating physician. Patient characteristics including symptoms and imaging were reviewed. RESULTS Of the 264 patients, 72% were male with mean age of 51 months and follow-up of 26.8 months. Approximately 73% followed up to 3 years. Fourteen patients (5.3%) had a recurrent obstruction. Among the failures, 85% were diagnosed and underwent successful redo pyeloplasty within 3 years. Six infants had a recurrence (43% of all unsuccessful surgeries) and were diagnosed within 3 years of the initial surgery. Patients undergoing a minimally invasive procedure were less likely to be followed for more than 3 years compared to an open procedure (p < 0.001). Patients with severe hydronephrosis preoperatively were followed longer (p = 0.031). Age at surgery and type of surgical approach (p < 0.01) were significant predictors of length of follow-up in a negative binomial regression. CONCLUSION Based on the results, a minimum of 3 years of follow-up is necessary to detect the majority of recurrent obstructions. Those patients who have higher than average lengths of follow-up tend to be younger and/or underwent an open surgical approach.
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Affiliation(s)
- Utsav K Bansal
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Pankaj P Dangle
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Heidi Stephany
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Asad Durrani
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Glenn Cannon
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Francis X Schneck
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Michael C Ost
- Department of Urology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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22
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Kumar M, Singh SK, Arora S, Mittal V, Patidar N, Sureka SK, Ansari MS. Follow-up imaging after pediatric pyeloplasty. Indian J Urol 2016; 32:221-6. [PMID: 27555681 PMCID: PMC4970394 DOI: 10.4103/0970-1591.185090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: The duration, methods and frequency of radiographic follow-up after pediatric pyeloplasty is not well-defined. We prospectively evaluated a cohort of children undergoing pyeloplasty to determine the method for follow-up. Methods: Between 2000 and 2008, children undergoing pyeloplasty for unilateral ureteropelvic junction obstruction were evaluated for this study. All patients were evaluated preoperatively with protocol ultrasound (USG) and diuretic renal scan (RS). On the basis of preoperative split renal function (SRF), these patients were divided into four groups – Group I: SRF > 40%, Group II: SRF 30–39%, Group III: SRF 20–29%, and Group IV: SRF 10–19%. In follow-up, USG and RS were done at 3 months and repeated at 6 months, 1 year, and then yearly after surgery for a minimum period of 5 years. Improvement, stability, or worsening of hydronephrosis was based on the changes in anteroposterior (AP) diameter of pelvis and caliectasis on USG. Absolute increase in split renal function (SRF) >5% was considered significant. Failure was defined as increase in AP diameter of pelvis and decrease in cortical thickness on 3 consecutive USG, t½ >20 min with obstructive drainage on RS and/or symptomatic patient. Results: 145 children were included in the study. Their mean age was 3.26 years and mean follow-up was 7.5 years. Pre- and post-operative SRF remain unchanged within 5% range in 35 of 41 patients (85%) in Group I. While 9 of 20 patients (45%) in Group II, 23 of 50 patients (46%) in Group III, and 14 of 34 patients (41%) in Group IV exhibited changes >5% after surgery. 5 patients failed, 2 in Group III, and 3 in Group IV. None of the patients deteriorated in Group I and II. Conclusion: After pyeloplasty in children with a baseline split GFR >30%, if a diuretic renogram and USG performed 3 months postoperatively shows nonobstructive drainage with t½ <20 min and decreased hydronephrosis, no further follow-up is required.
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Affiliation(s)
- Manoj Kumar
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjeet Kumar Singh
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sohrab Arora
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Varun Mittal
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nitesh Patidar
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M S Ansari
- Department of Urology and Renal Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Rickard M, Braga LH, Oliveria JP, Romao R, Demaria J, Lorenzo AJ. Percent improvement in renal pelvis antero-posterior diameter (PI-APD): Prospective validation and further exploration of cut-off values that predict success after pediatric pyeloplasty supporting safe monitoring with ultrasound alone. J Pediatr Urol 2016; 12:228.e1-6. [PMID: 27448846 DOI: 10.1016/j.jpurol.2016.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/29/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Renograms are frequently obtained post-pyeloplasty in patients with residual hydronephrosis to confirm adequate drainage. Recent evidence suggests that percent improvement in antero-posterior diameter (PI-APD) ≥38 is predictive of success. We sought to further explore PI-APD ranges that would allow identification of patients who would benefit from ultrasound (US) monitoring alone vs. post-operative renal scan, and those more likely to develop recurrent ureteropelvic junction obstruction (rUPJO). METHODS A single-center prospectively-collected pyeloplasty database (2008-2015) was queried (n = 151). Only patients with both pre- and post-operative APD measurements were included (n = 138). PI-APD was divided into 3 categories: <20%; 20-39%; ≥40%. The following variables were collected post-operatively: patients monitored with US alone, renogram and US, rUPJO and minimal or resolved hydronephrosis (SFU ≤2; UTD ≤1; APD ≤15 mm). RESULTS Mean age at first and last follow-up were 4.8 (median 4.0; range 0-60) months and 26.6 (median 20.5; range 1-77) months, respectively. Of 138 patients, 84 (61%) had US alone, 54 (39%) had a renogram and US post-operatively, and 6 (4%) developed rUPJO. Of 84 patients who had US alone, 71 (84%; p < 0.01) demonstrated ≥40% PI-APD. Of 54 patients with renogram and US 46 (85%; p < 0.01) had ≥40 PI-APD. Of the 6 patients who developed rUPJO, all were in the <20 PI-APD group (100%; p < 0.01). Resolution of hydronephrosis according to SFU, UTD and APD occurred in 96/138 (70%), 89/138 (64%) and 113/138 (82%) patients respectively. Of these, 87 (91%), 81 (91%), and 108 (95%) occurred in >40% PI-APD group. CONCLUSION ≥40% PI-APD at the first post-operative visit strongly predicts pyeloplasty success, as up to 82% of these patients showed resolved hydronephrosis and 61% underwent non-invasive monitoring by US alone. Our data suggests that up to 85% of renograms may have been unnecessary. Finally, <20% PI-APD permitted identification of all rUPJO cases. Stratification of patients based in PI-APD is a promising strategy for further minimizing radiation exposure while safely detecting children at risk for rUPJO.
