1
|
Xie Q, Wang C, Su C, Shi B, Li Y, Huang J, Chen C. Feasibility and Effectiveness of Repeat Laparoscopic Pyeloplasty for Recurrent Ureteropelvic Junction Obstruction in Pediatric Patients. J Endourol 2024; 38:584-589. [PMID: 38545757 DOI: 10.1089/end.2023.0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Objective: To assess the outcomes of redo laparoscopic pyeloplasty (RLP) in pediatric patients with recurrent ureteropelvic junction obstruction (UPJO) in contrast to redo open pyeloplasty (ROP). In addition, evaluate the feasibility and efficacy of RLP as a treatment modality for recurrent UPJO in children. Materials and Methods: The data of 44 patients from March 2012 to March 2022, who underwent redo pyeloplasty, were retrospectively reviewed. In Group RLP, the children underwent RLP, whereas ROP was attempted in Group ROP. Demographics, clinical manifestations, surgical duration, hospitalization duration, complication rates, and treatment success were examined within the respective groups. Moreover, preoperative and postoperative measurements of anterior-posterior diameter of the renal pelvis (APD), preoperative assessment of differential renal function (DRF), and the percentage of improvement in DRF (PI-DRF) were subject to analysis. Results: The study included 28 patients who underwent RLP (Group RLP), and 16 patients who underwent ROP (Group ROP). In all cases, the Anderson-Hynes technique was employed. There was no significant difference between the two groups regarding age, body mass index, gender distribution, affected side, preoperative APD, postoperative APD, and preoperative DRF. In comparison to Group ROP, Group RLP exhibited a shorter hospitalization duration, a longer surgical procedure duration, and a higher percentage improvement in PI-DRF. The median follow-up period for Group RLP was 25 months, whereas it was 25.5 months for Group ROP. Notably, the success rates were similar between the two groups, with a success rate of 89.2% in RLP and 87.5% in ROP (p = 0.634). Conclusion: RLP has a comparable success rate to ROP and is a safe, effective, and feasible procedure for the treatment of failed pyeloplasty in children.
Collapse
Affiliation(s)
- Qike Xie
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Congjun Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Cheng Su
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bo Shi
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yong Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junqiang Huang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chao Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
2
|
Mallikarjuna C, Ghouse SM, Madduri VKS, Bendigeri MT, Enganti B, Reddy P, Tak GR. Techniques in minimally invasive transperitoneal pyeloplasty: A compilation. Urol Ann 2024; 16:52-59. [PMID: 38415227 PMCID: PMC10896333 DOI: 10.4103/ua.ua_38_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 02/29/2024] Open
Abstract
Context Minimally invasive management (laparoscopic/robot assisted) is currently the standard of care for managing pelvi ureteric junction obstruction (PUJO). Open techniques of management of PUJO are well described in literature. However, there appears to be relative lack of description of minimally invasive techniques in the literature. Objective This article is aimed at describing in detail, with images, the various techniques and modifications in laparoscopic or robot-assisted management of PUJO. Evidence Acquisition A review of literature on PubMed was performed and all articles which detailed any technique of minimally invasive pyeloplasty were included. Evidence Synthesis The various techniques of minimally invasive pyeloplasty as well as the authors' techniques are compiled and described in detail with intraoperative images. Conclusions Operative techniques of minimally invasive pyeloplasty are not well described in literature. We have attempted to present a comprehensive resource of different techniques of minimally invasive pyeloplasty and the clinical scenarios in which they may be appropriate. This should prove to be a useful reference to the practicing urologist. Patient Summary In this paper, we have compiled the various surgical techniques of treating obstruction at the PUJ of the kidney along with intraoperative photograph.
Collapse
Affiliation(s)
- Chiruvella Mallikarjuna
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | - Syed Mohammed Ghouse
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | | | - Mohammed Taif Bendigeri
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | - Bhavatej Enganti
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | - Purnachandra Reddy
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | - Gopal Ramdas Tak
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| |
Collapse
|
3
|
Tang J, Wang R, Fang Z, Yang H. Application of fluorescence navigation during laparoscopic pyeloplasty for complex ureteropelvic junction obstruction. Asian J Surg 2023; 46:5751-5752. [PMID: 37652758 DOI: 10.1016/j.asjsur.2023.08.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Jianer Tang
- Department of Urology, First Affiliated Hospital of Huzhou Teachers College, Huzhou, China; Huzhou Key Laboratory of Precise Diagnosis and Treatment of Urinary Tumors, Huzhou, China
| | - Rongjiang Wang
- Department of Urology, First Affiliated Hospital of Huzhou Teachers College, Huzhou, China; Huzhou Key Laboratory of Precise Diagnosis and Treatment of Urinary Tumors, Huzhou, China
| | - Zhihai Fang
- Department of Urology, First Affiliated Hospital of Huzhou Teachers College, Huzhou, China; Huzhou Key Laboratory of Precise Diagnosis and Treatment of Urinary Tumors, Huzhou, China
| | - Hua Yang
- Department of Andrology, Huzhou Women and Children's Hospital, Huzhou, China.
