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Gorgen ARH, Abreu FJDS, Paludo ADO, Menegolla MP, de Oliveira RT, Tavares PM, Rosito TE. Laparoscopic pyeloplasty proficiency during a residency program after adoption of a standardized simulation training program is maintained during the COVID pandemic despite reduced surgery volume. Int Braz J Urol 2023; 49:462-468. [PMID: 37267611 PMCID: PMC10482452 DOI: 10.1590/s1677-5538.ibju.2023.0021] [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] [Received: 01/16/2023] [Accepted: 05/05/2023] [Indexed: 06/04/2023] Open
Abstract
PURPOSE To evaluate the effect of the standardized laparoscopic simulation training program in pyeloplasty, following its implementation and during the COVID-19 pandemic. MATERIAL AND METHODS A retrospective chart review was performed at Hospital de Clínicas de Porto Alegre, a tertiary referral center in south Brazil, in which 151 patients underwent laparoscopic pyeloplasty performed by residents between 2006-2021. They were divided into three groups: before and after adoption of a standardized laparoscopic simulation training program and during the COVID-19 pandemic. The main outcome was a combined negative outcome of conversion to open surgery, major postoperative complications (Clavien-Dindo III or higher) or unsuccessful procedure, defined as need for redo pyeloplasty. RESULTS There was a significant reduction in the combined negative outcome (21.1% vs 6.3%), surgical time (mean 200.0 min vs 177.4 min) and length of stay (median 5 days vs 3 days) after the adoption of simulation training program. These results were maintained during the COVID-19 pandemic (combined negative outcome of 6.3%, mean surgical time of 160.1 min and median length of stay of 3 days) despite a reduction in 55.4% of the surgical volume. CONCLUSION A structured laparoscopic simulation program can improve outcomes of laparoscopic pyeloplasty during the learning curve.
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Affiliation(s)
- Antonio Rebello Horta Gorgen
- Hospital de Clínicas de Porto AlegreServiço de Urologia de UrologiaPorto AlegreRSBrasilServiço de Urologia de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- University of CaliforniaDepartment of UrologyIrvineCAUSADepartment of Urology, University of California Irvine, CA, USA;
- Universidade Federal do Rio Grande do Sul - UFRSPrograma de Pós-Graduação em Ginecologia e ObstetríciaPorto AlegreRSBrasilPrograma de Pós-Graduação em Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul - UFRS, Porto Alegre, RS, Brasil;
| | - Fernando Jahn da Silva Abreu
- Hospital de Clínicas de Porto AlegreServiço de Urologia de UrologiaPorto AlegreRSBrasilServiço de Urologia de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- Universidade Federal do Rio Grande do Sul - UFRSPrograma de Pós-Graduação em Ginecologia e ObstetríciaPorto AlegreRSBrasilPrograma de Pós-Graduação em Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul - UFRS, Porto Alegre, RS, Brasil;
| | - Artur de Oliveira Paludo
- Hospital de Clínicas de Porto AlegreServiço de Urologia de UrologiaPorto AlegreRSBrasilServiço de Urologia de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Mauricio Picolo Menegolla
- Hospital de Clínicas de Porto AlegreServiço de Cirurgia GeralPorto AlegreRSBrasilServiço de Cirurgia Geral, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil;
| | - Renan Timóteo de Oliveira
- Hospital de Clínicas de Porto AlegreServiço de Urologia de UrologiaPorto AlegreRSBrasilServiço de Urologia de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- Universidade Federal do Rio Grande do Sul - UFRSPrograma de Pós-Graduação em Ginecologia e ObstetríciaPorto AlegreRSBrasilPrograma de Pós-Graduação em Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul - UFRS, Porto Alegre, RS, Brasil;
| | - Patric Machado Tavares
- Hospital de Clínicas de Porto AlegreServiço de Urologia de UrologiaPorto AlegreRSBrasilServiço de Urologia de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Tiago Elias Rosito
- Hospital de Clínicas de Porto AlegreServiço de Urologia de UrologiaPorto AlegreRSBrasilServiço de Urologia de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- Universidade Federal do Rio Grande do Sul - UFRSPrograma de Pós-Graduação em Ginecologia e ObstetríciaPorto AlegreRSBrasilPrograma de Pós-Graduação em Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul - UFRS, Porto Alegre, RS, Brasil;
