1
|
Langreen S, Ludwikowski B, Dingemann J, Ure BM, Hofmann AD, Kuebler JF. Laparoscopic pyeloplasty in neonates and infants is safe and efficient. Front Pediatr 2024; 12:1397614. [PMID: 39132308 PMCID: PMC11310035 DOI: 10.3389/fped.2024.1397614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/16/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction Dismembered laparoscopic pyeloplasty (LP) is a well-accepted treatment modality for ureteropelvic junction obstruction (UPJO) in children. However, its efficacy and safety in infants, particularly neonates, remain uncertain. To address this significant knowledge gap, we aimed to compare outcomes between a cohort of neonates and infants undergoing LP vs. open pyeloplasty (OP) at less than 6 months and 6 weeks of age. Material and methods We conducted a retrospective analysis of data from patients who underwent primary pyeloplasty at our institution between 2000 and 2022. Only patients aged 6 months or less at the time of surgery were included, excluding redo-procedures or conversions. Ethical approval was obtained, and data were assessed for redo-pyeloplasty and postoperative complications, classified according to the Clavien-Madadi classification. A standard postoperative assessment was performed 6 weeks postoperatively. This included an isotope scan and a routine ultrasound up to the year 2020. Results A total of 91 eligible patients were identified, of which 49 underwent LP and 42 underwent OP. Patients receiving LP had a median age of 11.4 (1-25.4) weeks, compared to 13.8 (0.5-25.9) weeks for those receiving OP (p > 0.31). Both groups in our main cohort had an age range of 0-6 months at the time of surgery. Nineteen patients were younger than 6 weeks at the time of surgery. The mean operating time was longer for LP (161 ± 43 min) than that for OP (109 ± 32 min, p < 0.001). However, the mean operating time was not longer in the patient group receiving LP at ≤6 weeks (145 ± 21.6) compared to that in our main cohort receiving LP. There was no significant difference in the length of stay between the groups. Four patients after LP required emergency nephrostomy compared to one patient after OP. The rate of revision pyeloplasty in our main cohort aged 0-6 months at surgery was 8% in the patient group receiving LP and 14% in the patient group receiving OP (not significant). Three revisions after LP were due to persistent UPJO, and one was due to stent migration. Only one patient requiring revision pyeloplasty was less than 6 weeks old. Conclusion To our knowledge, this is one of the largest collectives of laparoscopic pyeloplasty performed in infants, and it is the youngest cohort published to date. Based on our experience, LP in neonates and infants under 6 months appears to be as effective as open surgery.
Collapse
Affiliation(s)
- S. Langreen
- Pediatric Surgery Clinic, Center for Pediatrics and Adolescent Medicine, Hannover Medical School, Hanover, Germany
| | - B. Ludwikowski
- Department of Pediatric Surgery, Kinder- und Jugendkrankenhaus AUF DER BULT, Hanover, Germany
| | - J. Dingemann
- Pediatric Surgery Clinic, Center for Pediatrics and Adolescent Medicine, Hannover Medical School, Hanover, Germany
| | - B. M. Ure
- Pediatric Surgery Clinic, Center for Pediatrics and Adolescent Medicine, Hannover Medical School, Hanover, Germany
| | - A. D. Hofmann
- Pediatric Surgery Clinic, Center for Pediatrics and Adolescent Medicine, Hannover Medical School, Hanover, Germany
| | - J. F. Kuebler
- Pediatric Surgery Clinic, Center for Pediatrics and Adolescent Medicine, Hannover Medical School, Hanover, Germany
| |
Collapse
|
2
|
Hu Z, Chen S, Wang Z, Xu D, Zhang X, Lin Y, Zhang L, Wang J, Li L. The application of artificial technology in pediatric pyeloplasty the efficacy analysis of robotic-assisted laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction. Front Pediatr 2023; 11:1209359. [PMID: 37780043 PMCID: PMC10540863 DOI: 10.3389/fped.2023.1209359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/08/2023] [Indexed: 10/03/2023] Open
Abstract
Objective To investigate the clinical effect of the da Vinci robotic-assisted laparoscopic pyeloureteroplasty (RALP) in treating pediatric ureteropelvic junction obstruction (UPJO). Methods We retrospectively analyzed clinical data from 32 children with UPJO who suffered from RALP in our hospital from October 2020 to February 2023, compared with those treated with common laparoscopy at the same time. After the establishment of the robotic arm, a mesenteric approach was performed after entering the abdominal cavity to focus on the lesion site. The dilated renal pelvis was then cut and the stenotic ureter was removed; the anastomosis and the incision were sutured by layer. Results A total of 62 children (44 boys and 20 girls) with a median age of 14 months (ranging from 3 to 38 months) were included. All 62 cases had hydronephrosis caused by unilateral UPJO, and the surgery was successfully completed without conversion to open. All intraoperative blood losses amounted to less than 10 ml. In the RALP group, the average operative duration was 131.28 min (ranging from 108 to 180 min). The average catheter time was 3.66 days (ranging from 2 to 7 days). The average hematuria time was 3.84 days (ranging from 2 to 6 days). The average postoperative hospital stay was 7.8 days (ranging from 6 to 12 days). The average hospitalization costs were 59,048.31 yuan (ranging from 50,484 to 69,977 yuan). The double-J tube was removed 1 month after surgery. Only one patient suffered from complications, developing a urinary tract infection 4 weeks after surgery, and was cured with the administration of oral cefaclor anti-inflammatory drugs for 3 days. All patients were followed up for 2-28 months, with a median follow-up time of 12 months. The thickness of the renal cortex was increased after surgery [(1.95 ± 0.24) vs. (4.82 ± 0.50)] cm, and the isotope renograms revealed a definite recovery of the split renal function [(28.32 ± 1.95) vs. (37.01 ± 2.71)]%. Conclusion The robotic-assisted laparoscopic pyeloureteroplasty (RALP) in the treatment of children with upper ureteral obstruction has overall clinical efficiency. With technological advancements and an increased number of experienced surgeons, robotic surgery may become a new trend in surgery.
Collapse
Affiliation(s)
- Zhongli Hu
- Affiliated Hospital of Putian University, Putian, China
| | - Shan Chen
- Department of Laboratory, Fuzhou Second Hospital, Fuzhou, China
| | - Zhihong Wang
- Department of Hematology, Provincial Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Di Xu
- Department of Pediatric Surgery, Provincial Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xiaolang Zhang
- Department of Pediatric Surgery, Provincial Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Yang Lin
- Department of Pediatric Surgery, Provincial Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Lin Zhang
- Department of Pediatric Surgery, Provincial Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Jianbin Wang
- Department of Pediatric Surgery, Provincial Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Lizhi Li
- Department of Pediatric Surgery, Provincial Clinical Medical College, Fujian Medical University, Fuzhou, China
| |
Collapse
|
3
|
Tanash MA, Bollu BK, Naidoo R, Alexander A, Thomas G, Deshpande AV, Smith GH, Giutronich S. Laparoscopic versus open pyeloplasty in paediatric pelvi-ureteric junction obstruction. J Paediatr Child Health 2023; 59:974-978. [PMID: 37246761 DOI: 10.1111/jpc.16443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/13/2023] [Indexed: 05/30/2023]
Abstract
AIM Compared to open pyeloplasty (OP), we hypothesised that laparoscopic pyeloplasty (LP) is associated with early recovery, a shorter length of stay (LOS) and less analgesia requirement. METHODS Between 2011 and 2016, 146 dismembered pyeloplasty cases were reviewed, of which 113 were in the OP group and 33 were in the LP group. We evaluated both groups regarding operative time, LOS, success rate, complications rate and analgesia requirement. Subgroup analysis was done for patients above the age of 5 years, and within the OP group (dorsal lumbotomy (DL) vs. loin incision (LI)). RESULTS The success rate was 96% in the open group and 97% in the laparoscopic group. The median operative time was significantly shorter in the open group for the entire cohort (127 vs. 200 min; P < 0.05), and in children older than 5 years (n = 41, 134 vs. 225 min; P < 0.05). Other parameters were similar in both groups. The median LOS was significantly shorter (2 vs. 4 days; P < 0.05), and the median analgesia requirement was less (0.44 vs. 0.64 mg/kg morphine; P < 0.05) in the DL (n = 60) compared to LI (n = 53). CONCLUSION Both OP and LP dismembered approaches are equally effective in treating pelvi-ureteric junction obstruction. Overall, the LOS, complications rate and analgesia requirement were not significantly different; however, the operative time was significantly longer in LP.
Collapse
Affiliation(s)
- Mohammad A Tanash
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Division of Urology, Department of General Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Bapesh K Bollu
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Rasika Naidoo
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Angus Alexander
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Gordon Thomas
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Aniruddh V Deshpande
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Grahame Hh Smith
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Sarah Giutronich
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Menon P, Yhoshu E, Lakshmi K, Rao N, Bhattacharya A. Outcome analysis of reduction and nonreduction dismembered pyeloplasty in ureteropelvic junction obstruction: A randomized, prospective, comparative study. J Indian Assoc Pediatr Surg 2022; 27:25-31. [PMID: 35261510 PMCID: PMC8853589 DOI: 10.4103/jiaps.jiaps_229_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/02/2020] [Accepted: 11/27/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives: Materials and Methods: Results: Conclusion:
Collapse
|
5
|
Alhindi S, Mubarak M, Alaradi H. Evaluation of transverse dorsal lumbotomy in management of PUJ obstruction in patients younger than 6 months. Urologia 2021; 89:285-291. [PMID: 33586635 DOI: 10.1177/0391560321993600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The transverse dorsal lumbotomy approach provides excellent exposure to the PUJ and causes minimal tissue damage. In this study, we assess the efficacy of dorsal lumbotomy in PUJ obstruction in children younger than 6 months. METHODS All children less than 6 months who were managed with the dorsal lumbotomy approach between 2009 and 2017 were reviewed prospectively. Data included: demographic data, pre/post-operative renal ultrasound scan with SFU grading and RDS, operative time, post-operative complications, and follow up results. RESULTS A total of 42 children with a mean age of 4.4 ± 1 months were included. On pre-operative RDS, all patients had an obstructive pattern and a SRF of 30.3 ± 9.3. The mean operative duration was 49 min and analgesia was minimal. Post-operative ultrasound at 6 months showed an improvement in hydronephrosis (p < 0.05) and a mean SRF of 39.3 ± 6.1 (p < 0.001). CONCLUSION Transverse dorsal lumbotomy approach is a safe and efficient alternative in patients less than 6 month.