| |
Collapse
|
4
|
Gao W, Zhang L, He Y, Tian T, Li Z, Bai L, Shen Y, Huang C, Wang B, Zhang P, Feng N, Li X, Guo Y, Li X. Analysis of the efficacy and risk factors of surgical treatment of recurrent UPJO in adults. Int Urol Nephrol 2022; 55:1493-1499. [PMID: 36571668 DOI: 10.1007/s11255-022-03439-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/04/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND To compare the efficacy of secondary pyeloplasty and balloon dilation and to analyze the risk factors for secondary surgical failure in patients with recurrent uretero-pelvic junction obstruction (UPJO). METHODS We retrospectively analyzed 65 patients with recurrent UPJO who underwent secondary surgery between September 2011 and March 2019, of whom 33 had complete baseline data and follow-up data. General clinical information, perioperative data, and follow-up results were collected from patients. Risk factors for surgical failure in patients with recurrent UPJO were analyzed using logistic regression. RESULTS The failure rates of secondary pyeloplasty and balloon dilation in secondary surgery were 16.7% and 33.3%, respectively. Univariate analysis showed that ureteral stenosis length and operative time were associated with secondary pyeloplasty and balloon dilatation failure (p < 0.05), and ureteral stenosis length was an independent risk factor for secondary pyeloplasty failure (OR = 0.074, 95% CI: 0.006-0.864, p = 0.038). In the balloon dilation group, treatment failure rates were significantly lower in patients with stenotic segment lengths less than 1 ± 0.32 cm than in patients with stenotic segment lengths greater than 1 ± 0.32 cm (p = 0.019). CONCLUSIONS The secondary pyeloplasty may provide better benefit. Ureteral stricture length is an independent risk factor for failure of secondary pyeloplasty and a potential risk factor for balloon dilatation. Operation time is a potential risk factor for pyeloplasty and balloon dilatation.
Collapse
Affiliation(s)
- Wenzhi Gao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Department of Urology, The Third Hospital of Hebei Medical University, Ziqiang Road, Qiaoxi District, Shijiazhuang City, 050000, Hebei Province, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yuhui He
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Tai Tian
- Department of Urology, The Third Hospital of Hebei Medical University, Ziqiang Road, Qiaoxi District, Shijiazhuang City, 050000, Hebei Province, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Liangliang Bai
- Department of Urology, The Third Hospital of Hebei Medical University, Ziqiang Road, Qiaoxi District, Shijiazhuang City, 050000, Hebei Province, China
| | - Ying Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Chen Huang
- Department of Urology, Jian Gong Hospital, Beijing, 100034, China
| | - Bing Wang
- Department of Urology, Peking University First Hospital, Miyun Campus, Beijing, 100034, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, 100034, China
| | - Ninghan Feng
- Wuxi No. 2 People's Hospital of Nanjing Medical University, Nanjing Medical University, Jiangsu, 214002, China
| | - Xuechao Li
- Department of Urology, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, 100034, China
| | - Yuexian Guo
- Department of Urology, The Third Hospital of Hebei Medical University, Ziqiang Road, Qiaoxi District, Shijiazhuang City, 050000, Hebei Province, China.