- Universidade Federal do Rio Grande do SulFaculdade de MedicinaPorto AlegreRSBrasilFaculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Srougi V, Bandeira RASDT, Reis ST, dos Santos GA, Andrade HDS, Leite KRM, Hamilton-Cho D, Mitre AI, Arap MA, Srougi M, Duarte RJ. The influence of interstitial cells of Cajal density in the outcomes of pyeloplasty in adults: A prospective analysis. Urologia 2022; 90:30-35. [PMID: 35765765 DOI: 10.1177/03915603221107470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To evaluate if the density of interstitial cells of Cajal (ICC) in the ureteropelvic junction (UPJ) influences the outcomes of pyeloplasty in adults. Methods: Twenty-three patients with the diagnosis of ureteropelvic junction obstruction (UPJO) that underwent laparoscopic dismembered pyeloplasty were included. ICC density was measured using immunohistochemistry reaction for c-KIT expression in the resected UPJ segment. Pyeloplasty outcome was evaluated by patient self-report pain, urinary outflow using DTPA renogram and hydronephrosis assessment using ultrasound (US) at 12 months of follow-up. A logistic regression analysis was performed to assess the association of pyeloplasty outcomes and ICC density. Results: Low, moderate, and high ICC density were present in 17.4%, 30.4%, and 52.2% of the patients, respectively. Complete pain resolution was observed in 100%, 85.7%, and 75% of patients with low, moderate and high ICC density, respectively ( p = 0.791). DTPA renogram improved in 75%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively ( p = 0.739). Hydronephrosis improved in 25%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively ( p = 0.032). Conclusions: Patients with high ICC density have a significant amelioration of hydronephrosis after pyeloplasty. However, ICC density is not associated with functional outcomes.
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Affiliation(s)
- Victor Srougi
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Hospital Moriah, Sao Paulo, Brazil
| | | | - Sabrina Thalita Reis
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Minas Gerais State University (UEMG), Campos Passos, Brazil
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gabriel Arantes dos Santos
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- D’Or Institute for Research and Education (IDOR), Sao Paulo, Brazil
| | | | - Katia Ramos Moreira Leite
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - David Hamilton-Cho
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Anuar Ibrahim Mitre
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marco Antonio Arap
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Hospital Sirio Libanes, Sao Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Laboratory of Medical Investigation (LIM55), Urology Department, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- D’Or Institute for Research and Education (IDOR), Sao Paulo, Brazil
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Freitas PFS, Barbosa JABA, Cho DH, Boffa ABM, Andrade HS, Arap MA, Duarte RJ, Nahas WC, Srougi M, Srougi V. Short-term outcomes of pyeloplasty vs. nephrectomy in adult patients with ureteropelvic junction obstruction and differential renal function ≤15. Scand J Urol 2021; 55:192-196. [PMID: 33525931 DOI: 10.1080/21681805.2021.1879929] [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: 10/22/2022]
Abstract
OBJECTIVES To compare symptom resolution and short-term renal function after pyeloplasty or nephrectomy in adults with ureteropelvic junction obstruction (UPJO) in poorly functioning renal units (PFRU). METHODS Retrospective analysis of adult patients with UPJO and differential renal function (DRF) ≤ 15% who underwent laparoscopic pyeloplasty or nephrectomy. Primary endpoints included symptom resolution and estimated glomerular filtration rate (eGFR) at 12 months. Surgical complications were compared between groups. A secondary analysis was performed comparing baseline and postoperative DRF to evaluate the PFRU recovery potential after pyeloplasty. RESULTS Sixty-three patients were included; 19 underwent pyeloplasty and 44 underwent nephrectomy. The mean age of the cohort was 39.5 ± 13.8 years. Nephrectomy was associated with significantly higher intra-operative blood loss (p = 0.02). Operative time and length of hospital stay were not significantly different between groups. There were three complications in the nephrectomy group, and none in the pyeloplasty group (p = 0.34). Symptom resolution rates were equivalent between groups (73% vs. 76%; p = 0.78). The eGFR variation was not statistically different after pyeloplasty or nephrectomy (+6.2 vs. +0.1 mL/min/1.73m2, respectively; p = 0.18). Patients undergoing pyeloplasty had no significant change in the mean DRF (baseline 9.5 vs. 10%; p = 0.99). CONCLUSION Pyeloplasty can be considered for selected patients with UPJO in PFRU as an organ-sparing alternative to nephrectomy. Although there was no significant gain in mean DRF, pyeloplasty prevented further functional loss and relieved symptoms in most cases in the short-term with at least the same complication rates of nephrectomy.