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Affiliation(s)
- M Rickard
- McMaster Children's Hospital, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - L H Braga
- McMaster Children's Hospital, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada; McMaster University, Division of Urology, Department of Surgery, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada; McMaster Pediatric Surgery Research Collaborative, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada.
| | - J-P Oliveria
- McMaster University, Division of Urology, Department of Surgery, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - R Romao
- Dalhousie University, 6299 South Street, Halifax, Nova Scotia B3H 4R2, Canada
| | - J Demaria
- McMaster Children's Hospital, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada; McMaster University, Division of Urology, Department of Surgery, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - A J Lorenzo
- The Hospital for Sick Children, Division of Urology, 555 University Ave, Toronto, ON M5G 1X8, Canada
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Faure A, London K, Smith GH. Early mercaptoacetyltriglycine(MAG-3) diuretic renography results after pyeloplasty. BJU Int 2016; 118:790-796. [DOI: 10.1111/bju.13512] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Alice Faure
- Department of Urology; Children's Hospital at Westmead; Paediatrics and Childhealth; University of Sydney; Sydney New South Wales Australia
| | - Kevin London
- Department of Nuclear Medicine; Children's Hospital at Westmead; Paediatrics and Childhealth; University of Sydney; Sydney New South Wales Australia
| | - Grahame H.H. Smith
- Department of Urology; Children's Hospital at Westmead; Paediatrics and Childhealth; University of Sydney; Sydney New South Wales Australia
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Dy GW, Hsi RS, Holt SK, Lendvay TS, Gore JL, Harper JD. National Trends in Secondary Procedures Following Pediatric Pyeloplasty. J Urol 2016; 195:1209-14. [PMID: 26926543 DOI: 10.1016/j.juro.2015.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE Although reported success rates after pediatric pyeloplasty to correct ureteropelvic junction are high, failure may require intervention. We sought to characterize the incidence and timing of secondary procedures after pediatric pyeloplasty using a national employer based insurance database. MATERIALS AND METHODS Using the MarketScan® database we identified patients 0 to 18 years old who underwent pyeloplasty from 2007 to 2013 with greater than 3 months of postoperative enrollment. Secondary procedures following the index pyeloplasty were identified by CPT codes and classified as stent/drain, endoscopic, pyeloplasty, nephrectomy or transplant. The risk of undergoing a secondary procedure was ascertained using Cox proportional hazards models adjusting for demographic and clinical characteristics. RESULTS We identified 1,976 patients with a mean ± SD followup of 23.9 ± 19.8 months. Overall 226 children (11.4%) had undergone at least 1 post-pyeloplasty procedure. The first procedure was done within 1 year in 87.2% of patients with a mean postoperative interval of 5.9 ± 11.1 months. Stents/drains, endoscopic procedures and pyeloplasties were noted in 116 (5.9%), 34 (1.7%) and 71 patients (3.1%), respectively. Length of stay was associated with undergoing a secondary procedure. Compared with 2 days or less the HR of 3 to 5 and 6 days or greater was 1.65 and 3.94 (p = 0.001 and <0.001, respectively). CONCLUSIONS Following pediatric pyeloplasty 1 of 9 patients undergoes at least 1 secondary procedure with the majority performed within the first year. One of 11 patients undergoes intervention more extensive than placement of a single stent or drain, requiring management strategies that generally signify recurrent or persistent obstruction. Estimates of pyeloplasty success in this national data set are lower than in other published series.
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Affiliation(s)
- Geolani W Dy
- Department of Urology, University of Washington School of Medicine, Seattle, Washington.
| | - Ryan S Hsi
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Thomas S Lendvay
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
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26
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Hsi RS, Holt SK, Gore JL, Lendvay TS, Harper JD. National Trends in Followup Imaging after Pyeloplasty in Children in the United States. J Urol 2015; 194:777-82. [PMID: 25868576 DOI: 10.1016/j.juro.2015.03.123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Radiographic followup after pyeloplasty for the correction of ureteropelvic junction obstruction is not well defined in children. We characterize trends in frequency and modality of postoperative imaging after open and minimally invasive pediatric pyeloplasty. MATERIALS AND METHODS Using the MarketScan® database, we identified patients 0 to 18 years old undergoing pyeloplasty between 2007 and 2013. Followup imaging was classified as functional (diuretic renography, excretory urography) or nonfunctional (ultrasound, computerized tomography, magnetic resonance imaging). We excluded patients with less than 24 months of postoperative enrollment in MarketScan. Multivariate logistic regression was performed to determine associations between demographic variables and imaging use patterns. RESULTS We identified 926 patients with a mean ± SD followup of 3.6 ± 1.3 years, of whom 30% underwent minimally invasive pyeloplasty. Overall 5.9% of patients had no postoperative imaging available. Within the first 6 months postoperatively 853 patients (91%) underwent at least 1 imaging study and 192 (24%) underwent renography. Within the first 12 months postoperatively 91% of patients underwent at least 1 imaging study, most commonly ultrasound. After 12 months almost a third of the patients were not followed with imaging. Of the 71% undergoing imaging most underwent ultrasound. Younger age and female gender were independently associated with frequent imaging (at least yearly) on multivariate logistic regression. CONCLUSIONS Following pediatric pyeloplasty there is variation in modality and frequency of imaging followup. The majority of patients are followed with renal ultrasound, with less frequent use of functional imaging. Almost a third of patients do not undergo followup imaging after 1 year.