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| |
Collapse
|
5
|
Du T, Qi P, He L, Yang S, Zhang B, Shang P. Comparison of Secondary and Primary Minimally Invasive Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2022; 32:871-883. [PMID: 35319279 DOI: 10.1089/lap.2021.0771] [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: 11/12/2022] Open
Abstract
Objective: To compare the outcomes of secondary minimally invasive pyeloplasty (MIP) versus primary MIP for the patients with ureteropelvic junction obstruction (UPJO). Materials and Methods: We searched all the literature of PubMed, Web of Science, EMBASE, and Cochrane Library comparing secondary MIP and primary MIP and performed a systematic review and meta-analysis. Results: We included 15 studies involving 1637 patients with 1371 in the primary MIP group and 266 in the secondary MIP group. There were no significant differences in length of hospital stays, and the risk of hematuria, urinary tract infection, intestinal obstruction, stent complications, and overall complications (P > .05). Comparing with the secondary MIP group, the primary MIP group has shorter operative time (mean difference [MD] = -36.91 minutes, 95% confidence interval [CI]: -50.21 to -23.62, P < .00001), less estimated blood loss (MD = -16.70 mL, 95% CI: -31.60 to -1.80, P = .03), lower risk of urinary leakage and injury of blood vessel (relative risk [RR] = 0.32, 95% CI: 0.11-0.93, P = .04) (RR = 0.10, 95% CI: 0.02-0.61, P = .01), and higher success rate (RR = 1.07, 95% CI: 1.02-1.11, P = .003). The robot-assisted pyeloplasty is superior to the laparoscopic pyeloplasty in controlling the amount of blood loss in the secondary operation. Conclusions: Considering the poorer outcomes of secondary surgery, we believe that special attention should be paid to not missing crossing vessels, and it would be more prudent to perform a more definitive procedure with pyeloplasty instead of endopyelotomy for primary UPJO.
Collapse
Affiliation(s)
- Tianci Du
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Peng Qi
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Liangzhi He
- Department of Pediatric Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Shujun Yang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Biao Zhang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| | - Panfeng Shang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, China
| |
Collapse
|
6
|
Li J, Yang Y, Li Z, Fan S, Wang X, Yang Z, Liu P, Song H, Zhang W. Redo laparoscopic pyeloplasty for recurrent ureteropelvic junction obstruction: Propensity score matched analyses of a high-volume center. Front Pediatr 2022; 10:997196. [PMID: 36160807 PMCID: PMC9497869 DOI: 10.3389/fped.2022.997196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Review the experience of redo laparoscopic pyeloplasty (RLP) in patients with recurrent ureteropelvic junction obstruction (UPJO) in comparison to primary laparoscopic pyeloplasty (PLP) and redo open pyeloplasty (ROP), and determine the feasibility and effectiveness of RLP for recurrent UPJO in children. METHODS We retrospectively reviewed the clinical data of patients treated with transperitoneal PLP, RLP, and ROP for UPJO from December 2015 to December 2022. The Propensity score matching (PSM) was used to balance confounding variables. RLP patients were 1:4 matched with PLP and 1:3 matched with ROP. The primary outcomes were failure and post-operative complications. Complications were classified according to the Clavien-Dindo grading system. RESULTS The study included ten patients who underwent RLP, 43 patients who underwent ROP, and 412 patients who underwent PLP. The follow-up time ranged from 6 to 36 months in the RLP group, 12 to 60 months in the PLP group, and 24 to 54 months in the ROP group. In the RLP group, no failure but three post-operative complications (Clavien grade II) were observed during the follow-up. Compared with the PLP group, the older age, higher weight, larger pre-operative anteroposterior diameter (APD) and APD/cortical thickness (P/C ratio), longer operation time, and post-operative length of stay (LOS) in the RLP group (P < 0.05). After PSM, longer operation time and post-operative LOS were observed in the RLP group (P < 0.05). Compared with the ROP group, the older age, higher weight, and longer post-operative LOS in the RLP group (P < 0.05). After PSM, longer post-operative LOS was observed in the ROP group (P < 0.05). The failure and complication rates were comparable between RLP and PLP or RLP and ROP (P > 0.05). CONCLUSIONS Our result demonstrated that RLP performed as well as PLP except for a longer operation time. Compared with ROP, RLP has the advantages of a clearer surgical view, sufficient exposure, clearer anatomical landmark position, and minor trauma with a comparable clinical outcome. On experienced hands, RLP for recurrent UPJO after is a safe and effective procedure and should be considered an excellent alternative to the more commonly recommended ROP in select patients.
