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Khazali S, Nair R, Nisar P, Bachi A, Adamczyk M. Robotic Assisted En-Bloc Removal of Kidney, Ureter and Bladder Wall for Endometriosis. J Minim Invasive Gynecol 2024; 31:368. [PMID: 38360392 DOI: 10.1016/j.jmig.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/22/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
STUDY OBJECTIVE To highlight a case where a nephroureterectomy and partial bladder cystectomy needed to be done due to endometriosis. DESIGN A video article demonstrating a case study and the surgical management. SETTING Ureteral endometriosis is a complex form of endometriosis [1]. If left untreated, the ureter can become significantly compressed leading to hydroureter, hydronephrosis and complete loss of kidney function [2]. INTERVENTIONS This is a case of a 29-year-old patient with pelvic pain and cyclical rectal bleeding. Further investigation showed significant left hydronephrosis and almost complete loss of left kidney function (8% on renogram). MRI revealed endometriosis involving the posterior bladder wall and distal left ureter, a large full-thickness sigmoid nodule and a large left endometrioma. The patient underwent a robotic-assisted left nephroureterectomy, partial cystectomy (bladder), excision of pelvic endometriosis and sigmoid resection. This procedure was performed jointly with the gynecologist, urologist, and colorectal surgeon and the SOSURE technique was employed [3]. The specimen (left kidney, whole length of ureter and bladder wall around ureteric orifice) was removed en-bloc through a small 3cm extension of the umbilical incision. As the distance between the sigmoid nodule and the anal verge was 35cm, which was above the limit of the transanal circular stapler, a limited resection was performed over a discoid excision. The patient made a good recovery postoperatively. CONCLUSION Ureteral endometriosis is an indolent and aggressive condition which can lead to silent kidney loss. It is essential that hydronephrosis and hydroureter is ruled out in cases with deep endometriosis. Isolated hydronephrosis should also prompt a suspicion for endometriosis.
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Affiliation(s)
- Shaheen Khazali
- Centre for Endometriosis and Minimally Invasive Gynaecology, HCA The Lister Hospital, Chelsea Bridge Road (Drs. Khazali, Nisar, Bachi, and Adamczyk), London, United Kingdom
| | - Rajesh Nair
- Guys and St Thomas NHS Foundation Trust, Great Maze Pond (Dr. Nair), London, United Kingdom
| | - Pasha Nisar
- Centre for Endometriosis and Minimally Invasive Gynaecology, HCA The Lister Hospital, Chelsea Bridge Road (Drs. Khazali, Nisar, Bachi, and Adamczyk), London, United Kingdom
| | - Averyl Bachi
- Centre for Endometriosis and Minimally Invasive Gynaecology, HCA The Lister Hospital, Chelsea Bridge Road (Drs. Khazali, Nisar, Bachi, and Adamczyk), London, United Kingdom.
| | - Michael Adamczyk
- Centre for Endometriosis and Minimally Invasive Gynaecology, HCA The Lister Hospital, Chelsea Bridge Road (Drs. Khazali, Nisar, Bachi, and Adamczyk), London, United Kingdom
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Haberal HB, Tonyali S. Factors predicting the need for surgical intervention for hydronephrosis during pregnancy: a systematic review of the literature. Arch Gynecol Obstet 2024; 309:1801-1806. [PMID: 38413423 DOI: 10.1007/s00404-024-07391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Symptomatic hydronephrosis in pregnancy can cause both maternal and obstetric complications. In various studies, factors predicting the need for surgical intervention have been evaluated, however these factors have not been systematically assessed yet. This systematic review analyzes published studies about hydronephrosis during pregnancy and determines the predictive factors for the need for surgical intervention for hydronephrosis during pregnancy. MATERIALS AND METHODS A systematic review was conducted in January 2023 using the Medline, Web of Science and ScienceDirect/Scopus databases according to PRISMA guidelines. We searched these databases with the following search strategy: (intervention OR nephrostomy OR stent insertion) AND (pregnancy hydronephrosis). RESULTS The literature review revealed 2461 potentially eligible studies. After the screening, six studies were enrolled in this review. High neutrophil-to-lymphocyte ratio, high C-reactive protein level, high white blood cell count, high creatinine levels, fever, persistent pain for more than 4 days, presence of ureteral stones more than 8 mm, high grade hydronephrosis, high fetal body weight and high delta resistive index were reported to be related with the need for surgical intervention. CONCLUSION The rate of symptomatic hydronephrosis and requirement for surgical intervention is low during pregnancy. However, as symptomatic hydronephrosis may cause serious obstetric complications, it is important to know the parameters that can predict patients who may need surgical intervention. These results will assist gynecologists and urologists to stratify pregnant women for surgical intervention.
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Affiliation(s)
- Hakan Bahadir Haberal
- Department of Urology, Ankara Ataturk Sanatoryum Training and Research Hospital, Ministry of Health, University of Health Sciences, 06290, Ankara, Turkey.