Collapse
Affiliation(s)
- Saeed Alhindi
- Department of Surgery, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Mohamed Mubarak
- Department of Surgery, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Husain Alaradi
- Department of Surgery, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| |
Collapse
|
6
|
Sebaey A, Sherif H, Abdelrahman M, Elshazli A, Abdelsamee T, Gharib T. The prognostic value of histopathological pattern of the pelviureteric junction in the outcome of pyeloplasty in children. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The cause of pyeloplasty failure remains unclear; therefore, increasing interest has been directed to identify the reason for dissatisfactory surgical results. Some studies attempted to investigate the role of the histopathological pattern. The aim of the work is to study the correlation between the histopathological pattern of obstructed pelviureteric junction (PUJ) segment and the outcome of pyeloplasty in children with the PUJ.
Methods
Fifty-four patients with pelviureteric junction obstruction (PUJO) were included in the study; patients were evaluated preoperative. All patients were operated by the same surgeon using Anderson–Hynes pyeloplasty; the resected obstructed PUJ segment examined histopathological using light microscope and image analyzer system to identify mean renal pelvis smooth muscle thickness (mRPSMT), collagen-to-smooth muscle ratio and elastin content.
Results
The study includes 50 patients with mean age Mean 24.48 ± 15.3 months. Two patients show no improvement, while 24 improved at 3 months, 16 improved at 6 months, and 8 improved at 12 months. mRPSMT showed significant difference between improvement groups (136.02 ± 44.4, 173.47 ± 49.69 and 258.56 ± 96.82 μm), while elastin content or collagen-to-smooth muscle ratio showed no significant difference.
Conclusions
Our data showed a clear relationship between mRPSMT and the time over which radiological improvement occurs; increase in mRPSMT is associated with a delay in postoperative radiological improvement time. We found no relation between elastin content nor collagen-to-smooth muscle thickness and postoperative improvement course.
Collapse
|
7
|
Alizadeh F, Haghdani S, Seydmohammadi B. Minimally invasive open pyeloplasty in children: Long-term follow-up. Turk J Urol 2020; 46:393-397. [PMID: 32449670 DOI: 10.5152/tud.2020.20011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our aim was to report the long-term follow-up for minimally invasive open pyeloplasty in children. MATERIAL AND METHODS A total of 213 children with a mean age 16.33 months underwent miniature open pyeloplasty for ureteropelvic junction obstruction between January 2010 and May 2016. Anderson-Hynes dismembered pyeloplasty was performed through a subcostal miniature incision. The intraoperative and postoperative parameters including surgical operative time, incision size, intraoperative blood loss volume, postoperative analgesic use, hospital stay, complications, and success rate were documented. RESULTS The mean surgery time was 65 min (50-85 min), and incision size was 16.99 mm (12-36 mm). None of the patients required blood transfusion or narcotic analgesics in the postoperative period. The mean hospital stay was 21.97 h (10-48 h). Minor side effects included urinary tract infection (3.8%) and urinary leakage in one case (0.004%). Major complications were not observed. The mean antero-posterior pelvic diameter before and after surgery was 28.69 ± 11.54 mm and 15.89 ± 9.29 mm, respectively with a mean difference of 12.78 mm, which shows a significant decrease (P value = 0.001). The success rate was 98.1% with a mean follow-up of 21.43 months (3-56 months). Two of the recurrences occurred in the first postoperative year, another one after 1.5 years, and the last one after 4 years. CONCLUSION Our study confirms minimally invasive open pyeloplasty in children as a safe and efficient procedure with the least complication and hospital stay rate in comparison with other minimally invasive techniques. Moreover, long-term follow-up is a requirement in pyeloplasty surgery.
Collapse
Affiliation(s)
- Farshid Alizadeh
- Kidney Transplantation Research Center, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran
| | - Saeid Haghdani
- Department of Urology, Hasheminejad Kidney Research Center (HKRC), Iran University of Medical Science, Tehran, Iran
| | - Behnaz Seydmohammadi
- Kidney Transplantation Research Center, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran
| |
Collapse
|
8
|
Bishmanov R, Alchinbayev M. Simplified Stenting Methods during Laparoscopic Pyeloplasty in Children. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/7935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
9
|
Al-Hazmi H, Peycelon M, Carricaburu E, Manzoni G, Neel KF, Ali L, Grapin C, Paye-Jaouen A, El-Ghoneimi A. Redo Laparoscopic Pyeloplasty in Infants and Children: Feasible and Effective. Front Pediatr 2020; 8:546741. [PMID: 33240828 PMCID: PMC7683417 DOI: 10.3389/fped.2020.546741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose: To determine the feasibility and effectiveness of redo laparoscopic pyeloplasty among patients with failed previous pyeloplasty, specifically examining rates of success and complications. Materials and Methods: We retrospectively reviewed the charts of all patients, who underwent redo laparoscopic pyeloplasty from 2006 to 2017. This included patients who underwent primary pyeloplasty at our institution and those referred for failures. Analysis included demographics, operative time, complications, length of hospital stay, complications, and success. Success was defined as improvement of symptoms and hydronephrosis and/or improvement in drainage demonstrated by diuretic renogram, especially in those with persistent hydronephrosis. Descriptive statistics are presented. Results: We identified 22 patients who underwent redo laparoscopic pyeloplasty. All had Anderson-Hynes technique except two cases in which ureterocalicostomy was performed. Median (IQR) follow-up was 29 (2-120) months, median time between primary pyeloplasty and redo laparoscopic pyeloplasty was 12 (7-49) months. The median operative time was 200 (50-250) min, and median length of hospital stay was 3 (2-10) days. The procedure was feasible in all cases without conversion. During follow-up, all but two patients demonstrated an improvement in the symptoms and the degree of hydronephrosis. Ninety-one percent of patients experienced success and no major complications were noted. Conclusions: Redo laparoscopic pyeloplasty is feasible and effective with a high success rate and low complication rate.
Collapse
Affiliation(s)
- Hamdan Al-Hazmi
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,College of Medicine and King Saud University Medical City, King Saud University, Riyad, Saudi Arabia
| | - Matthieu Peycelon
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,University of Paris, Paris, France
| | - Elisabeth Carricaburu
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Gianantonio Manzoni
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,Department of Pediatric Urology Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Khalid Fouda Neel
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,College of Medicine and King Saud University Medical City, King Saud University, Riyad, Saudi Arabia
| | - Liza Ali
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Christine Grapin
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,University of Paris, Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Urology, Robert-Debré University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,University of Paris, Paris, France
| |
Collapse
|
10
|
Masieri L, Sforza S, Cini C, Escolino M, Grosso A, Esposito C, Minervini A, Carini M. Minilaparoscopic Versus Open Pyeloplasty in Children Less Than 1 Year. J Laparoendosc Adv Surg Tech A 2019; 29:970-975. [DOI: 10.1089/lap.2018.0586] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Lorenzo Masieri
- Paediatric Urology Unit, Meyer Children Hospital, University of Florence, Florence, Italy
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Sforza
- Paediatric Urology Unit, Meyer Children Hospital, University of Florence, Florence, Italy
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Chiara Cini
- Paediatric Urology Unit, Meyer Children Hospital, University of Florence, Florence, Italy
| | - Maria Escolino
- Paediatric Surgery Unit, Federico II Hospital, University of Neaples, Naples, Italy
| | - Antonio Grosso
- Paediatric Urology Unit, Meyer Children Hospital, University of Florence, Florence, Italy
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Ciro Esposito
- Paediatric Surgery Unit, Federico II Hospital, University of Neaples, Naples, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| |
Collapse
|
11
|
Kallas-Chemaly A, Peycelon M, Ali L, Grapin-Dagorno C, Carricaburu E, Philippe-Chomette P, Enezian G, Paye-Jaouen A, El-Ghoneimi A. Reflective Practice About Retroperitoneal Laparoscopy in Comparison to Open Surgery for Ureteropelvic Junction Obstruction Repair in Children Less Than 1 Year of Age. Front Pediatr 2019; 7:194. [PMID: 31179250 PMCID: PMC6543804 DOI: 10.3389/fped.2019.00194] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/25/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: The interest in laparoscopy in the treatment of ureteropelvic junction obstruction (UPJO) in children under 12 months of age remains controversial. The aim of this study is to evaluate feasibility and benefits of retroperitoneal laparoscopy (RL) compared to open surgery in this age group. Materials and Methods: Between January 2012 and May 2017, we performed 222 pyeloplasties: 144 by laparoscopy and 78 by open surgery. From 2012, the choice of operative technique was decided according to the laparoscopic experience of the surgeon; two surgeons operated laparoscopically on all children <12 months of age, while others operated using posterior lumbotomy (PL). The RL is standardized and performed by 3 trocars (5, 3, 3). Pre, per and postoperative parameters were analyzed retrospectively. Statistical tests: Pearson, Fisher, Student and Mann-Whitney. Results: During this 5-year period, 24 RL and 53 PL were included with a median follow-up of 27 months (5-63). In the LR group, postoperative drainage was performed by JJ (13 cases) and external stent (11 cases). No conversion has been listed in this group. In each group there was one failure that needed redo pyeloplasty. Duration of hospitalization and intravenous acetaminophen use were significantly lower in the RL group (2.8 vs. 2.3 days, p = 0.02, respectively) while operating time was significantly longer (163 vs. 85.8 min, p = 0.001). The postoperative complication rate was statistically identical in each group (urinary tract infection, wall hematoma, hematuria…). Conclusion: RL is feasible in children under 1 year of age in the hands of well-experienced surgeons with longer operative time but without added morbidity. Subject to the retrospective nature of our study, the RL seems to offer a benefit regarding duration of hospitalization and analgesics consumption.