Collapse
Affiliation(s)
- Jiayi Li
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yang Yang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zonghan Li
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Songqiao Fan
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xinyu Wang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zhenzhen Yang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Pei Liu
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hongcheng Song
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Weiping Zhang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
[Advance in re-do pyeloplasty for the management of recurrent ureteropelvic junction obstruction after surgery]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52. [PMID: 32773819 PMCID: PMC7433613 DOI: 10.19723/j.issn.1671-167x.2020.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Ureteropelvic junction obstruction (UPJO) is characterized by decreased flow of urine down the ureter and increased fluid pressure inside the kidney. Open pyeloplasty had been regarded as the standard management of UPJO for a long time. Laparoscopic pyeloplasty reports high success rates, for both retroperitoneal and transperitoneal approaches, which are comparable to those of open pyeloplasty. However, open and laparoscopic pyeloplasty have yielded disappointing failure rates of 2.5%-10%. The main causes for recurrent UPJO are severe peripelvic and periureteric fibrosis due to urinary extravasation, ureteral ischemia, and inadequate hemostasis. In addition, failing to diagnose lower pole crossing vessels before or during the primary procedure is also responsible for recurrent UPJO. In addition, poor preoperative split renal function, hydronephrosis, presence of renal stones, patient age, diabetes, prior endopyelotomy history, and retrograde pyelography history were considered as predictors of pyeloplasty failure. The failure is usually defined by persistent pain, persistent radiographic obstruction (infection or stones), continued decline in split renal function, or a combination of the above. And the failure of pye-loplasty often occurs in the first 2 years after the surgery. The available options for managing recurrent UPJO with a salvageable renal unit include endopyelotomy, re-do pyeloplasty, stent implantation, percutaneous nephrostomy, ureterocalicostomy, and nephrectomy. Re-do pyeloplasty has such merits as high successful rates and rare complications, compared with endopyelotomy or ureterocalicostomy. And some investigators think that re-do pyeloplasty should be regarded as the gold standard for secondary therapy if feasible. Open pyeloplasty can enlarge the operating field, facilitate the exposure of the ureteropelvic junction, reduce the difficulty of operation, and thus reduce the occurrence of complications. There are no significant differences among the success rates of re-do pyeloplasty under open approach, traditional laparoscopy and robot-assisted laparoscopy, according to previous reports. However, traditional laparoscopic and robot-assisted pyeloplasty give advantages of cosmetology, small trauma, less postoperative pain, speedy recovery and shorter hospitalization, fewer complications and lower recurrent rates. If the primary pyeloplasty is an open operation in retroperitoneal approach, the traditional laparoscopic and robotic operation with retroperitoneal approach should be considered for secondary repair. The cause of recurrent UPJO should be evaluated before surgery and identified intraoperatively to minimize the possibility of recurrence.
Collapse
|
8
|
Zhang P, Shi T, Fam X, Gu L, Xuan Y, Yang L, Wang B, Ai X, Jia Z, Li H, Zhang X, Ma X. Robotic-assisted laparoscopic pyeloplasty as management for recurrent ureteropelvic junction obstruction: a comparison study with primary pyeloplasty. Transl Androl Urol 2020; 9:1278-1285. [PMID: 32676411 PMCID: PMC7354308 DOI: 10.21037/tau.2020.03.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background To analyze the perioperative parameters and outcomes of robotic-assisted laparoscopic pyeloplasty (RALP) for recurrent ureteropelvic junction obstruction (UPJO) and compare them with our series of RALP for primary UPJO. Secondary pyeloplasty can be a challenging procedure because of ureteral devascularization, fibrosis and dense stricture formation. Robotic approach could be adjunct to these repairs. Methods Between August 2015 to March 2019, 96 patients in our hospital underwent RALP, with 32 patients as secondary intervention for recurrent UPJO. We compared the perioperative parameters of RALP for both primary UPJO and recurrent UPJO. Patient demographics, perioperative parameters, postoperative outcomes and complications from both groups were analyzed and compared. Results RALP was successfully performed for all cases in both groups. The median operating time was longer for secondary RALP than for primary RALP [125 (108.5–155) vs. 151 (120–190) minutes, P=0.004]. There were no conversions to open surgery or significant perioperative complications. No difference in blood loss, transfusion rate and perioperative complication rates was noted between the two groups. The success rates were 98.44% (63/64) and 96.88% (31/32) at a median follow up of 32 and 20 months (P=0.001) for the primary and secondary groups, respectively. Conclusions Secondary RALP is associated with significantly longer operative time as compared to primary RALP, especially during the exposure of the UPJO, however it is a safe surgical modality for recurrent UPJO with durable outcome. RALP should be an alternative treatment modality for recurrent UPJO whenever the facility and expert are available.