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Affiliation(s)
- Pedro F S Freitas
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - João A B A Barbosa
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - David H Cho
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Ana B M Boffa
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Hiury S Andrade
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Marco A Arap
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Ricardo J Duarte
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - William C Nahas
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Victor Srougi
- Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.,Hospital Moriah, São Paulo, Brazil
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Nascimento B, Andrade HS, Miranda EP, Barbosa JABA, Moscardi PR, Arap MA, Mitre AI, Srougi M, Srougi V, Duarte RJ. Laparoscopic pyeloplasty as an alternative to nephrectomy in adults with poorly functioning kidneys due to ureteropelvic junction obstruction. Int Urol Nephrol 2020; 53:269-273. [PMID: 32862329 DOI: 10.1007/s11255-020-02626-4] [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: 06/23/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate outcomes of laparoscopic pyeloplasty (LP) in adults with poorly functioning kidney due to ureteropelvic junction obstruction (UPJO). METHODS A retrospective comparative analysis was performed between adult patients who underwent LP due to UPJO with differential renal function (DRF) ≤ 15% and DRF > 15%. LP success rate and complications were assessed. LP success was defined as symptoms improvement and DRF improvement or stabilization. DRF and estimated glomerular filtration rate (eGFR) were analyzed before and 12 months after surgery to evaluate renal function recovery. DRF was estimated using Tc-99 m DMSA renal scintigraphy. RESULTS Among 121 LP performed in the study period at our institution, 15 and 42 were included in the DRF ≤ 15% and DRF > 15% groups, respectively. At a median follow-up of 17.8 months, all patients with DRF ≤ 15% reported symptoms improvement. LP success rate was 86.7% and 90.5% (p = 0.65) for patients with DRF ≤ 15% and DRF > 15%, respectively. There were no complications in the DRF ≤ 15% group, while there were three complications recorded in the DRF > 15% group (Clavien 2 and 3b). In the DRF ≤ 15% group, mean pre-operative and post-operative DRF was 9.5% ± 3.6 and 10.5% ± 7.8 (p = 0.49), respectively. Median pre-operative and post-operative eGFR was 68.5 ml/min and 79.8 ml/min (p = 0.93), respectively. Two patients had DRF improvement after LP. CONCLUSIONS LP in adult patients with UPJO and poor function kidneys is an effective and safe procedure. DRF recovery is seen in a minority of the patients; however, LP is an alternative to nephrectomy.
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Affiliation(s)
- Bruno Nascimento
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil
| | - Hiury S Andrade
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil
| | - Eduardo P Miranda
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil
| | - João Arthur Brunhara Alves Barbosa
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil. .,Hospital Israelita Albert Einstein, Av Albert Einstein 627, Sao Paulo, SP, 04652-900, Brazil.
| | - Paulo R Moscardi
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil
| | - Marco A Arap
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil.,Hospital Sirio Libanês, Rua Barata Ribeiro 387, Sao Paulo, SP, 01308-050, Brazil
| | - Anuar I Mitre
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil.,Hospital Sirio Libanês, Rua Barata Ribeiro 387, Sao Paulo, SP, 01308-050, Brazil
| | - Miguel Srougi
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil
| | - Victor Srougi
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil.,Hospital Moriah. Av. Moaci, 974, Sao Paulo, SP, 04083-002, Brazil
| | - Ricardo J Duarte
- Division of Urology, University of Sao Paulo Medical School, Av Dr. Eneas de Carvalho Aguiar, 255,, Sao Paulo, SP, 05403000, Brazil
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Molina CAF, Bessa Junior J, Estevanato AG, Viana GS, Facincani I, Netto JMB, Tucci Junior S. Applicability of Laparoscopic Nephrectomy in the Treatment of Multicystic Dysplastic Kidney: Sorting Out Surgical Indication. Cureus 2018. [PMID: 29515943 PMCID: PMC5832395 DOI: 10.7759/cureus.2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction We evaluated the applicability of laparoscopic nephrectomy in the treatment of multicystic dysplastic kidney (MCDK) in children, including procedures performed by resident physicians or trainees in surgical urology. Methods We retrospectively evaluated the medical records of 20 children with MCDK who underwent laparoscopic nephrectomy over a six-year period. Data collected included gender, laterality of the affected kidney, age at the time of surgery, the largest diameter of the multicystic kidney and associated urological diagnoses, surgical, and postoperative data. All surgical procedures were performed transperitoneally. Results The mean age at the time of surgery was 46 months with a slight predominance of girls. The right side was the more affected side, and the average diameter of the affected kidney at the time of surgical excision was 5.8 cm. Other changes in the urinary tract were found in five children. The mean operative time was 133 minutes. On pathological examination, on average, the pieces measured 4.8 cm and weighed 18.1 g. There were no operative complications. The average length of hospital stay was 37.35 hours. Conclusion Laparoscopic nephrectomy was confirmed as an applicable treatment for MCDK. The technique was easy to perform, safe and efficient, even when performed by trainees in pediatric urology.
