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Zuo W, Li X, Tao Z, Li Z, Yang K, Tang Q, Zhu H, Zhang P, Wang B, Gu Y, Diao Y, Zhou L, Li X. Preoperative double J stent indwelling contributes to recurrent stricture in patients after ureteral reconstruction surgery. Minerva Urol Nephrol 2024; 76:249-252. [PMID: 38421338 DOI: 10.23736/s2724-6051.24.05761-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Wei Zuo
- Department of Urology, Institute of Urology, Peking University First Hospital, National Urological Cancer Center, Peking University, Beijing, China
| | - Xinfei Li
- Department of Urology, Institute of Urology, Peking University First Hospital, National Urological Cancer Center, Peking University, Beijing, China
| | - Zihao Tao
- Department of Urology, Institute of Urology, Peking University First Hospital, National Urological Cancer Center, Peking University, Beijing, China
| | - Zhihua Li
- Department of Urology, Institute of Urology, Peking University First Hospital, National Urological Cancer Center, Peking University, Beijing, China
| | - Kunlin Yang
- Department of Urology, Institute of Urology, Peking University First Hospital, National Urological Cancer Center, Peking University, Beijing, China
| | - Qi Tang
- Department of Urology, Institute of Urology, Peking University First Hospital, National Urological Cancer Center, Peking University, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Bing Wang
- Department of Urology, The Capital Medical University Mi Yun Teaching Hospital, Beijing, China
| | - Yaming Gu
- Department of Urology, The Capital Medical University Mi Yun Teaching Hospital, Beijing, China
| | - Yingzhi Diao
- Department of Urology, The Capital Medical University Mi Yun Teaching Hospital, Beijing, China
| | - Liqun Zhou
- Department of Urology, Institute of Urology, Peking University First Hospital, National Urological Cancer Center, Peking University, Beijing, China
| | - Xuesong Li
- Department of Urology, Institute of Urology, Peking University First Hospital, National Urological Cancer Center, Peking University, Beijing, China -
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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.
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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
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Han C, Ma L, Li P, Wang J, Zhou X, Tao T, Cao H, Tao Y, Yang Y, Zhao Y, Zhu W, Guo T, Lyu X, Zhuo R, Zhou H. Modified robotic-assisted laparoscopic pyeloplasty in children for ureteropelvic junction obstruction with long proximal ureteral stricture: The "double-flap" technique. Front Pediatr 2022; 10:964147. [PMID: 36313892 PMCID: PMC9614221 DOI: 10.3389/fped.2022.964147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this study is to introduce a novel technique of robotic-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction obstruction (UPJO) with long proximal ureteral stricture in children. MATERIALS AND METHODS Clinical information on patients who underwent a modified RALP between July 2018 and May 2019 in our center was collected retrospectively. Our surgical modifications mainly include "double-flap" tailoring of the renal pelvis and anastomosis of spatulate ureter with the double-flap. Demographic, perioperative, postoperative, and follow-up information was recorded in detail. RESULTS A total of 13 patients were included in the study. All the patients underwent a modified RALP without conversion to open surgery. They were followed up with a median time of 36 months. The anteroposterior diameter of the renal pelvis was 1.19 ± 0.21 at 6 months after the surgery, which was significantly lower than that on admission (3.93 ± 0.79). The split renal function of the children was also significantly improved from 0.37 ± 0.05) to 0.46 ± 0.02 at 6 months after surgery (p < 0.05). The diuretic renography revealed that all the patients have a T1/2 time less than 20 min postoperatively. The children were in good condition during the follow-up period. CONCLUSIONS Modified RALP is an effective surgical treatment for children with UPJO with long proximal ureteral stricture. The success rate of this modification has been preliminarily confirmed.