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Affiliation(s)
- Ryan S Hsi
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington.
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
| | - John L Gore
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
| | - Thomas S Lendvay
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology (TSL), Seattle Children's Hospital, Seattle, Washington
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Lee HE, Park K, Choi H. An analysis of long-term occurrence of renal complications following pediatric pyeloplasty. J Pediatr Urol 2014; 10:1083-8. [PMID: 24856974 DOI: 10.1016/j.jpurol.2014.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/24/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Few reports discuss post-pubertal renal complications after pyeloplasty. We analyzed long-term complications, such as decreased renal function (RF) measured by serum creatinine (SCr), hypertension (HTN), or proteinuria (protU) following pediatric pyeloplasty. SUBJECTS AND METHODS We retrospectively investigated 257 patients who underwent dismembered pyeloplasty due to ureteropelvic junction obstruction from January 1986 to December 2001. Medical history, preoperative and postoperative blood pressure, urinalysis, and SCr results were reviewed. RESULTS Fifty-five patients (47 male, 8 female) who were followed up for at least 10 years with post-pubertal follow-up data available were analyzed. Seven (12.7%) patients were diagnosed with HTN, and 10 (18.2%) with protU. The grade of hydronephrosis decreased, and the differential RF measured by MAG-3 renal scan significantly increased at final analysis (p<0.001). Presence of preoperative symptoms (p=0.034), and SCr elevation (p=0.018) showed correlation with HTN. HTN took 15.7 (±5.8) (7-25) years, and protU detection took 16.2 (±5.9) (6-23) years, with the highest incidence of both HTN and protU between 15 and 20 years postoperatively. CONCLUSION According to our investigation, a prudent evaluation of signs of RF decrease at 10 years after surgery, and then every 5 years, until 20 years should be recommended, although further studies are necessary.
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Affiliation(s)
- Hahn-Ey Lee
- Department of Urology, Gachon University Gil Medical Center, Seoul, South Korea
| | - Kwanjin Park
- Department of Urology, The Armed Forces Medical Command, South Korea.
| | - Hwang Choi
- Department of Urology, The Armed Forces Medical Command, South Korea
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Hsi RS, Holt SK, Gore JL, Harper JD. Trends in followup imaging after adult pyeloplasty. J Urol 2014; 191:1357-62. [PMID: 24423439 DOI: 10.1016/j.juro.2013.12.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Although success rates are reported to be high, radiographic followup after pyeloplasty to correct ureteropelvic junction obstruction varies in intensity and modality. We characterized postoperative care after pyeloplasty to identify imaging trends. MATERIALS AND METHODS Using the MarketScan® database we identified patients 17 to 65 years old treated with pyeloplasty from 2007 to 2010. Followup imaging was classified as functional (diuretic renogram or excretory urogram) and nonfunctional (ultrasound, computerized tomography or magnetic resonance imaging). The postoperative period was divided into intervals of less than 6, 6 to 12, 12 to 24, 24 to 36 and greater than 36 months. We excluded from study patients with less than 24 months of postoperative enrollment in MarketScan. Multivariate logistic regression was used to determine associations between demographic variables and imaging utilization patterns. RESULTS We identified 742 patients with a mean ± SD followup of 36.8 ± 3.7 months, of whom 65% underwent minimally invasive pyeloplasty. Of the patients 12% underwent no postoperative imaging. Within the first 6 months 554 patients (75%) underwent at least 1 imaging study and within the first 12 months 82% underwent at least 1 imaging study, which was most commonly functional. After 12 months 54% of patients underwent any imaging, which was most commonly nonfunctional. At least annual imaging was significantly associated with older age, female gender and longer hospital stay. Secondary procedures were required in 62 patients (8%). CONCLUSIONS After pyeloplasty in adulthood most patients undergo a functional imaging study within 6 months. However, after 1 year only half of patients undergo followup imaging. Variability and insufficient radiological followup may bias the belief of pyeloplasty success.
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Affiliation(s)
- Ryan S Hsi
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington.
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Bansal P, Gupta A, Mongha R, Narayan S, Kundu AK, Chakraborty SC, Das RK, Bera MK. Laparoscopic versus open pyeloplasty: Comparison of two surgical approaches -- a single centre experience of three years. J Minim Access Surg 2013; 4:76-9. [PMID: 19547693 PMCID: PMC2699080 DOI: 10.4103/0972-9941.43091] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 08/12/2008] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Ureteropelvic junction obstruction (UPJO) causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new technique must be compared. We compared laparoscopic (LP) and open pyeloplasty (OP) in a randomized prospective trial. MATERIALS AND METHODS: A prospective randomized study was done from January 2004 to January 2007 in which a total of 28 laparoscopic and 34 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally. Standard open Anderson Hynes pyeloplasty, spiral flap or VY plasty was done depending on anatomic consideration. Patients were followed with DTPA scan at three months and IVP at six months. Perioperative parameters including operative time, analgesic use, hospital stay, and complication and success rates were compared. RESULTS: Mean total operative time with stent placement in LP group was 244.2 min (188-300 min) compared to 122 min (100-140 min) in OP group. Compared to OP group, the post operative diclofenac requirement was significantly less in LP group (mean 107.14 mg) and OP group required mean of (682.35 mg). The duration of analgesic requirement was also significantly less in LP group. The postoperative hospital stay in LP was mean 3.14 Days (2-7 days) significantly less than the open group mean of 8.29 days (7-11 days). CONCLUSION: LP has a minimal level of morbidity and short hospital stay compared to open approach. Although, laparoscopic pyeloplasty has the disadvantages of longer operative time and requires significant skill of intracorporeal knotting but it is here to stay and represents an emerging standard of care.