Collapse
Affiliation(s)
- Anthony Kallas-Chemaly
- Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Pediatric Surgery and Urology, National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France.,Department of Pediatric Surgery and Urology, Faculty of Medicine, Université Saint-Joseph, Hôtel-Dieu de France, Beirut, Lebanon
| | - Matthieu Peycelon
- Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Pediatric Surgery and Urology, National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Liza Ali
- Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Pediatric Surgery and Urology, National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Christine Grapin-Dagorno
- Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Pediatric Surgery and Urology, National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Elisabeth Carricaburu
- Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Pediatric Surgery and Urology, National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Pascale Philippe-Chomette
- Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Pediatric Surgery and Urology, National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Goharig Enezian
- Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Pediatric Surgery and Urology, National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Annabel Paye-Jaouen
- Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Pediatric Surgery and Urology, National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| | - Alaa El-Ghoneimi
- Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Pediatric Surgery and Urology, National Reference Center of Rare Urinary Tract Malformations (MARVU), Paris, France
| |
Collapse
|
12
|
Dwivedi D, Sawhney S, Sud S, Dudeja P, Raman S, Dey S. Retrospective analysis of regional anesthesia techniques employed for postoperative pain management in pediatric patients undergoing pyeloplasty. INDIAN JOURNAL OF PAIN 2019. [DOI: 10.4103/ijpn.ijpn_27_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
13
|
Erol İ, Karamık K, İslamoğlu ME, Ateş M, Savaş M. Outcomes of infants undergoing laparoscopic pyeloplasty: A single-center experience. Urologia 2018; 86:27-31. [PMID: 30253705 DOI: 10.1177/0391560318802165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE: The aim of this study was to evaluate the outcomes of laparoscopic pyeloplasty in children less than 12 months of age. MATERIALS AND METHODS: The records of 20 infants, who had pelviureteric junction obstruction and subsequently underwent LP from January 2013 to November 2016 with at least 1 year of follow-up, were retrospectively reviewed. Patients demographics, the results of preoperative and postoperative imaging studies, perioperative details, complications, and results were noted. RESULTS: The mean age of 20 infants was 4.75 months. The gender of cases was 5 females (25%) and 15 males (75%). Of that, 13 (65%) laparoscopic pyeloplasties were in left side and 7 (35%) were in right side. No cases needed open conversation. Aberrant crossing vessel was observed in three patients (15%). The mean operation time was 79.35 min (45-128 min). The mean hospital stay was 2.9 ± 0.308 days (2-3 days). There were complications in three children (15%); two patients developed stent migration and one child had fever over 38°. Three children with complications did not require a second intervention. In one child, the kidney was non-functioning in follow-up and nephrectomy was performed. The anteroposterior diameter significantly reduced. Preoperative mean value was 24.305 ± 5.6157 and postoperative mean value was 15.40 ± 6.030 (p = 0.000, p < 0.05). There was a significant degree of improvement in renal split function for all patients. Preoperative mean values were 45.53 ± 11.512, while postoperative values were 47.850 ± 13.347 (p = 0.029, p < 0.05). CONCLUSION: Although there are doubts about the reliability and efficacy of results for pyeloplasty in children less 12 months, many studies including this study show that laparoscopic pyeloplasty is an effective and reliable method for infants.
Collapse
Affiliation(s)
- İbrahim Erol
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Kaan Karamık
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mahmut Ekrem İslamoğlu
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mutlu Ateş
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Murat Savaş
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| |
Collapse
|
14
|
Laparoscopic-Assisted Extracorporeal Pyeloplasty: A Minimally Invasive Approach to Pediatric Ureteropelvic Junction Obstruction. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.83823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
15
|
Gadelmoula M, Abdel-Kader MS, Shalaby M, Abdelrazek M, Moeen AM, Zarzour MA, Mohammed N, Fornara P. Laparoscopic versus open pyeloplasty: a multi-institutional prospective study. Cent European J Urol 2018; 71:342-345. [PMID: 30386658 PMCID: PMC6202628 DOI: 10.5173/ceju.2018.1693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/16/2018] [Accepted: 08/06/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To prospectively compare the perioperative and functional outcomes of laparoscopic (LP) and open pyeloplasty (OP) in three academic institutions. MATERIAL AND METHODS Between September 2012 and September 2016, 102 patients with primary uteropelvic junction obstruction (UPJO) underwent pyeloplasty (51 LP and OP for the other 51 patients). Demographic data, perioperative parameters, including operative time, estimated blood loss, complications, length of hospital stay, and functional outcome were compared, and SF-8 Health Survey scoring was recorded for each group.Patients were followed up by ultrasound (US) and /or intravenous urography (IVU) at 3, 6 and 12 months. A MAG-3 renal scan was performed at 3 months postoperatively. RESULTS The mean operative time was significantly shorter in the open group (153.2 ±42 min vs. 219.8 ±46 min; P <0.001). Compared to OP, the mean postoperative analgesia (Diclofenac) requirement was significantly less in the LP group (101.1 ±36 mg vs. 459.1 ±123 mg; P <0.001). The median hospital stay was significantly shorter for LP (2.7 ±1.8 days vs. 9.09 ±7.3 days; P <0.001). The median follow-up period was 19.7 months (12-28 months). The success rate was 96.1% in the OP group and 94.1% in the LP group. CONCLUSIONS In spite of being a technically demanding procedure, LP offers faster recovery and higher patient satisfaction. In our hands, OP still has a shorter operative time and relatively lower retreatment rate.
Collapse
Affiliation(s)
- Mohamed Gadelmoula
- Assiut University, Urology and Nephrology Hospital, Department of Urology, Assiut, Egypt
| | | | - Mahmoud Shalaby
- Assiut University, Urology and Nephrology Hospital, Department of Urology, Assiut, Egypt
| | - Mostafa Abdelrazek
- Department of Urology, Qena Faculty of Medicine, South Valley University, Egypt
| | - Ahmed Mohamed Moeen
- Assiut University, Urology and Nephrology Hospital, Department of Urology, Assiut, Egypt
| | - Mohamed Ali Zarzour
- Department of Urology and Kidney Transplantation, Martin-Luther University, Halle (Saale), Germany
| | - Nasreldin Mohammed
- Department of Urology and Kidney Transplantation, Martin-Luther University, Halle (Saale), Germany
| | - Paolo Fornara
- Department of Urology and Kidney Transplantation, Martin-Luther University, Halle (Saale), Germany
| |
Collapse
|
16
|
Sharifiaghdas F, Mirzaei M, Daneshpajooh A, Abbaszadeh S. Minimally invasive open dismembered pyeloplasty technique: Miniature incision, muscle-splitting dissection, and nopelvis reduction in children. Asian J Urol 2018; 6:290-293. [PMID: 31297321 PMCID: PMC6595094 DOI: 10.1016/j.ajur.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 04/18/2017] [Accepted: 09/27/2017] [Indexed: 12/01/2022] Open
Abstract
Objective To report the outcomes and complications of open dismembered Anderson-Hynes pyeloplasty with miniature incision in treating children's ureteropelvic junction obstruction. Methods Between March 2007 and April 2011, 109 children with a mean age of 2 years and 8 months old with ureteropelvic junction obstruction underwent open dismembered pyeloplasty. Clinical manifestations, radiographic assessments, incision size, surgery time, hospital stay, and complication rate were recorded. All patients had a documented ureteropelvic junction obstruction (having T1/2 more than 20 min in diethylenetriaminepentaacetic acid [DTPA] scan) with symptomatic stenosis or decreased kidney function (differential function <40%). Pyeloplasty was done by a retroperitoneal flank approach with miniature incision without pelvis reduction. One surgeon did all the surgeries. Success rate and complications were assessed in a 3-year follow-up. Results Mean surgery time was 52 min (47–60 min). Incision size was 18–28 mm. Mean hospital stay was 3 days (2–8 days). The surgery was successful in 98.2% of patients with a mean follow-up time of 36 months (success was defined as disappearance of symptoms, if present, with improved ultrasound imaging results or Reno graphic parameters). The complication rate was 7.33%, including urinary leakage, double-J urethral stent dislocation and infection. Conclusion Open dismembered pyeloplasty is a safe, technically feasible and effective therapy in treatment of children's ureteropelvic junction obstruction. It takes a short time to do, requires a small incision and has few complications and a short recovery period.
Collapse
Affiliation(s)
- Farzaneh Sharifiaghdas
- Urology-Nephrology Research Center, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Mirzaei
- Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Azar Daneshpajooh
- Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahin Abbaszadeh
- Urology-Nephrology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
17
|
Prospective evaluation of retroperitoneal laparoscopic pyeloplasty in children in the first 2 years of life: Is age a risk factor for conversion? J Pediatr Urol 2017; 13:511.e1-511.e4. [PMID: 28483468 DOI: 10.1016/j.jpurol.2017.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 03/22/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Laparoscopic pyeloplasty in children has stood the test of time. A clear advantage of laparoscopic pyeloplasty over open pyeloplasty has been proven both by retrospective and prospective trials. The aim of the current study was to address, in a prospective design, the outcomes, safety, conversion rates and risk factors for conversion in children aged <2 years who underwent retroperitonoscopic pyeloplasty by a single surgeon. PATIENTS AND METHODS In the period April 2014 to May 2016, 15 children with a median age of 6 months (range 1-24) and ureteropelvic junction (UPJ) obstruction were operated by a single surgeon using retroperitonoscopic pyeloplasty with antegrade renal stenting. The position and sites of tracers are shown in the figure. RESULTS With a median follow-up of 6 months, there were no recurrent cases of UPJO; one child had postoperative complications and recovered conservatively; median hospital stay was 1 day (range 1-7); and conversion to open pyeloplasty was encountered in three children (20%) aged <3 months. A statistically significant difference between laparoscopic and converted cases was present concerning the age (P = 0.048); neither gender nor side was significantly different. DISCUSSION Laparoscopic pyeloplasty in young children has been reported in many retrospective trials. Retroperitonoscopic pyeloplasty in young children has not been reported in prospectively designed studies to address safety and outcome. The current study reported experience in young children, defining the age category <3 months as a high-risk group for conversion to open surgery, but not to higher incidence of complications. CONCLUSION Retroperitonoscopic pyeloplasty in children aged <2 years is feasible, safe and successful. High conversion rates to open pyeloplasty have to be expected in children aged <3 months.