Collapse
Affiliation(s)
- Peng Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Taoping Shi
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Xenginn Fam
- Urology Unit, Department of Surgery, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Yundong Xuan
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Luojia Yang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Baojun Wang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Xing Ai
- Department of Urology, PLA Army General Hospital, Beijing 100853, China
| | - Zhuomin Jia
- Department of Urology, PLA Army General Hospital, Beijing 100853, China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Medical School of Chinese PLA, Beijing 100853, China
| |
Collapse
|
9
|
Farouk A, Tawfick A, Reda M, Saafan AM, Mousa W, Tawfeek AM, Shaker H. Fibrin glue as a sealant in stentless laparoscopic pyeloplasty: A randomised controlled trial. Arab J Urol 2019; 17:228-233. [PMID: 31489240 PMCID: PMC6711147 DOI: 10.1080/2090598x.2019.1611990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 12/05/2022] Open
Abstract
Objective: To evaluate the value of adding fibrin glue, as a sealant material, to the anastomotic line during stentless laparoscopic pyeloplasty (LPP). Patients and methods: In all, 92 patients with pelvi-ureteric junction obstruction (PUJO), scheduled for LPP, were randomised into two groups (46 in each group). Group A, underwent transperitoneal stentless LLP sealed with fibrin glue, whilst Group B underwent the same procedure without fibrin glue. Results: Both groups were similar for patient demographics and presentation. Despite that, we found a significant statistical difference between the groups for operative time and blood loss. The total number of patients that had a urinary leak was 10 and 24 patients, in groups A and B respectively (P = 0.002). A prolonged leak lasting for >5 days, which stopped spontaneously occurred in three patients (7.14%) in Group A and six (14.3%) in Group B (P = 0.265). A persistent 14-day leak that needed intervention developed in two patients (4.3%) in Group A and five (10.9%) in Group B (P = 0.434). One patient in Group B developed urinoma 1 week after discharge, and another patient in the same group developed deep venous thrombosis. There was no significant difference between the groups for postoperative complications in the early 3-month period. The success rate was 39 (92.86%) and 36 patients (85.7%), in groups A and B respectively (P = 0.265). Conclusion: Adding fibrin glue to seal the anastomosis decreased urinary leakage but did not have a significant impact on outcomes. Abbreviations: CONSORT: Consolidated Standards of Reporting Trials; DTPA: diethylene-triamine-penta-acetic acid; LPP: laparoscopic pyeloplasty; PUJO: PUJ obstruction; T½: clearance halftime (renogram)
Collapse
Affiliation(s)
- Ahmed Farouk
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Ahmed Tawfick
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Mahmoud Reda
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Ahmed M Saafan
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Waleed Mousa
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Ahmed M Tawfeek
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Hassan Shaker
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| |
Collapse
|
10
|
Is secondary robotic pyeloplasty safe and effective as primary robotic pyeloplasty? A systematic review and meta-analysis. J Robot Surg 2019; 14:241-248. [PMID: 31280462 DOI: 10.1007/s11701-019-00997-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/02/2019] [Indexed: 12/14/2022]
Abstract
Robot-assisted laparoscopic pyeloplasty (RLP) has excellent surgical safety and efficacy in primary pyeloplasty. In recent, the application of robotics has explored to more complex surgical conditions such as failed pyeloplasty. This meta-analysis aimed to evaluate the surgical and clinical outcomes of secondary RLP compared with primary RLP. Following PRISMA guidelines, we carried out an extensive literature search in the PubMed, Web of Science, Cochrane Library, Scopus, and Google Scholar to extract the published articles comparing primary vs. secondary RLP up to April 2019. Interested surgical and clinical outcomes were extracted from each study and then used RevMan 5.3 Software for meta-analysis comparison. Furthermore, the quality of each study was assessed using the Modified Newcastle-Ottawa Scale for cohort studies. Our search has yielded seven studies that met our inclusion criteria. These studies contained 613 vs. 107 patients in primary vs. secondary RLP, respectively. Using random effect model, the analysis showed no statistical difference between the groups in the presence of a crossing vessel, complications, length of hospital stays (LOS), and follow-up period. However, the operative time, estimated blood loss (EBL), and recurrence rate were significantly higher in the secondary RLP compared with primary RLP (p = 0.004), (p = 0.01), and (p = 0.04), respectively. Our results indicate that secondary RLP is associated with significantly increased operative time and EBL and higher recurrence rates compared with primary RLP. We believe that our findings might help surgeon's decision making in patient selection and consultation during redo pyeloplasty surgical planning.