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Affiliation(s)
- Ce Han
- Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Lifei Ma
- Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Pin Li
- Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Jia'nan Wang
- Surgical Intensive Care Unit, The Second Medical Center of PLA General Hospital, Beijing, China
| | - Xiaoguang Zhou
- Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Tian Tao
- Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Hualin Cao
- Department of Urology, Nanxi Shan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Yuandong Tao
- Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Yunjie Yang
- Department of Urology, Southern Medical University Affiliated Nanhai Hospital, Foshan, China
| | - Yang Zhao
- Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Weiwei Zhu
- Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Tao Guo
- Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Xuexue Lyu
- Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Ran Zhuo
- Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Huixia Zhou
- Department of Pediatric Urology, Department of Senior Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatric Urology, Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital, Beijing, China
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Wu G, Li H, Zhong P, Chen D, Zhang Z, Guo Z, Zhuo Y, Xue L, Lai C. Initial Experience with the Comprehensive Modified Laparoscopic Pyeloplasty Technique Based on Membrane Anatomy for Treating Ureteropelvic Junction Obstruction. Urol Int 2021; 106:487-494. [PMID: 34844250 DOI: 10.1159/000519929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the objective was to present our initial experience and evaluate the feasibility of the novel comprehensive modified laparoscopic pyeloplasty (CMLP) technique based on membrane anatomy. MATERIALS AND METHODS Forty-eight patients underwent CMLP from February 2016 to October 2020. CMLP involves the following: dissection of the ureter was based on the fascia or fusion fascia formed by embryonic development. The ureter was separated from the ureteral sheath, and the pelvis and ureter were incised with incomplete amputation. The first stitch was placed between the lower point of the spatulated ureter and the lowest corner of the renal pelvis to ensure correct orientation of the anastomosis; anastomosis of the renal pelvis and ureter was performed using the touchless technique. RESULTS All CMLPs were completed successfully without conversion. The mean overall operating time was 230.96 min. The median estimated blood loss was 50.00 (interquartile range 20.00-57.50) mL. The average postoperative hospital stay was 9.31 days. The average follow-up time was 24.73 months. No major complications occurred. In 1 case, revision laparoscopic pyeloplasty was performed, but the obstruction persisted after double J stent removal, so ultimately, the double J stent required regular replacement. Another asymptomatic patient with hydronephrosis experienced failed treatment and is still under follow-up. The overall success rate was 95.83% (46/48). The success rate in patients with recurrent ureteropelvic junction obstruction (UPJO) was 87.5% (7/8). CONCLUSIONS CMLP is a practical and effective treatment option for UPJO with a high success rate. An advantage of CMLP is the clear surgical field.
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Affiliation(s)
- Guohao Wu
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, Dongguan, China,
| | - Haomin Li
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Peifeng Zhong
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Dongjiang Chen
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhihua Zhang
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zexiong Guo
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yumin Zhuo
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lianfang Xue
- Department of Pharmacy, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Caiyong Lai
- Department of Urology, The Sixth Affiliated Hospital of Jinan University, Dongguan, China.,Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Zhu W, Zhu Z, Li Z, Li X, Zhang J, Xu Y, Wang X, Zhang P, Huang B, Huang C, Zhang D, Zhu H, Li X, Lin J, Zhou L. A ureteral stricture disease score and classification system: correlation with upper urinary tract reconstructive surgery complexity. Transl Androl Urol 2021; 10:3745-3755. [PMID: 34804818 PMCID: PMC8575562 DOI: 10.21037/tau-21-575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/02/2021] [Indexed: 11/15/2022] Open
Abstract