Collapse
|
18
|
The Comparative Effectiveness of Treatments for Ureteropelvic Junction Obstruction. Urology 2017; 111:72-77. [PMID: 28943371 DOI: 10.1016/j.urology.2017.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/31/2017] [Accepted: 09/06/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the effectiveness of the 3 primary treatments for ureteropelvic junction obstruction (ie, open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy) as assessed by failure rates. MATERIALS AND METHODS Using MarketScan data, we identified adults (ages 18-64 years) who underwent treatment for ureteropelvic junction obstruction between 2002 and 2010. Our primary outcome was failure (ie, need for a secondary procedure). We fit a Cox proportional hazards model to examine the effects of different patient, regional, and provider characteristics on treatment failure. We then implemented a survival analysis framework to examine the failure-free probability for each treatment. RESULTS We identified 1125 minimally invasive pyeloplasties, 775 open pyeloplasties, and 1315 endopyelotomies with failure rates of 7%, 9%, and 15%, respectively. Compared with endopyelotomy, minimally invasive pyeloplasty was associated with a lower risk of treatment failure (adjusted hazards ratio [aHR] 0.52; 95% confidence interval [CI], 0.39-0.69). Minimally invasive and open pyeloplasties had similar failure rates. Compared with open pyeloplasty, endopyelotomy was associated with a higher risk of treatment failure (aHR 1.78; 95% CI, 1.33-2.37). The average length of stay was 2.7 days for minimally invasive pyeloplasty and 4.2 days for open pyeloplasty (P <.001). CONCLUSION Endopyelotomy has the highest failure rate, yet it remains a common treatment for ureteropelvic junction obstruction. Future research should examine to what extent patients and physicians are driving the use of endopyelotomy.
Collapse
|
19
|
Piaggio LA, Corbetta JP, Weller S, Dingevan RA, Duran V, Ruiz J, Lopez JC. Comparative, Prospective, Case-Control Study of Open versus Laparoscopic Pyeloplasty in Children with Ureteropelvic Junction Obstruction: Long-term Results. Front Pediatr 2017; 5:10. [PMID: 28203561 PMCID: PMC5285361 DOI: 10.3389/fped.2017.00010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/13/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION We compare open pyeloplasty (OP) versus laparoscopic pyeloplasty (LP) in children in a multicenter, prospective, case-control study. MATERIALS AND METHODS From May 2007 to March 2009, a program was established at Hospital Garrahan, the reference center, to perform LP with a mentoring surgeon that would attend the institution once a month. Every new case of ureteropelvic junction obstruction (UPJO) diagnosed in the reference institution was offered to participate in the study. If the patient was enrolled, it was scheduled for LP. The following patient diagnosed with UPJO was operated on with open technique and served as a case-control. In three other facilities, patients were only offered LP and had a matched control open case at the reference institution. The first end point of the study was patient recovery: analgesia requirement and length of hospitalization (LOH). The second end point of the study was resolution of UPJO in long-term follow-up for the two techniques. Demographic data, surgical time, perioperative complications, analgesia requirement, analgesia score during hospitalization, LOH, and outcome were recorded. Both groups received the same postoperative indications for pain control. Parents were asked to assess pain in their children every 4 h postoperatively and to complete a pain scale chart to which the nurses were blinded. RESULTS Fifteen OP and 15 LP were compared. Groups were similar with regard to sex, age, weight, and laterality. Mean surgical time was longer in LP than in OP group (mean 188 versus 65 min) (p < 0.01). Hospitalization was shorter for LP group with a mean of 1.9 versus 2.5 days for OP group (p < 0.05). Postoperative analgesia requirement was significantly higher in the OP group with a mean use of morphine of 1.7 versus 0.06 mg/kg in the LP group (p < 0.05). Pain scores were similar in both the groups. At a mean follow-up of 58 months there were no failures. CONCLUSION In this prospective comparative cohort, LP was a longer procedure than OP. Both procedures had the same efficacy and complication rates, but patients undergoing LP needed fewer narcotics for pain control and had a shorter hospitalization.
Collapse
Affiliation(s)
- Lisandro A Piaggio
- Division of Pediatric Urology, Hospital IGA Dr. José Penna, Hospital Italiano Regional del Sur, Hospital Privado Dr. Raúl Matera , Bahía Blanca , Argentina
| | - Juan P Corbetta
- Division of Pediatric Urology, Hospital Nacional de Pediatría SAMIC Dr. JP Garrahan , Buenos Aires , Argentina
| | - Santiago Weller
- Division of Pediatric Urology, Hospital Nacional de Pediatría SAMIC Dr. JP Garrahan , Buenos Aires , Argentina
| | - Ricardo Augusto Dingevan
- Division of Pediatric Urology, Hospital Nacional de Pediatría SAMIC Dr. JP Garrahan , Buenos Aires , Argentina
| | - Víctor Duran
- Division of Pediatric Urology, Hospital Nacional de Pediatría SAMIC Dr. JP Garrahan , Buenos Aires , Argentina
| | - Javier Ruiz
- Division of Pediatric Urology, Hospital Nacional de Pediatría SAMIC Dr. JP Garrahan , Buenos Aires , Argentina
| | - Juan C Lopez
- Division of Pediatric Urology, Hospital Nacional de Pediatría SAMIC Dr. JP Garrahan , Buenos Aires , Argentina
| |
Collapse
|
20
|
Antoniou D, Karetsos C. Laparoscopy or retroperitoneoscopy: which is the best approach in pediatric urology? Transl Pediatr 2016; 5:205-213. [PMID: 27867841 PMCID: PMC5107381 DOI: 10.21037/tp.2016.10.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The emergence of minimally invasive surgery about 20 years ago revolutionized pediatric urology. Advances in pediatric devices allowed the widespread use of minimally invasive techniques in almost the entire range of pediatric urology. In this context, laparoscopy and later retroperitoneoscopy were developed and applied in a wide spectrum of urological diseases. Both approaches have since presented benefits and disadvantages that have been documented in various series. However, few comparative studies have been conducted. The aim of this review is to compare the two approaches and establish which is preferable in each field of pediatric urology.
Collapse
Affiliation(s)
- Dimitrios Antoniou
- Sulaiman Al Habib Hospital - Al Takhassusi, Takhassusi Road, 11393 Riyadh, KSA
| | | |
Collapse
|
21
|
Turrà F, Escolino M, Farina A, Settimi A, Esposito C, Varlet F. Pyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients. Transl Pediatr 2016; 5:251-255. [PMID: 27867848 PMCID: PMC5107382 DOI: 10.21037/tp.2016.10.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hydronephrosis is the most common presentation of ureteropelvic junction (UPJ) obstruction. We reviewed literature, collecting data from Medline, to evaluate the current status of minimally invasive surgery (MIS) approach to pyeloplasty. Since the first pyeloplasty was described in 1939, several techniques has been applied to correct UPJ obstruction, but Anderson-Hynes dismembered pyeloplasty is established as the gold standard, to date also in MIS technique. According to literature several studies underline the safety and effectiveness of this approach for both trans- and retro-peritoneal routes, with a success rate between 81-100% and an operative time between 90-228 min. These studies have demonstrated the safety and efficacy of this procedure in the management of UPJ obstruction in children. Whether better the transperitoneal, than the retroperitoneal approach is still debated. A long learning curve is needed especially in suturing and knotting.
Collapse
Affiliation(s)
- Francesco Turrà
- Department of Pediatric Surgery, "Federico II" University of Naples School of Medicine, Naples, Italy
| | - Maria Escolino
- Department of Pediatric Surgery, "Federico II" University of Naples School of Medicine, Naples, Italy
| | - Alessandra Farina
- Department of Pediatric Surgery, "Federico II" University of Naples School of Medicine, Naples, Italy
| | - Alessandro Settimi
- Department of Pediatric Surgery, "Federico II" University of Naples School of Medicine, Naples, Italy
| | - Ciro Esposito
- Department of Pediatric Surgery, "Federico II" University of Naples School of Medicine, Naples, Italy
| | - François Varlet
- Department of Pediatric Surgery, CHU Saint Etienne, Saint Etienne, France
| |
Collapse
|
22
|
Singh V, Garg M, Sharma P, Sinha RJ, Kumar M. Mini incision open pyeloplasty - Improvement in patient outcome. Int Braz J Urol 2015; 41:927-34. [PMID: 26689518 PMCID: PMC4756969 DOI: 10.1590/s1677-5538.ibju.2014.0024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/21/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To assess the subjective and objective outcomes of mini-incision dismembered Anderson-Hynes pyeloplasty in the treatment of primary ureteropelvic junction obstruction (UPJO). MATERIALS AND METHODS Between January 2008 to January 2013, Anderson-Hynes pyeloplasty was performed in 71 patients diagnosed with primary UPJO. Small subcostal muscle splitting incision was used in all cases. Sixteen patients with renal calculi underwent concomitant pyelolithotomy. Subjective outcome was assessed using visual pain analogue score (VAS). For objective assessment, the improvement in differential renal function (DRF) and radio-tracer wash out time (T1/2) on Tc-99m DTPA scan and decrease in hydronephrosis (HDN) on renal ultrasound (USG) and urography (IVU) were assessed. RESULTS Mean incision length was 5.2 cm. The average operating time and postoperative hospital stay was 63 (52-124) minutes and 2.5 (2-6) days respectively. Concomitant renal calculi were successfully removed in all the patients. Overall complication rates were 8.4% and overall success rate was 98.6% at median follow-up of 16 months. There was significant improvement in pain score (p=0.0001) and significant decrease in HDN after the procedure. While preoperative mean T1/2 was 26.7±6.4 minutes, postoperative half-time decreased to 7.8±4.2 minutes at 6 months and to 6.7±3.3 minutes at 1 year. Mean pre-operative DRF was 26.45% and it was 31.38% and 33.19% at 6 months and 1 year respectively. CONCLUSIONS Mini-incision pyeloplasty is a safe and effective technique with combined advantage of high success rates of standard open pyeloplasty with decreased morbidity of laparoscopic approach. Excellent functional and objective outcomes can be achieved without extra technical difficulty.