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Affiliation(s)
- Punit Bansal
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
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Wang F, Xu Y, Zhong H. Robot-assisted versus laparoscopic pyeloplasty for patients with ureteropelvic junction obstruction: An updated systematic review and meta-analysis. Scand J Urol 2013; 47:251-64. [DOI: 10.3109/21681805.2013.780184] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Romao RLP, Farhat WA, Pippi Salle JL, Braga LHP, Figueroa V, Bägli DJ, Koyle MA, Lorenzo AJ. Early postoperative ultrasound after open pyeloplasty in children with prenatal hydronephrosis helps identify low risk of recurrent obstruction. J Urol 2012; 188:2347-53. [PMID: 23088981 DOI: 10.1016/j.juro.2012.08.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE Prediction of successful pyeloplasty can be challenging, particularly in asymptomatic children treated for worsening prenatally diagnosed hydronephrosis. We evaluated early noninvasive objective predictors of success in this population. MATERIALS AND METHODS We reviewed patients who underwent pyeloplasty for asymptomatic, prenatally detected, worsening hydronephrosis treated between 2000 and 2010 with followup greater than 1 year. For all patients renal pelvis anteroposterior diameter in a mid transverse view and Society for Fetal Urology hydronephrosis grade were evaluated preoperatively and 3 to 4 months postoperatively. Aside from subjective evaluation based on change in hydronephrosis grade, we estimated the percentage of improvement in anteroposterior diameter (preoperative diameter--postoperative diameter/preoperative diameter). Repeat intervention after pyeloplasty arbitrarily defined failure. Patients were categorized into 3 groups, ie no failure on followup ultrasound (group 1), no failure with postoperative nuclear scan to document success (group 2) and failed pyeloplasty (group 3). ROC curves were plotted to correlate 4 variables with failure, namely preoperative anteroposterior diameter, postoperative anteroposterior diameter, percent improvement in anteroposterior diameter and subjective change in grade. RESULTS Of 229 patients 192 (84%) who met inclusion criteria had ultrasound at 3 to 4 months postoperatively available. Mean age at surgery was 19 months and mean ± SD followup was 49.9 ± 27.7 months. Percent improvement in anteroposterior diameter and postoperative anteroposterior diameter measure were the most reliable variables to predict failure (AUC 0.88 and 0.86, respectively, p <0.0001), whereas preoperative anteroposterior diameter and subjective changes in grade were not good predictors (AUC 0.52, p >0.05). A percent improvement in anteroposterior diameter of 38% or greater or postoperative anteroposterior diameter of 11.5 mm or less was associated with success, with sensitivity of 100% and specificity of 61% and 55%, respectively. CONCLUSIONS Percent improvement in anteroposterior diameter and postoperative pelvic anteroposterior diameter measure can provide objective guidance as to which patients need closer monitoring during followup, and can help select children at low risk for repeat intervention after pyeloplasty.
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Affiliation(s)
- Rodrigo L P Romao
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Bhat GS, Maregowda S, Jayaram S, Siddappa S. Is renal biopsy a better predictor of the outcome of pyeloplasty in adult ureteropelvic junction obstruction? Urology 2011; 79:321-5. [PMID: 22173181 DOI: 10.1016/j.urology.2011.10.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 09/14/2011] [Accepted: 10/11/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To prospectively evaluate per operative renal biopsy as a predictor of outcome of pyeloplasty in cases of unilateral pelviureteric junction obstruction in adults. MATERIALS AND METHODS We conducted a prospective study on 24 patients with unilateral UPJ obstruction undergoing pyeloplasty between November 2005 and August 2006 and followed them until December 2010. Intraoperative renal wedge biopsy was obtained in these patients and this was correlated with preoperative DRF on diuretic renogram. Outcome of pyeloplasty was assessed at 1 and 3 years by diuretic renograms and the renal biopsy as a predictive tool was compared with preoperative DRF. RESULTS Histology suggestive of obstructive damage to kidneys, such as significant glomerulosclerosis, widened Bowman's capsule, interstitial fibrosis, and tubular atrophy on renal biopsy was the highly significant predictor of poor outcome of pyeloplasty with a P value=.001 compared with preoperative DRF. CONCLUSION Renal biopsy is better predictor of outcome of pyeloplasty compared with preoperative DRF in UPJ obstruction. In the presence of severe obstructive changes in renal biopsy, recoverability of renal function despite achievement of successful drainage is significantly decreased.
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Affiliation(s)
- Gajanan S Bhat
- Institute of Nephro-urology, Victoria Hospital campus, Bangalore, Karnataka, India.