Background To develop an original and standardized ureteral stricture disease (USD) score and classification system for quantifying ureter stricture characteristics, assessing complexity of the minimally invasive upper urinary tract reconstructive (UUTR) surgical procedure, formulating preoperative plans, and offering objective comparisons of surgical techniques between different institutions and surgeons. Methods We retrospectively reviewed a test set of 64 patients and a validation set of 170 patients who underwent minimally invasive UUTR surgery from January 2018 to January 2021. Three factors were selected to be included in the USD score and classification system: (I) stricture etiology (E, 1–2 points); (II) stricture segment (S, 0–3 points); and (III) length of stricture (L, 1–5 points). The UUTR surgery involves low-complex surgeries (cystoscopy with ureteral dilation and stent placement, ureteropyeloplasty, end to end repair, ureteral reimplantation) and high-complex surgeries (onlay repair (buccal mucosae, lingual mucosae, appendix mucosae), Boari flap repair and ileal ureter replacement). Estimated blood loss and operative time were used as surrogate indicators of surgical complexity. Results The interrater reliability of the USD score and classification system was 0.908. A linear relationship between the USD score and estimated blood loss was observed (rs =0.676, P<0.001). The USD score was also correlated with operative time (rs =0.638, P<0.001). A significant difference in USD scores was found between the high and low complexity surgery groups (4 vs. 7, P<0.001). Variability of UUTR surgery is based on USD classification system, but with regularity to conform to. Conclusions The USD score and classification system is a concise, easily applicable, and validated scale to delineate the clinically significant features of ureter stricture that correlate with the complexity of the UUTR surgical procedure. The use of this score and classification system can facilitate preoperative plan and comparison of USD treatments in clinical practice and urological literature. Research with large sample is needed to further examine and modify the use of the system.
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Affiliation(s)
- Weijie Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Zhenpeng Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Jianye Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Yangyang Xu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Xiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Bingwei Huang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Chen Huang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Dengxiang Zhang
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Jian Lin
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
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Tokat E, Gurocak S, Akdemir O, Gonul II, Tan MO. Relation between Cajal Cell Density and Radiological and Scintigraphic Outcomes in Patients with Ureteropelvic Junction Obstruction. Urol Int 2021; 105:1046-1051. [PMID: 34218231 DOI: 10.1159/000516675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In this study, we aimed to investigate the correlation between Cajal cell density and preoperative and postoperative radiological and scintigraphic parameters in ureteropelvic junction obstruction (UPJO). METHODS The study group consisted of 41 renal units (38 consecutive patients; 13 female and 25 male) surgically treated for UPJO. UPJ specimens from patients were immuno-stained with CD117 (c-kit) antibody for interstitial Cajal cells (ICCs). The relation between Cajal cell density and preoperative and postoperative radiological and scintigraphic parameters was evaluated. RESULTS The mean age of the patients was 8.52 ± 8.86 (0-35) years. The density of Cajal cells was defined in 2 groups for convenient analysis as 0-5 cells (low) in 19 (46.3%) patients and >5 cells (moderate-high) in 22 (53.6%). There was significant difference between the preoperative and postoperative anteroposterior diameters of the related kidneys in both Cajal groups (p = 0.001-low, p = 0.000-moderate-high) independent of Cajal cell density. Regression in hydronephrosis postoperatively was determined in both Cajal groups (77.8%-low, 64.7%-moderate-high); however, there was no difference between them (p = 0.39). Preoperative T1/2 was significantly longer in the low Cajal group (p = 0.02). Postoperative T1/2 decreased in both low (p = 0.000) and moderate-high (p = 0.001) Cajal groups, but no difference was found between them (p = 0.24). There was significant improvement in the kidney differential function after surgery in the low Cajal density group (p = 0.015) while there was no correlation between the scintigraphic success or improvement and Cajal cell density (p = 0.51). DISCUSSION/CONCLUSION ICC deficiency/density could not be shown as a predictive factor for the determination of success rate of pyeloplasty. Despite the lack of any evidence for the degree of deficiency as an indicator for the severity of obstruction and prediction of surgical success, further studies are needed for confirmation.
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Affiliation(s)
- Eda Tokat
- Department of Urology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Serhat Gurocak
- Department of Urology, Section of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Ozgur Akdemir
- Department of Nuclear Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Ipek Isik Gonul
- Department of Pathology, Gazi University School of Medicine, Ankara, Turkey
| | - Mustafa Ozgur Tan
- Department of Urology, Section of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey
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