Collapse
Affiliation(s)
- Vishwajeet Singh
- Department of Urology, King George Medical University, Chhatrapati Shahuji Maharaj Medical University), Lucknow, India
| | - Manish Garg
- Department of Urology, King George Medical University, Chhatrapati Shahuji Maharaj Medical University), Lucknow, India
| | - Pradeep Sharma
- Department of Urology, King George Medical University, Chhatrapati Shahuji Maharaj Medical University), Lucknow, India
| | - Rahul Janak Sinha
- Department of Urology, King George Medical University, Chhatrapati Shahuji Maharaj Medical University), Lucknow, India
| | - Manoj Kumar
- Department of Urology, King George Medical University, Chhatrapati Shahuji Maharaj Medical University), Lucknow, India
| |
Collapse
|
23
|
Abstract
BACKGROUND To survey the effects of one-trocar-assisted pyeloplasty (OTAP) in the treatment of ureteropelvic junction obstruction (UPJO) in kids. MATERIALS AND METHODS Forty-four children (±3.5 years) were submitted to OTAP procedure. A flank incision under the XII rib was made, the Gerota's fascia was achieved and a balloon Hasson trocar with an operative telescope inserted for retroperitoneal access. The renal pelvis and ureter were isolated and exteriorised. Forty-two patients underwent Anderson-Hynes dismembered and one Fenger pyeloplasty . One patient was converted to an open procedure. Two patients presented an aberrant crossing vessel. In all patients, a double J stent was positioned. The operative time and length of stay (LOS) were evaluated. Renal scan and ultrasound (US) were utilised to evaluate the results from 6 to 12 months. RESULTS OTAP was successful in all but 1 patient. Mean operative time and LOS were 128 min and 3,5 days. We had four operative complications (9.09%). The US and a nuclear scan confirmed the resolution of the UPJO in all patients except one with the Fenger pyeloplasty who had an open Anderson-Hynes. CONCLUSIONS The combination of retroperitoneoscopic and open procedures for dismembered pyeloplasty offers a simple, time-saving method in a minimally invasive fashion with low morbidity for patients with UPJO.
Collapse
Affiliation(s)
| | - Alfonso Papparella
- Department of Paediatrics and Paediatric Surgery, Second University of Naples, Caserta, Italy
| |
Collapse
|
24
|
Ekin RG, Celik O, Ilbey YO. An up-to-date overview of minimally invasive treatment methods in ureteropelvic junction obstruction. Cent European J Urol 2015; 68:245-51. [PMID: 26251754 PMCID: PMC4526614 DOI: 10.5173/ceju.2015.543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/15/2015] [Accepted: 04/18/2015] [Indexed: 12/20/2022] Open
Abstract
Introduction Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction have been developed and are bcoming more popular. Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, for both the transperitoneal and retroperitoneal approaches. In this review, we aimed to analyze the current status of minimally invasive therapy of ureteropelvic junction obstruction. Material and methods A PubMed database search was conducted to examine minimally invasive treatments of ureteropelvic junction obstruction. Results A large number of cases have been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric populations. A clear advantage, in terms of hospital stay, of minimally invasive over open pyeloplasty was observed only in the adult population. Conclusions Studies have shown that minimally invasive pyeloplasty techniques are a safe, effective, and feasible in adult and pediatric populations.
Collapse
Affiliation(s)
- Rahmi Gokhan Ekin
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Orcun Celik
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| | - Yusuf Ozlem Ilbey
- Tepecik Teaching and Research Hospital, Department of Urology, Izmir, Turkey
| |
Collapse
|
25
|
|
26
|
Badawy H, Zoaier A, Ghoneim T, Hanno A. Transperitoneal versus retroperitoneal laparoscopic pyeloplasty in children: Randomized clinical trial. J Pediatr Urol 2015; 11:122.e1-6. [PMID: 25979219 DOI: 10.1016/j.jpurol.2014.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 11/26/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Laparoscopic pyeloplasty achieves good cosmetic and functional outcomes. Both transperitoneal and retroperitoneal approaches are used. No single study to date has compared the two approaches in a prospective randomized design. OBJECTIVE We present a prospective randomized comparison between both approaches in children in a trial to define which technique is better with regard to multiple factors including operative time, hospital stay, recovery of bowel movement, analgesic requirement and complication rate. STUDY DESIGN In the period from June 2010 to September 2012, 38 children (25 boys and 13 girls) were operated laparoscopically. Children were randomized into Group I (19 children) operated by the transperitoneal approach, and Group II (19 children) operated by the retroperitoneal approach. Both groups were compared as regards to the operative time, anesthetic changes, and postoperative recovery. A minimum sample size required was calculated to be 19 for each arm based on previous studies of laparoscopic pyeloplasty, using a mean difference in operative time = 40 min, effect size = 0.95, an alpha of 0.05 and power 80% and an online sample size calculator. Statistical analysis was performed using SPSS software using the Fischer exact test, chi square test and Mann-Whitney U test. The operative time was the primary endpoint for comparison between both approaches. DISCUSSION Our series is the first in the literature that compares in a prospective randomized design the transperitoneal and retroperitoneal laparoscopic pyeloplasty in children. Shouma et al. is the only prospective randomized study to compare both techniques in adult pyeloplasty. They had a significantly shorter operative time in the transperitoneal group however, the author in the discussion mentioned that he was at the start of the learning curve for retroperitonoscopic pyeloplasty when he conducted his study, which affected the result of the operative time. Hence, as mentioned above, we stressed the importance of a single surgeon with adequate equal experience in both techniques. The recovery of the intestinal motility and start of oral feeding were significantly faster in the retroperitoneal group compared to the transperitoneal group. In our opinion this can be explained by the absence of intraperitoneal manipulations and urine leakage in the peritoneal space. In their series of retroperitoneal pyeloplasty, El Ghoneimi et al. reported feeding after a mean of 1.4 days, however, in our series there was even earlier oral feeding. Shouma et al. reported no significant difference in the start of oral feeding in their adult series. The limitations of our study are: the choice of the 40 min difference created a statistically significant difference in operative time between the groups which might not be considered a truly clinically important difference. In addition, the single author operating for both approaches, which might create a bias, however the author has sufficient experience in both approaches. Moreover, although there were significant differences in hospital stay and intestinal movement between the two groups, it is not clear if these were of clinical significance. CONCLUSION Both transperitoneal and retroperitoneal approaches have high success rate. The shorter operative time, shorter hospital stay, rapid recovery of intestinal movement and early resumption of oral feeding are in favor with the retroperitoneal approach.
Collapse
Affiliation(s)
- Haytham Badawy
- Unit of Pediatric Urology, Department of Urology, University of Alexandria, Egypt.
| | - Amr Zoaier
- Unit of Pediatric Urology, Department of Urology, Sporting Children Insurance Hospital, Egypt
| | - Tamer Ghoneim
- Department of Anaesthesia, University of Alexandria, Egypt
| | - Ahmed Hanno
- Department of Urology, University of Alexandria, Egypt
| |
Collapse
|
27
|
Harel M, Herbst KW, Silvis R, Makari JH, Ferrer FA, Kim C. Objective pain assessment after ureteral reimplantation: comparison of open versus robotic approach. J Pediatr Urol 2015; 11:82.e1-8. [PMID: 25864615 DOI: 10.1016/j.jpurol.2014.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 12/18/2014] [Indexed: 12/26/2022]
Abstract
INTRODUCTION While open ureteral reimplantation is the gold standard of surgical intervention for vesicoureteral reflux (VUR), minimally invasive approaches offer the potential benefits of decreased postoperative pain, improved cosmesis, and shorter hospital stay and convalescence. Studies comparing open and minimally invasive surgery with respect to postoperative pain in children have been inconclusive. OBJECTIVE We sought to compare postoperative pain in children undergoing open versus robotic ureteral reimplantation by using age-appropriate, validated pain assessment scales. METHODS A prospective cohort of all patients enrolled in an Institutional Review Board-approved VUR surgery registry between July 2010 and February 2013 was analyzed. Patients who underwent endoscopic treatment or who received caudal or epidural anesthesia were excluded. Age-appropriate, validated pain scales ranging from 0 to 10 were utilized for pain assessment. Pain scores and narcotic doses administered on the first postoperative day were analyzed. RESULTS Of the 34 subjects included, 11 underwent open intravesical reimplantation, while 23 patients underwent robotic extravesical reimplantation. Table 1 displays patient characteristics and results of pain assessment. Robotic surgery was associated with lower narcotic requirement compared to open surgery (P < 0.05). The difference in pain scores between the two cohorts approached, but did not reach, statistical significance (P = 0.12). However, the percentage of patients with mild or no pain (57% robotic, 27% open) versus severe pain (9% robotic, 45% open) was notably different between the two cohorts. DISCUSSION Previous studies addressing the effect of surgical modality on pediatric postoperative pain are limited by their reliance on narcotic administration as an indirect surrogate for measuring pain. In the present study, postoperative pain was assessed with narcotic requirements and consistently collected validated pain scores, which more accurately reflect a patient's perceived pain. Although there was no significant difference in subjective pain scores between patients undergoing open versus robotic reimplantation, the percentage of patients with mild or no pain (57% robotic, 27% open) versus severe pain (9% robotic, 45% open) was notably different between the two cohorts. This study was limited by a lack of randomization as well as small sample size, which did not allow for age sub-group analysis or small differences to be statistically significant. CONCLUSIONS In the present study, robotic ureteral reimplantation was associated with lower narcotic requirement compared to open surgery, and lower intensity of postoperative pain according to a direct pain assessment tool. Larger sample sizes are necessary to strengthen statistical comparisons.