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33
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Bansal P, Gupta A, Mongha R, Narayan S, Das RK, Bera M, Chakraborty SC, Kundu AK. Laparoscopic versus open pyeloplasty: comparison of two surgical approaches- a single centre experience of three years. Indian J Surg 2011; 73:264-7. [PMID: 22851839 DOI: 10.1007/s12262-011-0237-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 03/16/2011] [Indexed: 11/25/2022] Open
Abstract
UPJO causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new technique must be compared. We analyzed the comparison of Laparoscopic and open pyeloplasty in a randomized prospective trial. A prospective randomized study was done from January 2004 to January 2007 in which a total of 28 Laparoscopic and 34 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally. Standard open Anderson Hynes pyeloplasty, spiral flap or VY plasty was done depending on anatomic consideration. Patients were followed with DTPA scan at 3 months and IVP at 6 months. Perioperative parameters including operative time, analgesic use, hospital stay, and complication and success rates were compared. Mean total operative time with stent placement in LP group was 244.2 min (188-300 min) compared to 122 min (100-140 min) in open group. Compared to open pyeloplasty the post operative diclofenac requirement was significantly less in LP group (mean107.14 mg) and open group required mean of (682.35 mg) The duration of analgesic requirement was also significantly less in LP group. The post operative hospital stay in LP was mean 8.29 days (7-11) and was significantly less than open group (mean 3.14 Days (2-7 days). Open pyeloplasty has been the gold standard for UPJO repair and achieves success rates exceeding 90%. Laparoscopic pyeloplasty provides a minimally invasive alternative to repair UPJO and has developed world wide as the first minimally option to match success rate of open pyeloplasty. Its potential advantages including less post op pain, shorter hospital stay an improved cosmesis has been proved in some comparative series. The only disadvantage seems to be longer operative time. LP has a minimal level of morbidity and short hospital stay compared to open approach Although Laparoscopic pyeloplasty has the disadvantages of longer operative time and requires significant skill of intracorporeal knotting but it is here to stay and represents an emerging standard of care.
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Affiliation(s)
- Punit Bansal
- IPGMER &SSKM HOSPITAL, 329, Doctors Hostel, 242, AJC Bose Road, Kolkata, 700020 India
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Almodhen F, Jednak R, Capolicchio JP, Eassa W, Brzezinski A, El-Sherbiny M. Is Routine Renography Required After Pyeloplasty? J Urol 2010; 184:1128-33. [DOI: 10.1016/j.juro.2010.05.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Indexed: 12/01/2022]
Affiliation(s)
- Fayez Almodhen
- Division of Pediatric Urology, Montreal Children's Hospital and McGill University Health Center, Montreal, Quebec, Canada
| | - Roman Jednak
- Division of Pediatric Urology, Montreal Children's Hospital and McGill University Health Center, Montreal, Quebec, Canada
| | - John-Paul Capolicchio
- Division of Pediatric Urology, Montreal Children's Hospital and McGill University Health Center, Montreal, Quebec, Canada
| | - Waleed Eassa
- Division of Pediatric Urology, Montreal Children's Hospital and McGill University Health Center, Montreal, Quebec, Canada
| | - Alex Brzezinski
- Division of Pediatric Urology, Montreal Children's Hospital and McGill University Health Center, Montreal, Quebec, Canada
| | - Mohamed El-Sherbiny
- Division of Pediatric Urology, Montreal Children's Hospital and McGill University Health Center, Montreal, Quebec, Canada
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Thomas DFM. Prenatal diagnosis: what do we know of long-term outcomes? J Pediatr Urol 2010; 6:204-11. [PMID: 20347395 DOI: 10.1016/j.jpurol.2010.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
Abstract
Although prenatal diagnosis has been a prominent feature of Paediatric Urology for more than two decades the published literature has been largely characterized by studies reporting short to medium-term follow up. This deficiency is now being addressed by the growing availability of published and unpublished long-term outcome data for a range of prenatally detected anomalies. This review analyses the evidence on long-term outcomes which is provided by studies with mean or median follow- up exceeding 5 years, with particular emphasis on the small number of studies reporting follow -up at 10 years and beyond. The natural history and outcome of conservatively managed uropathies is considered in conjunction with an appraisal of evidence- based indications for surgical intervention. This review evaluates the relative benefits and drawbacks of prenatal diagnosis for children and their parents and also considers the impact of prenatal diagnosis on the delivery of Paediatric Urological services and specialist training.
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Affiliation(s)
- D F M Thomas
- Department of Paediatric Urology, Clinical Sciences Building, St James's University Hospital, Leeds LS9 7TF, UK.
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36
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Screening ultrasound in follow-up after pediatric pyeloplasty. Urology 2010; 76:175-9. [PMID: 20223509 DOI: 10.1016/j.urology.2009.09.092] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Revised: 09/04/2009] [Accepted: 09/24/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate whether an initial ultrasound (US) adequately identifies those patients who need further investigation and possibly intervention while decreasing instrumentation and radiation exposure. The recommended imaging after pediatric pyeloplasty has included intravenous pyelography, radionucleotide renography, and ultrasound US. METHODS We retrospectively reviewed pediatric open pyeloplasty cases performed between 1999 and 2007. Of 116 patients reviewed, 49 met the inclusion criteria of unilateral pyeloplasty with pre- and postoperative US and mercaptoacetyltriglycine (MAG-3). Hydronephrosis was judged by anterior posterior pelvic diameter and caliectasis. Change in renal function on MAG-3 was defined as increase or decrease in function >5%. RESULTS Of 49 patients, 42 (85.7%) showed improved or stable hydronephrosis postoperatively and 7 (14.3%) showed increased hydronephrosis. Forty-six (93.8%) patients had either improved or stable renal function. Of 42 patients with stable or improved hydronephrosis, 41 (97.6%) also had stable or improved function. Comparatively, of 7 patients with increasing hydronephrosis, 2 (28.6%) showed deteriorated renal function, P = .05. CONCLUSIONS Postpediatric pyeloplasty imaging should aim to identify those who require further intervention. Our data demonstrate that at-risk patients can be identified with a sentinel US and selectively determine who needs further MAG-3 investigation. This should increase compliance while decreasing costs, instrumentation, and radiation exposure.