Collapse
|
11
|
Solano Perdomo LK, Montero Barrera DA, Salgado Tovar JM. ¿Existe un estudio ideal para el seguimiento posoperatorio de los paciente llevados a pieloplastia por laparoscopia? Rev Urol 2017. [DOI: 10.1016/j.uroco.2017.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Hung SC, Chiu KY, Cheng CL, Ou YC, Ho HC, Wang SS, Chen CS, Li JR, Yang CK, Chang LW. Ureteroscopy-Assisted Laparoscopic Segmental Resection of Ureteral Stricture with a Modified Flank Position: Clinical Experience. J Laparoendosc Adv Surg Tech A 2017; 27:691-695. [PMID: 28402160 DOI: 10.1089/lap.2016.0632] [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: 11/12/2022] Open
Abstract
PURPOSE To share the surgical technique that possesses the advantage of a perioperative ureteroscope without position change, which allows for a laparoscopic segmental resection of the ureteral stricture to be performed more precisely. PATIENTS AND METHODS Between 2006 January and 2015 December, 10 patients with a ureteral stricture received a laparoscopic segmental resection and ureteroureterostomy in our clinical institute. The etiology included stone, endometriosis, crossing vessel, and idiopathic benign ureteral polyp. With the advance of bilateral lower extremities extended and abducted, 1 assistant used a ureteroscope as a direct guide to the precise location of the stricture affected ureter. Thus, the surgeon was able to perform a more specific resection without an unnecessary excision, which may have compromised the blood supply or increased the tension at anastomosis. RESULTS Five patients received the traditional transperitoneal laparoscopic approach, whereas the other 5 patients received a ureteroscopy-assisted laparoscopic segmental resection and ureteroureterostomy. The operating time appears to be no different between the two groups (124 minutes versus 142 minutes, P = .351), and, thus, no additional time is consumed for the ureteroscope procedure. After at least 1 year of follow-up, only 1 patient in the traditional laparoscopic group suffered from recurrence. One patient had a right ureteral stricture due to stone impaction, where with the advantage of a ureteroscope guide without change position, the operator was able to make a limited excision at the affected location. No complications related to the decubitus and bilateral leg in the extended position were noted. CONCLUSIONS Ureteroscopy-assisted laparoscopic segmental resection of the ureter without a change in position is a feasible and safe procedure when dealing with a refractory ureter stricture. Although it is convenient, the surgeon should be aware of possible pressure sores at the dependent part.
Collapse
Affiliation(s)
- Sheng-Chun Hung
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Kun-Yuan Chiu
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Chen-Li Cheng
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Yen-Chuan Ou
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan .,2 Department of Research, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Hao-Chung Ho
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Shian-Shiang Wang
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Chuan-Shu Chen
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Jian-Ri Li
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Chun-Kuang Yang
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| | - Li-Wen Chang
- 1 Division of Urology, Department of Surgery, Taichung Veterans General Hospital , Taichung, Taiwan
| |
Collapse
|
13
|
A modified technique of paraumbilical three-port laparoscopic dismembered pyeloplasty for infants and children. Pediatr Surg Int 2016; 32:1037-1045. [PMID: 27567622 DOI: 10.1007/s00383-016-3958-2] [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] [Accepted: 08/22/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Common causes of complications of laparoscopic pyeloplasty in children include anastomotic stricture, poor drainage due to high ureteropelvic anastomosis, and torsion of ureter. Herewith, we described our modified technique of paraumbilical three-port laparoscopic dismembered pyeloplasty (PTLDP) to minimize these complications. PATIENTS AND METHODS Data from 62 patients (age: 1-180 months, median: 12 months) with ureteropelvic junction obstruction (UPJO) who underwent pyeloplasty using our modified technique of PTLDP between February 2014 and September 2014 at our institution were reviewed. The key steps of our modified method involve identifying the lowest point of the renal pelvis and the lateral aspect of the ureter to guarantee a low pelviureteric and correct orientation anastomosis, and using a 4-0 silk for assistant suturing to avoid crushing of the anastomotic tissue. RESULTS All surgeries were successfully completed without conversion. Three patients required an accessory port for the anastomosis. All the patients achieved complete clinical or radiologic resolution after the operation. The mean operative time was 103.4 min, and mean estimated blood loss was 14.4 mL. Mean postoperative differential function of affected kidney was 43.0 ± 16.3 % (range 24-100 %), increased from 39.7 ± 18.0 % (range 18-100 %), preoperatively (p < 0.001). The success rate was 100 % at a mean follow-up of 18.3 ± 2.9 (range 13-25) months. CONCLUSIONS Our modified technique of PTLDP is safe and feasible and to allow high success rate for the treatment of pelviureteric junction obstruction in children.
Collapse
|
14
|
|