Collapse
Affiliation(s)
- M Harel
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA; Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA.
| | - K W Herbst
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA.
| | - R Silvis
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA.
| | - J H Makari
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA; Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA.
| | - F A Ferrer
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA; Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA.
| | - C Kim
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA; Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA.
| |
Collapse
|
28
|
García-Aparicio L, Blazquez-Gomez E, Martin O, Manzanares A, García-Smith N, Bejarano M, Rodo J, Ribó JM. Anderson-Hynes Pyeloplasty in Patients Less Than 12 Months Old. Is the Laparoscopic Approach Safe and Feasible? J Endourol 2014; 28:906-8. [DOI: 10.1089/end.2013.0704] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Luis García-Aparicio
- Pediatric Urology Division, Pediatric Surgery Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Eva Blazquez-Gomez
- Hospital Universitario Virgen Macarena, University of Sevilla, Sevilla, Spain
| | - Oriol Martin
- Pediatric Urology Division, Pediatric Surgery Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Alejandro Manzanares
- Pediatric Urology Division, Pediatric Surgery Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Natalie García-Smith
- Pediatric Urology Division, Pediatric Surgery Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Miguel Bejarano
- Pediatric Urology Division, Pediatric Surgery Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Joan Rodo
- Pediatric Urology Division, Pediatric Surgery Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Josep M. Ribó
- Pediatric Urology Division, Pediatric Surgery Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| |
Collapse
|
29
|
Khoder WY, Waidelich R, Becker AJ, Karl A, Haseke N, Bauer RM, Stief CG, Bachmann A, Ebinger Mundorff N. Patients' Perception of Surgical Outcomes and Quality of Life after Retroperitoneoscopic and Open Pyeloplasty. Urol Int 2014; 92:74-82. [DOI: 10.1159/000352055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 05/02/2013] [Indexed: 11/19/2022]
|
30
|
Herndon CDA, Herbst K, Smith C. The transition from open to laparoscopic pediatric pyeloplasty: a single-surgeon experience. J Pediatr Urol 2013; 9:409-14. [PMID: 22796268 DOI: 10.1016/j.jpurol.2012.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 06/20/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We present outcomes from a single-surgeon experience in a practice that transitioned away from an open towards a strictly laparoscopic approach to the surgical correction of congenital ureteropelvic junction (UPJ) obstruction. MATERIAL AND METHODS A retrospective chart review was performed on all patients undergoing a dismembered pyeloplasty for UPJ obstruction by one surgeon in 2004-2010. A total of 75 (49 open group (OG), 26 laparoscopic group (LG)) procedures (4 bilateral, 4 re-operative (1 outside institution)) in 67 (66% male, and 73% white) patients were available for review. Median age was 10 months (<1-132) for the OG and 72 months (2-204) for the LG (p < 0.001). The UPJ obstruction was left in 55%, right 34% and bilateral in 11%. A crossing vessel was present in 32% of procedures. None of these values were statistically different in comparing the two cohorts. Patients either had SFU grade IV hydronephrosis, worsening SFU Grade III with tension, or were symptomatic. A total of 36 patients presented symptomatically. Co-morbidities were present in 9%. All patients in the LG were stented post-op compared to 35% in the OG (p < 0.001). Outcome variables assessed included learning curve, post-op result (worse, improved, same), complications, need for intervention and length of stay. The surgeon had some exposure in residency to hand-assisted laparoscopy. In pediatric urology fellowship, all complex procedures were performed open. RESULTS Mean operative time was significantly longer in the LG: 387 min vs 281 min in the OG (p < 0.001). The learning curve trend line for both cohorts demonstrated slight improvement over time, but confidence intervals were wide in both and this trend was not significant. Following surgical intervention, the length of stay was comparable between the two groups with 96% discharged post-op day 1 in LG and 87% in OG (p = 0.2). With a minimal follow-up of 6 months, most patients demonstrated improvement in hydronephrosis (LG 96% vs OG 96%). Re-operation was successfully performed in 3 patients (2 OG, 1 LG) for persistent obstruction. Complications were present in both groups: 14% OG and 8% LG (p = NS). CONCLUSIONS In summary, it is feasible to successfully transition from an open surgical practice towards a strictly laparoscopic approach to the surgical correction of UPJ obstruction. Even in the absence of laparoscopic training in fellowship, the learning curve should be relatively flat with the laparoscopic repair but will always take longer than the open procedure.
Collapse
Affiliation(s)
- C D Anthony Herndon
- The University of Virginia, Department of Urology, Charlottesville, VA, USA.
| | | | | |
Collapse
|
31
|
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.
Collapse
Affiliation(s)
- Punit Bansal
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Autorino R, Eden C, El-Ghoneimi A, Guazzoni G, Buffi N, Peters CA, Stein RJ, Gettman M. Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis. Eur Urol 2013; 65:430-52. [PMID: 23856037 DOI: 10.1016/j.eururo.2013.06.053] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/26/2013] [Indexed: 12/15/2022]
Abstract
CONTEXT Over the last two decades, minimally invasive treatment options for ureteropelvic junction obstruction (UPJO) have been developed and popularized. OBJECTIVE To critically analyze the current status of laparoscopic and robotic repair of UPJO. EVIDENCE ACQUISITION A systematic literature review was performed in November 2012 using PubMed. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. EVIDENCE SYNTHESIS Multiple series of laparoscopic pyeloplasty have demonstrated high success rates and low perioperative morbidity in pediatric and adult populations, with both the transperitoneal and retroperitoneal approaches. Data on pediatric robot-assisted pyeloplasty are increasingly becoming available. A larger number of cases have also been reported for adult patients, confirming that robotic pyeloplasty represents a viable option for either primary or secondary repair. Robot-assisted redo pyeloplasty has been mostly described in the pediatric population. Different technical variations have been implemented with the aim of tailoring the procedure to each specific case. The type of stenting, retrograde versus antegrade, continues to be debated. Internal-external stenting as well as a stentless approach have been used, especially in the pediatric population. Comparative studies demonstrate similar success and complication rates between minimally invasive and open pyeloplasty in both the adult and pediatric setting. A clear advantage in terms of hospital stay for minimally invasive over open pyeloplasty was observed only in the adult population. CONCLUSIONS Laparoscopy represents an efficient and effective less invasive alternative to open pyeloplasty. Robotic pyeloplasty is likely to emerge as the new minimally invasive standard of care whenever robotic technology is available because its precise suturing and shorter learning curve represent unique attractive features. For both laparoscopy and robotics, the technique can be tailored to the specific case according to intraoperative findings and personal surgical experience.
Collapse
Affiliation(s)
- Riccardo Autorino
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Service, Second University of Naples, Naples, Italy.
| | - Christopher Eden
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Hôpital Robert Debré, Assistance Publique-Hopitaux de Paris, University of Paris Diderot, Paris, France
| | - Giorgio Guazzoni
- Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy
| | - Nicolòmaria Buffi
- Department of Urology, Vita-Salute University, San Raffaele-Turro Hospital, Milan, Italy
| | - Craig A Peters
- Department of Pediatric Surgery, Children's National Medical Center, Washington, DC, USA
| | - Robert J Stein
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | |
Collapse
|
33
|
van der Toorn F, van den Hoek J, Wolffenbuttel KP, Scheepe JR. Laparoscopic transperitoneal pyeloplasty in children from age of 3 years: our clinical outcomes compared with open surgery. J Pediatr Urol 2013; 9:161-8. [PMID: 22321813 DOI: 10.1016/j.jpurol.2012.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 01/09/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report clinical outcomes for laparoscopic pyeloplasty (LP) in children compared with open pyeloplasty (OP) and literature findings. PATIENTS AND METHODS In a prospective study, the outcomes of 57 consecutive transperitoneal LP in children from the age of 3 years were analyzed and compared with a matched historic control group of OP and with series of LP in the literature. Successful result was defined as resolution of symptoms, no conversion or re-operation, improved hydronephrosis, and/or improved renographic drainage. RESULTS Mean operative time was 177 (SD 50.5)min in the LP group and 108 (SD 25.6)min in the OP group (p < 0.001). Mean hospital stay was 1.2 (SD 0.46) days in the LP and 6.7 (SD 1.2) days in the OP group. Improvement in renographic drainage was observed more often after LP than after OP (98% vs 83%; p = 0.010). A successful result was reported in 56 (98%) LP and 54 (95%) OP (p = 0.298) patients. Our LP series demonstrates a high success rate compared to literature data. CONCLUSIONS Our LP has a similar success rate and more often improved renographic drainage in comparison to OP. Furthermore, our LP demonstrates a shorter hospital stay and favorable outcomes compared to the literature. We thus regard LP as standard treatment for repair of ureteropelvic junction obstruction in children from the age of 3 years.