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Pouliot F, Lebel MH, Audet JF, Dujardin T. Determination of Success by Objective Scintigraphic Criteria After Laparoscopic Pyeloplasty. J Endourol 2010; 24:299-304. [DOI: 10.1089/end.2009.0134] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frédéric Pouliot
- Centre Hospitalier Universitaire de Québec and Université Laval Québec, Québec, Canada
| | - Michel Hugues Lebel
- Centre Hospitalier Universitaire de Québec and Université Laval Québec, Québec, Canada
| | - Jean-François Audet
- Centre Hospitalier Universitaire de Québec and Université Laval Québec, Québec, Canada
| | - Thierry Dujardin
- Centre Hospitalier Universitaire de Québec and Université Laval Québec, Québec, Canada
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Editorial comment. Urology 2009; 74:1312; author reply 1312-3. [PMID: 19962534 DOI: 10.1016/j.urology.2009.07.1254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 07/06/2009] [Accepted: 07/07/2009] [Indexed: 11/23/2022]
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Pediatric Pyeloplasty: Comparison of Literature Meta-Analysis of Laparoscopic and Open Techniques With Open Surgery at a Single Institution. J Urol 2009; 182:2428-32. [PMID: 19765755 DOI: 10.1016/j.juro.2009.07.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Indexed: 11/21/2022]
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40
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Systematic Review and Meta-Analysis of Robotic-Assisted versus Conventional Laparoscopic Pyeloplasty for Patients with Ureteropelvic Junction Obstruction: Effect on Operative Time, Length of Hospital Stay, Postoperative Complications, and Success Rate. Eur Urol 2009; 56:848-57. [DOI: 10.1016/j.eururo.2009.03.063] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 03/24/2009] [Indexed: 11/22/2022]
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Chertin B, Pollack A, Koulikov D, Rabinowitz R, Shen O, Hain D, Hadas-Halpren I, Farkas A. Does Renal Function Remain Stable After Puberty in Children With Prenatal Hydronephrosis and Improved Renal Function After Pyeloplasty? J Urol 2009; 182:1845-8. [DOI: 10.1016/j.juro.2009.03.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Indexed: 11/27/2022]
Affiliation(s)
- Boris Chertin
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
- Department of Urology (Division of Pediatric Urology), Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Avner Pollack
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
- Department of Urology (Division of Pediatric Urology), Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Dmitry Koulikov
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Ron Rabinowitz
- Obstetric Ultrasound Unit, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Ori Shen
- Obstetric Ultrasound Unit, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Daniel Hain
- Department of Nuclear Medicine, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Irit Hadas-Halpren
- Department of Diagnostic Radiology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Amicur Farkas
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
- Department of Urology (Division of Pediatric Urology), Shaare Zedek Medical Center, Jerusalem, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
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Abstract
PURPOSE OF REVIEW To evaluate the current role of robotic surgery in upper urinary tract reconstruction. RECENT FINDINGS Robotic techniques have been increasingly adopted by urologists for reconstruction of the upper urinary tract. The improved dexterity, visualization, and ergonomics of robotic systems have applied naturally to reconstruction and have facilitated intracorporeal suturing compared with traditional laparoscopy. In particular, robotic techniques have been used for anastamotic suturing during minimally invasive pyeloplasty. Series of robotic pyeloplasty have demonstrated comparable long-term outcomes to laparoscopy, a shorter learning curve, subjective operator benefits, and potential advantages in operative time. Other robotic reconstructive procedures of the upper tract have included ureterocalicostomy, ureteroureterostomy, ureterolysis, and ureteral reimplantation with and without psoas hitch. SUMMARY Robotic techniques provide clear advantages for minimally invasive upper tract reconstruction, though the objective benefits need further delineation. These procedures are in their early experience, and larger series with prospective randomized comparison with the standard of care are warranted. Low volume of upper tract reconstruction in general will likely require multi-institutional study. Continued study of cost-effectiveness is necessary to define the optimal role for robotic reconstruction in both medical and economic terms.
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Thomas DFM. Prenatally diagnosed urinary tract abnormalities: long-term outcome. Semin Fetal Neonatal Med 2008; 13:189-95. [PMID: 18037084 DOI: 10.1016/j.siny.2007.10.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The long-term outcomes of prenatally detected uropathies are poorly documented. Limited data on fetal intervention show a possible reduction in early mortality from pulmonary hypoplasia, but no beneficial effect on long-term prognosis for renal function. Prenatally detected vesicoureteric reflux (VUR) is characterised by males with high-grade primary reflux, who are at long-term risk of renal impairment. Prenatal diagnosis and surgical intervention have contributed to a reduction in long-term morbidity in children with pelviureteric junction (PUJ) obstruction. By the same token, many children have almost certainly undergone unnecessary early pyeloplasty for an obstruction that would have resolved spontaneously. Multicystic dysplastic kidney (MCDK) carries a low (1%) risk of hypertension in childhood. The limited evidence on the long-term outcome of mild dilatation (pelvicaliectasis) indicates this is a largely innocent finding, which carries no increased risk of morbidity.