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Affiliation(s)
- Carlos Augusto F Molina
- Division of Urology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of University of São Paulo (fmrp-Usp)
| | - Jose Bessa Junior
- Division of Urology, Department of Surgery, Universidade Estadual De Feira De Santana - UEFS
| | - Andrey G Estevanato
- Division of Urology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of University of São Paulo (fmrp-Ùsp)
| | - Gustavo S Viana
- Division of Urology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of University of São Paulo (fmrp-Usp)
| | - Inalda Facincani
- Division of Pediatric Nephrology, Department of Pediatrics and Childcare, Ribeirão Preto Medical School of University of São Paulo (fmrp-Usp)
| | - Jose Murillo Bastos Netto
- Division of Urology, Department of Surgery, Federal University of Juiz De Fora (ufjf)and Hospital E Maternidade Therezinha De Jesus of the School of Medical Sciences and Health of Juiz De Fora (hmtj/suprema)
| | - Silvio Tucci Junior
- Division of Urology, Department of Surgery and Anatomy, Ribeirão Preto Medical School of University of São Paulo (fmrp-Usp)
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Gite VA, Siddiqui AKN, Bote SM, Patil SR, Kandi AJ, Nikose JV. Ureterocalycostomy - final resort in the management of secondary pelvi-ureteric junction obstruction: our experience. Int Braz J Urol 2016; 42:501-6. [PMID: 27286113 PMCID: PMC4920567 DOI: 10.1590/s1677-5538.ibju.2015.0368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 10/15/2015] [Indexed: 11/21/2022] Open
Abstract
Ureterocalycostomy can be performed in patients in whom desired methods of treating secondary PUJ (Pelvi-Ureteric Junction) obstructions either failed or could not be used. In our study, one child and two adults in whom one redo-ureterocalycostomy and two ureterocalycostomies were performed for severely scarred PUJ. The causes for secondary PUJ obstruction were post-pyelolithotomy in one case, post-pyeloplasty and ureterocalycostomy for PUJ obstruction in the second patient and the third patient had long upper ureteric stricture post-ureteropyeloplasty due to tuberculosis. In all these cases ureterocalycostomy proved to be salvage/final resort for preserving functional renal unit.
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Affiliation(s)
- Venkat A Gite
- Department of Urology, Grant Govt. Medical College & Sir J.J. Group of Hospitals, Mumbai -Mumbai, India
| | - Ayub Karam Nabi Siddiqui
- Department of Urology, Grant Govt. Medical College & Sir J.J. Group of Hospitals, Mumbai -Mumbai, India
| | - Sachin M Bote
- Department of Urology, Grant Govt. Medical College & Sir J.J. Group of Hospitals, Mumbai -Mumbai, India
| | - Saurabh Ramesh Patil
- Department of Urology, Grant Govt. Medical College & Sir J.J. Group of Hospitals, Mumbai -Mumbai, India
| | - Anita J Kandi
- Department of Surgery, GMC Aurangabad - Aurangabad, India
| | - Jayant V Nikose
- Department of Urology, Grant Govt. Medical College & Sir J.J. Group of Hospitals, Mumbai -Mumbai, India
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Laparoscopic ureterocalicostomy for complicated upper urinary tract obstruction: mid-term follow-up. Int Urol Nephrol 2013; 46:865-9. [PMID: 24217801 DOI: 10.1007/s11255-013-0591-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To report on the largest series of laparoscopic ureterocalicostomies done for complicated upper urinary obstruction. METHODS We retrospectively reviewed the data from 6 transperitoneal laparoscopic ureterocalicostomies performed in our institution from January 2008 to January 2012. Symptomatic complicated upper urinary obstruction was the main reason for all the procedures. The recorded data included age, gender, clinical presentation, duration of symptoms, laterality, mean operative time, hospital stay, complications and clinical and functional outcomes. RESULTS The median patient age was 20.1 (2-44) years, and all patients were females. Patients underwent laparoscopic ureterocalicostomy due to previous failed procedures (3 patients), anatomic abnormalities (2 patients) and a severe upper ureteral stenosis (1 patient). The median operative time was 215 (180-270) min. There were no major complications. There were no conversions to open surgery. In a median follow-up of 30 (8-56) months, all patients presented with clinical and radiological improvement with no signs of obstruction. In all cases, the postoperative renal scintigraphy revealed a T1/2 lower than 10 min. CONCLUSION Laparoscopic ureterocalicostomy is feasible and associated with high success rate in well-selected cases with complicated upper urinary obstructions.
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