Collapse
Affiliation(s)
- Fred van der Toorn
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC Rotterdam, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
| | | | | | | |
Collapse
|
34
|
Knoedler J, Han L, Granberg C, Kramer S, Chow G, Gettman M, Kimball B, Moriarty J, Kim S, Husmann D. Population-based comparison of laparoscopic and open pyeloplasty in paediatric pelvi-ureretic junction obstruction. BJU Int 2013; 111:1141-7. [DOI: 10.1111/bju.12039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- John Knoedler
- Department of Urology; Mayo Clinic; Rochester MN USA
| | - Leona Han
- Division of Health Care Policy and Research; Mayo Clinic; Rochester MN USA
| | | | | | - George Chow
- Department of Urology; Mayo Clinic; Rochester MN USA
| | | | - Brittany Kimball
- Division of Health Care Policy and Research; Mayo Clinic; Rochester MN USA
| | - James Moriarty
- Division of Health Care Policy and Research; Mayo Clinic; Rochester MN USA
| | - Simon Kim
- Department of Urology; Mayo Clinic; Rochester MN USA
| | | |
Collapse
|
35
|
Blanc T, Muller C, Abdoul H, Peev S, Paye-Jaouen A, Peycelon M, Carricaburu E, El-Ghoneimi A. Retroperitoneal Laparoscopic Pyeloplasty in Children: Long-Term Outcome and Critical Analysis of 10-Year Experience in a Teaching Center. Eur Urol 2013; 63:565-72. [DOI: 10.1016/j.eururo.2012.07.051] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
|
36
|
Jacobs BL, Kaufman SR, Morgenstern H, Hollenbeck BK, Wolf JS, Hollingsworth JM. Trends in the treatment of adults with ureteropelvic junction obstruction. J Endourol 2013; 27:355-60. [PMID: 22967009 PMCID: PMC3593686 DOI: 10.1089/end.2012.0017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Minimally invasive pyeloplasty is an effective treatment for patients with ureteropelvic junction obstruction that offers quicker convalescence than open pyeloplasty. Technical challenges, however, may have limited its dissemination. We examined population trends and determinants of surgical options for ureteropelvic junction obstruction. PATIENTS AND METHODS Using the State Inpatient and Ambulatory Surgery Databases for Florida, we identified adults who underwent ureteropelvic junction obstruction repair between 2001 and 2009. After determining the surgical approach (minimally invasive pyeloplasty, open pyeloplasty, or endopyelotomy), we estimated annual utilization rates and the effects of patient, surgeon, and hospital predictors on surgery type, using multilevel multinomial logistic regression. RESULTS Rates of minimally invasive pyeloplasty increased 360% (P for monotonic trend < 0.01), while rates of open pyeloplasty decreased 56% (P<0.01). Rates of endopyelotomy were substantially higher and remained relatively stable (P=0.27). Compared with open pyeloplasty, minimally invasive pyeloplasty was used more commonly among patients with private insurance (odds ratio [OR] 1.6; 95% confidence interval [CI], 1.2-2.3), those treated at teaching hospitals (OR 1.6; CI 1.0-2.6), and those treated by high-volume surgeons (OR 2.9; CI 2.0-4.2). Its use was less frequent among patients with multiple comorbidities (OR 0.53; CI 0.37-0.76). Similar associations were observed when comparing receipt of minimally invasive pyeloplasty with endopyelotomy; however, patients who underwent endopyelotomy were older. CONCLUSIONS The use of minimally invasive pyeloplasty has dramatically increased, largely replacing open pyeloplasty, while the use of endopyelotomy, albeit significantly more common than the other approaches, has remained stable. The surgical approach is influenced by several patient, surgeon, and hospital factors.
Collapse
Affiliation(s)
- Bruce L Jacobs
- Department of Urology, Divisions of Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
| | | | | | | | | | | |
Collapse
|
37
|
O'Brien ST, Shukla AR. Transition from open to robotic-assisted pediatric pyeloplasty: a feasibility and outcome study. J Pediatr Urol 2012; 8:276-81. [PMID: 21616719 DOI: 10.1016/j.jpurol.2011.04.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 04/20/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE Laparoscopic reconstructive procedures in the pediatric patient are associated with a steep learning curve. Outcomes from robotic-assisted pediatric urology have been reported by surgeons with known facility in laparoscopic surgery. We describe the experience of a single surgeon in transitioning from open to robotic-assisted laparoscopic pyeloplasty (RALP) without previous training in traditional laparoscopic pyeloplasty or intracorporeal suturing. MATERIALS AND METHODS We reviewed our experience with 20 (mean age 7.4 years) consecutive children undergoing RALP for ureteropelvic junction obstruction at our institution over 36 months. Additionally, a literature search was conducted to identify age-similar patient groups who underwent open and laparoscopic pyeloplasty. RESULTS Length of hospitalization and postoperative analgesia requirement were greater in the age-similar open pyeloplasty group compared to the other two groups. Intraoperative times were greater in the laparoscopic and RALP groups compared to the open pyeloplasty group. CONCLUSIONS Our experience confirms the feasibility of transitioning from open to robotic-assisted laparoscopic pediatric pyeloplasty without previous experience in conventional laparoscopy. Outcomes, analgesic requirement and hospitalization for the patients from our institution are comparable to the laparoscopy patient group and improved compared to open pyeloplasty patients from the literature.
Collapse
Affiliation(s)
- Sean T O'Brien
- Section of Pediatric Urology, University of Minnesota, Department of Urology, USA.
| | | |
Collapse
|
38
|
Subotic S, Weiss H, Wyler S, Rentsch CA, Rassweiler J, Bachmann A, Teber D. Dismembered and non-dismembered retroperitoneoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction in children. World J Urol 2012; 31:689-95. [PMID: 22618575 DOI: 10.1007/s00345-012-0887-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 05/08/2012] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Open dismembered pyeloplasty according to Anderson-Hynes (AHP) is the gold standard treatment for ureteropelvic junction obstruction in children. However, during the last decade, the management has been revolutionized with introduction of laparoscopy and endourology yielding comparable results and less morbid outcomes. METHODS Between 1997 and 2010, dismembered and non-dismembered retroperitoneoscopic pyeloplasty was performed in 41 children with a median age of 130 month (range 5-192). 20 children underwent a dismembered pyeloplasty (Anderson-Hynes) and 21 children were operated by a non-dismembered pyeloplasty (Y-V-Plasty). RESULTS The mean operation time was 120 min (range 52-257). Intraoperative findings revealed in 29 cases a significant crossing vessel. Based on a furosemide nephrogram and subjective complaints, the success rate was 88 % with a median follow-up of 69 month (range 14-142). The 5 failures (2 Y-V-Plasty, 3 AHP) have been treated by open AHP (n = 2), Laser endopyelotomy (n = 2) and Lap-AHP (n = 1) without further problems. CONCLUSION With increasing improvement of the suture techniques, the laparoscopic pyeloplasty represents in experienced hands an alternative method with comparable success rates to the open technique. In our opinion, retroperitoneoscopic pyeloplasty is technically possible and feasible even in infants. We found in our series no statistically significant difference between dismembered and non-dismembered pyeloplasty.
Collapse
Affiliation(s)
- Svetozar Subotic
- Department of Urology, University Hospital Basel, Spitalstr. 21, 4031, Basel, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
39
|
Hidas G, Watts B, Khoury AE. The evolving role of laparoscopic surgery in paediatric urology. Arab J Urol 2012; 10:74-80. [PMID: 26558007 PMCID: PMC4442882 DOI: 10.1016/j.aju.2011.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 12/01/2011] [Accepted: 12/03/2011] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We review the various applications of laparoscopic and robotic-assisted laparoscopy in paediatric urology, as the laparoscopic and robotic approach in this population is gradually being recognised. METHODS We searched PubMed for human studies in English that were published between 1990 and the present, focusing on laparoscopic nephrectomies and partial nephrectomies, laparoscopic and robotic pyeloplasties and ureteric reimplantation, laparoscopic orchidopexy and varicocelectomy. We also reviewed robotic-assisted laparoscopic urological major reconstructions. Key articles were reviewed, extracting the indications, techniques, and the advantages and disadvantages. RESULTS AND CONCLUSIONS Laparoscopy has a defined place in modern paediatric urological surgery. Laparoscopic nephrectomies, pyeloplasties and abdominal exploration for the evaluation and management of impalpable undescended testicles have become the standard of care. Robotic-assisted laparoscopic surgery is developing as a safe and effective option even for infant patients.
Collapse
Affiliation(s)
- Guy Hidas
- Department of Paediatric Urology, UC Irvine and Children's Hospital of Orange County, Orange, CA, USA
| | - Blake Watts
- Department of Paediatric Urology, UC Irvine and Children's Hospital of Orange County, Orange, CA, USA
| | - Antoine E Khoury
- Department of Paediatric Urology, UC Irvine and Children's Hospital of Orange County, Orange, CA, USA
| |
Collapse
|
40
|
Tomaszewski JJ, Casella DP, Turner RM, Casale P, Ost MC. Pediatric laparoscopic and robot-assisted laparoscopic surgery: technical considerations. J Endourol 2011; 26:602-13. [PMID: 22050504 DOI: 10.1089/end.2011.0252] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Laparoscopy has become an effective modality for the treatment of many pediatric urologic conditions that need both extirpative and reconstructive techniques. Laparoscopic procedures for urologic diseases in children, such as pyeloplasty, orchiopexy, nephrectomy, and bladder augmentation, have proven to be safe and effective with outcomes comparable to those of open techniques. Given the steep learning curve and technical difficulty of laparoscopic surgery, robot-assisted laparoscopic surgery (RAS) is increasingly being adopted in pediatric patients worldwide. Anything that can be performed laparoscopically in adults can be extended into pediatric practice with minor technical refinements. We review the role of laparoscopic and RAS in pediatric urology and provide technical considerations necessary to perform minimally invasive surgery successfully.