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Affiliation(s)
- D F M Thomas
- Department Paediatric Surgery, St James's University Hospital, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Treatment and outcome of prenatally detected newborn hydronephrosis. J Pediatr Urol 2007; 3:469-76. [PMID: 18947797 DOI: 10.1016/j.jpurol.2007.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 05/10/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE For neonates with antenatally diagnosed primary ureteropelvic junction (UPJ)-type hydronephrosis, to attempt to clarify and refine criteria for establishing optimal follow-up and treatment guidelines. PATIENTS AND METHODS A total of 162 newborns (228 hydronephrotic kidneys) with this condition were prospectively followed and treated by the same surgeon in 2001-2005 for a mean of 53 (13-72) months. Ultrasonography and diuretic renogram were used for diagnosis and follow up, and Onen's grading system to determine degree of hydronephrosis. RESULTS On first postnatal ultrasound, the severity of hydronephrosis was grade 1 in 152 kidneys (surgery, 0%), 2 in 41 (surgery, 19.5%), 3 in 19 (surgery, 42.1%), and 4 in 16 kidneys (surgery, 93.8%). All the grade 1 cases resolved spontaneously without renal deterioration (renal function >40%). Renal function ranged between 7% and 34% in grade 4 patients. Overall, 201 hydronephrotic kidneys (88.2%) resolved spontaneously, while 27 (11.8%) required pyeloplasty because of evidence of obstructive injury, including increased hydronephrosis in 14/27 (6/27 had less than 10% decrease in renal function), greater than 10% decrease of renal function in 9/27, and greater than 10% decrease of renal function as well as increased hydronephrosis in 4/27 patients (15%). CONCLUSION In most cases, neonatal hydronephrosis is a relatively benign condition that can be followed safely by an initial non-operative approach unless there is evidence of obstructive injury. A follow-up protocol that permits early identification of a limited number of kidneys that may develop signs of obstruction and require pyeloplasty is crucial for a favorable outcome in patients with primary UPJ-type hydronephrosis. Onen's hydronephrosis grading system promises an easier and more appropriate follow up and timely treatment for children with this condition. A sufficient follow-up interval, especially during the first 3 years of life, is essential to help prevent permanent loss of renal function in kidneys that do develop signs of obstruction.
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Failed Pyeloplasty in Children: Comparative Analysis of Retrograde Endopyelotomy Versus Redo Pyeloplasty. J Urol 2007; 178:2571-5; discussion 2575. [DOI: 10.1016/j.juro.2007.08.050] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Indexed: 11/24/2022]
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Abstract
The ideal treatment for ureteropelvic junction (UPJ) obstruction should have the highest success rate, enable treatment of all types of obstruction, allow removal coexisting renal stones, and be minimally invasive. Open pyeloplasty offers all these features except the last (minimal invasiveness), whereas endourology techniques guarantee only the last one. Different techniques of pyeloplasty can be applied laparoscopically, although the best results are seen with dismembered pyeloplasty (Anderson-Hynes technique). Various methods of tissue approximation have been devised to avoid the difficult-to-master, time-consuming conventional suturing technique. Laparoscopic (antegrade) stenting is preferred by some surgeons, but we consider retrograde stenting is superior, as this rules out the presence of associated distal-ureteral obstruction. The transperitoneal approach has the advantages of a larger working space and readily identifiable anatomic landmarks. However, access to the renal pelvis requires considerable mobilization and retraction of the overlying loops of bowel. The retroperitoneal approach has the perceived disadvantage of a somewhat limited working space and absence of readily identifiable intra-abdominal anatomic structures such as the liver and spleen. However, the retroperitoneal approach has the advantage of greater familiarity, better detection of crossing vessels, direct and rapid access to the UPJ, and less risk of ileus. The robot-assisted technique has made suturing easier and may allow expansion of advanced laparoscopic procedures to surgeons without expertise in advanced laparoscopic surgery. The optimal length of follow-up after pyeloplasty is still unclear. Although most failures occur within the first 2 years, failures continue to appear after 5 and 10 years.
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Affiliation(s)
- M A El-Shazly
- Department of Urology, Menoufiya University, Shebin El-Kom Egypt
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Onen A. An alternative grading system to refine the criteria for severity of hydronephrosis and optimal treatment guidelines in neonates with primary UPJ-type hydronephrosis. J Pediatr Urol 2007; 3:200-5. [PMID: 18947735 DOI: 10.1016/j.jpurol.2006.08.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 08/04/2006] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We present our alternative hydronephrosis grading system (AGS) in an attempt to establish optimal treatment guidelines, and clarify and refine the criteria for severity of hydronephrosis in neonates. PATIENTS AND METHODS A total of 162 newborns (228 affected kidneys) with antenatally diagnosed primary ureteropelvic junction-type hydronephrosis were prospectively followed and treated by the same surgeon for a mean of 46 (6-65) months. Ultrasonography and diuretic renogram were used for diagnosis and follow up. Society for Fetal Urology (SFU) grading system, anteroposterior diameter of renal pelvis (APDRP) and our AGS were used to determine the degree of hydronephrosis. AGS: 0, no hydronephrosis; 1, dilatation of renal pelvis alone; 2, plus caliceal dilatation; 3, plus <1/2 (mild-to-moderate) renal parenchymal loss; 4, plus >1/2 (severe) renal parenchymal loss (cyst-like kidney with no visually significant renal parenchyma). RESULTS On the first postnatal ultrasound, the severity of hydronephrosis was SFU< or =2 in 152 kidneys (surgery, 0%), SFU-3 in 41 kidneys (surgery, 19.5%) and SFU-4 in 35 kidneys (surgery, 68.6%). The follow up, treatment and outcome of SFU-1 and SFU-2 patients were similar; all resolved spontaneously without renal deterioration (renal function >40%). Renal function ranged between 7% and 39% in SFU-4 patients. Intrarenal pelvis was found in one patient with an APDRP of <15 mm, seven patients of 16-30 mm, and five patients of >30 mm. Overall, 201 hydronephrotic kidneys (88.2%) resolved spontaneously while 27 (11.8%) required pyeloplasty. CONCLUSION Neither an SFU grading system nor measurement of APDRP is the gold standard in determining the severity of hydronephrosis. Both methods may fail, particularly in children with intrarenal pelvis configuration or SFU-4 hydronephrosis. Our AGS promises easier follow up and more timely treatment.