Collapse
Affiliation(s)
- Jeffrey J Tomaszewski
- Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | | | | | | | | |
Collapse
|
41
|
Scuderi MG, Arena S, Di Benedetto V. One-Trocar–Assisted Pyeloplasty. J Laparoendosc Adv Surg Tech A 2011; 21:651-4. [DOI: 10.1089/lap.2010.0115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maria Grazia Scuderi
- Department of Pediatric Surgery, Unit of Pediatric Surgery, University of Catania, Italy
| | - Salvatore Arena
- Department of Pediatric Surgery, Unit of Pediatric Surgery, University of Catania, Italy
| | - Vincenzo Di Benedetto
- Department of Pediatric Surgery, Unit of Pediatric Surgery, University of Catania, Italy
| |
Collapse
|
42
|
Juliano RV, Mendonça RR, Meyer F, Rubinstein M, Lasmar MTC, Korkes F, Tavares A, Pompeo ACL, Tobias-Machado M. Long-Term Outcome of Laparoscopic Pyeloplasty: Multicentric Comparative Study of Techniques and Accesses. J Laparoendosc Adv Surg Tech A 2011; 21:399-403. [DOI: 10.1089/lap.2010.0281] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Marco Túlio Coelho Lasmar
- Laparoscopic Division of Hospital Felício Rocho, Belo Horizonte, Minas Gerais, Brazil
- Division of Laparoscopic Urology, ABC Medical School, Santo André, Sao Paulo, Brazil
| | - Fernando Korkes
- Division of Urology, ABC Medical School, Santo André, Sao Paulo, Brazil
| | | | | | - Marcos Tobias-Machado
- Section of Minimally Invasive Surgery, Department of Urology, ABC Medical School, Santo André, Sao Paulo, Brazil
| |
Collapse
|
43
|
Kajbafzadeh AM, Tourchi A, Nezami BG, Khakpour M, Mousavian AA, Talab SS. Miniature pyeloplasty as a minimally invasive surgery with less than 1 day admission in infants. J Pediatr Urol 2011; 7:283-8. [PMID: 21527237 DOI: 10.1016/j.jpurol.2011.02.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Open dismembered pyeloplasty is usually performed through flank, anterior subcostal or posterior lumbotomy incisions. These incisions are cosmetically less acceptable and may produce significant postoperative pain. We present the smallest incision for open pyeloplasty, called a 'miniature pyeloplasty'. The aim of this study was to reduce hospital stay and postoperative pain, along with enhanced cosmetic results. PATIENTS AND METHOD 373 infants (mean age 4 months) with hugely dilated pelvises underwent the miniature pyeloplasty. The exact site of incision was determined by intraoperative renal ultrasonography and palpation. A muscle-splitting incision was made in the most dependent part of the lower quadrant. After meticulous dissection of the ureteropelvic junction component, the affected section was pulled out and underwent classic dismembered pyeloplasty without renal pelvis reduction. All children had long-duration stented anastomoses. Surgical incision size, operative time, hospital stay, postoperative analgesic use and complication rate were recorded. RESULTS The operation was successful in all patients. The mean operative time was 53 min (range 43-75) and patients were discharged after 18 ± 3 (mean ± SD) h. Incision size ranged from 11 to 15 mm (mean 13). No narcotic analgesic was required postoperatively and there were no major complications during follow up. CONCLUSIONS Miniature pyeloplasty is a safe and successful technique for ureteropelvic junction obstruction that avoids long operative time with negligible postoperative pain compared to the classic open pyeloplasty in infants. The exact incision site must be reconfirmed intraoperatively by physical examination or renal ultrasonography.
Collapse
Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
| | | | | | | | | | | |
Collapse
|
44
|
Maheshwari R, Ansari MS, Mandhani A, Srivastava A, Kapoor R. Laparoscopic pyeloplasty in pediatric patients: the SGPGI experience. Indian J Urol 2011; 26:36-40. [PMID: 20535282 PMCID: PMC2878435 DOI: 10.4103/0970-1591.60441] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objectives: To determine the safety, efficacy and long-term outcome of laparoscopic pyeloplasty in pediatric patients. Materials and Methods: A prospective analysis of data of pediatric patients under the age of 15 years, who had undergone laparoscopic pyeloplasty from January 2000 to June 2008 was done. The various parameters analyzed were; operative time, blood loss, need for analgesics, intra/postoperative complications, hospital stay and postoperative outcome. Success was defined on the basis of either improvement in the symptoms/or better drainage on postoperative isotope renography. Results: A total of 82 patients with a mean age of 7.12 years (four months to 15 years) and male to female ratio of 4.3:1 were included in the study. Dismembered pyeloplasty was done in 70 patients and Foley Y-V plasty in 12 patients via transperitoneal approach using three ports in 79 or four ports in three children. Mean operative time was 151 minutes (78-369); mean blood loss was 88.01 ml (50-250) with a mean hospital stay of 5.05 days (2-11). Conversion to open surgery was required in four (4.87%) patients. Follow-up renograms were available in 74 patients who showed improvement in drainage in 69 patients and obstructed pattern in five; of these two patients had significant deterioration in split function. Two patients among the obstructed group underwent redo pyeloplasty by open technique while the rest three elected for conservative approach. At a mean follow-up of 41.58 months (8-75) the overall success rate was 91.89%. Conclusion: Laparoscopic pyeloplasty is effective and safe in children with minimal morbidity and gives excellent long-term results.
Collapse
Affiliation(s)
- Ruchir Maheshwari
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
| | | | | | | | | |
Collapse
|
45
|
Mei H, Pu J, Yang C, Zhang H, Zheng L, Tong Q. Laparoscopic Versus Open Pyeloplasty for Ureteropelvic Junction Obstruction in Children: A Systematic Review and Meta-Analysis. J Endourol 2011; 25:727-36. [PMID: 21476861 DOI: 10.1089/end.2010.0544] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Hong Mei
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiarui Pu
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunlei Yang
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huanyu Zhang
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liduan Zheng
- Department of Pathology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiangsong Tong
- Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
46
|
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.
Collapse
Affiliation(s)
- Punit Bansal
- IPGMER &SSKM HOSPITAL, 329, Doctors Hostel, 242, AJC Bose Road, Kolkata, 700020 India
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Sweeney DD, Ost MC, Schneck FX, Docimo SG. Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Children. J Laparoendosc Adv Surg Tech A 2011; 21:261-5. [DOI: 10.1089/lap.2010.0155] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Danielle D. Sweeney
- Department of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael C. Ost
- Department of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Francis X. Schneck
- Department of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Steven G. Docimo
- Department of Pediatric Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
48
|
Helmy T, Blanc T, Paye-Jaouen A, El-Ghoneimi A. Preliminary Experience With External Ureteropelvic Stent: Alternative to Double-J Stent in Laparoscopic Pyeloplasty in Children. J Urol 2011; 185:1065-9. [DOI: 10.1016/j.juro.2010.10.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Tamer Helmy
- Department of Pediatric Surgery and Urology, Robert Debré University Hospital, AP-HP University of Paris VII-Denis Diderot, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Robert Debré University Hospital, AP-HP University of Paris VII-Denis Diderot, Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Surgery and Urology, Robert Debré University Hospital, AP-HP University of Paris VII-Denis Diderot, Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Robert Debré University Hospital, AP-HP University of Paris VII-Denis Diderot, Paris, France
| |
Collapse
|
49
|
Lavonas EJ, Reynolds KM, Dart RC. Therapeutic acetaminophen is not associated with liver injury in children: a systematic review. Pediatrics 2010; 126:e1430-44. [PMID: 21098156 DOI: 10.1542/peds.2009-3352] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Concern exists about the potential for liver injury with therapeutic dosing of acetaminophen in children. OBJECTIVE We systematically reviewed the medical literature to determine the rate at which liver injury has been reported for children prescribed therapeutic doses of acetaminophen (≤75 mg/kg per day orally or intravenously or ≤100 mg/kg per day rectally). METHODS We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials to locate all studies in which acetaminophen was administered to a defined pediatric population for ≥24 hours and for all case reports of liver injury after therapeutic acetaminophen dosing. Trained reviewers extracted data from each report. Major and minor hepatic adverse events (AEs) were defined prospectively. Causality was assessed by using the Naranjo algorithm. RESULTS A total of 62 studies that enrolled 32,414 children were included. No child (0% [95% confidence interval: 0.000-0.009]) was reported to have exhibited signs or symptoms of liver disease, to have received an antidote or transplantation, or to have died. Major or minor hepatic AEs were reported for 10 children (0.031% [95% confidence interval: 0.015-0.057]). The highest transaminase value reported was 600 IU/L. Naranjo scores (2-3) suggested "possible" causation. Twenty-two case reports were identified. In 9 cases, the Naranjo score suggested "probable" causation (5-6). CONCLUSIONS Hepatoxicity after therapeutic dosing of acetaminophen in children is rarely reported in defined-population studies. Case reports suggest that this phenomenon may occur, but few reports contain sufficient data to support a probable causal relationship.
Collapse
Affiliation(s)
- Eric J Lavonas
- Rocky Mountain Poison & Drug Center, 777 Bannock St, MC 0180, Denver, CO 80204, USA.
| | | | | |
Collapse
|
50
|
Caione P, Lais A, Nappo SG. One-Port Retroperitoneoscopic Assisted Pyeloplasty Versus Open Dismembered Pyeloplasty in Young Children: Preliminary Experience. J Urol 2010; 184:2109-15. [DOI: 10.1016/j.juro.2010.06.126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Paolo Caione
- Division of Pediatric Urology, Department of Nephrology-Urology, “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy
| | - Alberto Lais
- Division of Pediatric Urology, Department of Nephrology-Urology, “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy
| | - Simona Gerocarni Nappo
- Division of Pediatric Urology, Department of Nephrology-Urology, “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy
| |
Collapse
|