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Affiliation(s)
- Abdurrahman Onen
- Department of Paediatric Surgery, Medical Faculty of Dicle University, 21280 Diyarbakir, Turkey.
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van den Hoek J, de Jong A, Scheepe J, van der Toorn F, Wolffenbuttel K. Prolonged follow-up after paediatric pyeloplasty: are repeat scans necessary? BJU Int 2007; 100:1150-2. [PMID: 17535274 DOI: 10.1111/j.1464-410x.2007.07033.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish the value of repeat renal scans to assess the relative renal function after successful paediatric pyeloplasty. PATIENTS AND METHODS Renal scans were assessed from 138 patients after successful pyeloplasty; the relative renal function before and immediately after pyeloplasty were compared, as was split renal function at 3.5 and 5.5 years after surgery. RESULTS With a few exceptions the relative renal function before and after pyeloplasty was stable. Repeat renal scans 3.5 and 5.5 years after surgery also showed stable split renal function, even if the renal function was already diminished. CONCLUSIONS Repeat renal scans are not necessary after successful pyeloplasty in children, as most operated renal units showed stable renal function for 5-7 years. Further studies are needed to investigate whether renal function changes further after puberty.
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Affiliation(s)
- Joop van den Hoek
- Paediatric Urology, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands.
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Chertin B, Pollack A, Koulikov D, Rabinowitz R, Hain D, Hadas-Halpren I, Farkas A. Conservative Treatment of Ureteropelvic Junction Obstruction in Children with Antenatal Diagnosis of Hydronephrosis: Lessons Learned after 16 Years of Follow-Up. Eur Urol 2006; 49:734-8. [PMID: 16504374 DOI: 10.1016/j.eururo.2006.01.046] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2005] [Accepted: 01/30/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We attempted to define predictive factors for surgery in children with antenatal diagnosis of hydronephrosis that led to postnatal diagnosis of ureteropelvic junction (UPJ) obstruction. METHODS We retrospectively evaluated our 16-yr experience (1988-2003) with 343 children (260 male and 83 female) with antenatal diagnosis of hydronephrosis that led to postnatal diagnosis of UPJ obstruction and who were followed conservatively. Right-sided hydronephrosis was present in 110 and left-sided in 233 children. According to the Society for Fetal Urology (SFU) classification none had grade 0 of postnatal hydronephrosis, 20 had grade 1, 118 grade 2, 147 grade 3, and the remaining 58 children grade 4 postnatal hydronephrosis. Relative renal function (RRF) on radionuclide scans revealed 235 children with RRF>40%, 68 with RRF between 30% and 40%, and 40 patients with RRF<30%. Renal function deterioration >5% was the main indication for surgery. Commercially available software GraphPad Prism 4.0 (GraphPad prism, Prism 4 for Windows, version 4) using the Fisher exact test was used for statistical evaluation. RESULTS Surgical correction was needed in 179 children (52.2%) during the course of conservative management. The average age at surgery was 10.6 mo (range, 1 mo to 7 yr). Of those, 50% underwent surgery during the first 2 yr of life and the majority of the remaining patients underwent surgery between the 2 and 4 yr of age; only two patients required surgery later on. Univariate analysis revealed that child sex, side of hydronephrosis, and SFU grade of prenatal hydronephrosis were not significant predictive factors for surgery. However, SFU grade 3-4 of postnatal hydronephrosis (p<0.0001; odds ratio, 0.06281) and RRF<40% (p<0.0001; odds ratio, 0.1022) were significant independent risk factors for surgery. CONCLUSION In contrast with previous publications by others and by us these data show that >50% of children with antenatal diagnosis of UPJ obstruction in this series required surgical correction while on conservative protocol. SFU grade 3-4 of postnatal hydronephrosis and RRF<40% are significant independent predictive factors for surgery.
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Affiliation(s)
- Boris Chertin
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Faculty for the Health Sciences, Ben-Gurion University of the Negev, Israel.
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Tal R, Bar-Sever Z, Livne PM. Dismembered pyeloplasty in children: A review of 5 years single center experience. Int J Urol 2005; 12:1028-31. [PMID: 16409604 DOI: 10.1111/j.1442-2042.2005.01201.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Dismembered pyeloplasty is the treatment of choice for significant ureteropelvic junction obstruction in children. In the present study, we review our experience in 103 pediatric patients and present the clinical characteristics, the surgical treatment and its complications and the long term results. METHODS We have reviewed the medical charts of 103 consecutive patients who underwent dismembered pyeloplasty in a 5-year period, from 1997 to 2002. Preoperative data, short- and long-term complications and outcome were recorded. Imaging studies included urinary tract sonography and dynamic renal scans, the results of which were compared pre- and postoperatively. RESULTS Most of our patients were boys (81%), diagnosed prenatally (78%). We had no major complications and acceptable incidence of minor complications. Postoperative outcome was excellent, with decreased hydronephrosis (81%), improved renal drainage (87%) and preserved or improved renal function (89%). CONCLUSION Dismembered pyeloplasty can be performed with a low incidence of minor complications, no major complications and excellent long-term outcome.
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Affiliation(s)
- Raanan Tal
- Schneider Children's Medical Center of Israel, Urology, Petah-Tikva, Israel.
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