| | - Senol Tonyali
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Morizawa Y, Aoki K, Fukui S, Tomizawa M, Shimizu T, Onishi K, Hori S, Gotoh D, Nakai Y, Miyake M, Torimoto K, Fujimoto K, Otani T, Fujimoto K. Long-term follow-up of congenital hydronephrosis in a single-center study. Int J Urol 2024; 31:507-511. [PMID: 38205874 DOI: 10.1111/iju.15391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES Many congenital hydronephroses spontaneously resolve. This study evaluated a long-term follow-up of more than 4 years of patients with congenital hydronephrosis at a single center. METHODS In total, 215 patients (286 kidneys) with congenital hydronephrosis were included. Hydronephrosis outcomes (resolution, improvement, and persistence) and time-to-outcome were evaluated. RESULTS Fourteen patients underwent early surgical intervention until the age of 2 years. A total of 189 congenital hydronephrosis cases (66%) showed resolution at a median of 16 months (interquartile range: 7-21 months) and 169 (80%) of 210 kidneys with grade I to II hydronephrosis showed resolution at a median of 14 months (interquartile range: 6-23 months). Of 76 kidneys with grade III to IV hydronephrosis, 24 (32%) showed resolution at a median of 29 months (interquartile range: 24-41 months), and 56 (74%) showed improvement to grade II or less at a median of 12 months (interquartile range: 5-23 months). Of the 76 kidneys with grade III to IV hydronephrosis, five required delayed pyeloplasty at a median of 66 months (interquartile range: 42-89 months). One patient was asymptomatic, with a marked worsening of hydronephrosis and decreased renal function 6 years after the resolution of hydronephrosis. CONCLUSIONS None of the patients with grade I to II hydronephrosis required surgical treatment, and a shorter follow-up may be sufficient. Grade III to IV severe hydronephrosis should be considered for a longer and more careful follow-up, given the possibility of asymptomatic exacerbation of hydronephrosis.
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Affiliation(s)
- Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
- Department of Pediatric Urology, Nara Prefecture General Medical Center, Nara, Nara, Japan
- Department of Urology, Okanami General Hospital, Iga, Mie, Japan
- Department of Urology, Matsusaka Chuo General Hospital, Matsusaka, Mie, Japan
| | - Katsuya Aoki
- Department of Pediatric Urology, Nara Prefecture General Medical Center, Nara, Nara, Japan
| | - Shinji Fukui
- Department of Urology, Yamato Takada Municipal Hospital, Yamato Takada, Nara, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Takuto Shimizu
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kenta Onishi
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Ken Fujimoto
- Department of Urology, Okanami General Hospital, Iga, Mie, Japan
| | - Takeshi Otani
- Department of Urology, Matsusaka Chuo General Hospital, Matsusaka, Mie, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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Kim JS, Shalaby-Rana E, Krill A, Pohl H, Majd M. Hydronephrotic lower moiety of duplex systems: Observations using diuresis renography. Clin Imaging 2024; 109:110138. [PMID: 38579501 DOI: 10.1016/j.clinimag.2024.110138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE The purpose of this study is to characterize the prevalence and behavior of hydronephrosis of non-refluxing lower moiety of duplex kidneys using MAG-3 diuresis renography. We compare our data to previous case series and ureteropelvic junction obstruction of single systems. MATERIALS AND METHODS An IRB-approved database of over 5000 diuresis renograms performed in 2025 patients was queried to identify cases of hydronephrosis of lower moiety of duplex kidneys suspicious for ureteropelvic obstruction, excluding those with hydroureter or reflux. Kidney function and post-furosemide drainage parameters on initial and follow-up diuresis renograms were recorded. Medical records and patient outcomes were reviewed. RESULTS In total, 19 renal units were identified in 18 patients (11 male, 7 female), age range 0.5 months to 17.8 years, including one patient with bilateral lower moiety hydronephrosis. Initial diuresis renograms in 12 asymptomatic patients (13 renal units) with antenatal hydronephrosis demonstrated varying drainage patterns from normal to obstructed. Follow-up studies showed worsening drainage in 3 patients, who all underwent surgery. Drainage improved in 4 patients and remained unchanged in 5 patients (6 renal units). Of the 6 patients presenting with Dietl's crisis, 5 showed obstructive drainage on initial diuresis renogram, 2/5 with decreased function. All 5 obstructed patients underwent surgery. CONCLUSION Hydronephrosis of the lower moiety of a duplex system is rare and behaves similarly to single systems. The majority are diagnosed antenatally, display a dynamic nature, and may present with acute obstruction. Diuresis renography is a valuable tool in its evaluation and management.
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Affiliation(s)
- Jane S Kim
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America.
| | - Eglal Shalaby-Rana
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America.
| | - Aaron Krill
- Division of Urology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America.
| | - Hans Pohl
- Division of Urology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America.
| | - Massoud Majd
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, D.C. 20010, United States of America
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Kadoriku F, Sasaki Y, Fukuta K, Nishiyama M, Utsunomiya S, Kobayashi S, Shiozaki K, Daizumoto K, Ueno Y, Seto K, Tomida R, Kusuhara Y, Fukawa T, Nakanishi R, Yamaguchi K, Yamamoto Y, Izaki H, Takahashi M, Furukawa J. Robot-assisted intracorporeal ileal conduit urinary diversion: A two-center comparative study of Bricker versus Wallace ureteroileal anastomosis. Asian J Endosc Surg 2024; 17:e13307. [PMID: 38561598 DOI: 10.1111/ases.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION This study was performed to evaluate the differences in the perioperative results, renal function, and incidence of hydronephrosis over time between the use of Bricker anastomosis and Wallace anastomosis for robot-assisted intracorporeal ileal conduit urinary diversion (RICIC). METHODS Fifty-five patients who underwent RICIC at two institutions were evaluated (Bricker, n = 23; Wallace, n = 32). We investigated changes in estimated glomerular filtration rate and hydronephrosis before surgery and at 3, 6, and 12 months after surgery. RESULTS The patients in the Bricker group were significantly older than those in the Wallace group. The urinary diversion time was significantly longer in the Bricker group. No significant difference in postoperative renal function was observed. Additionally, no significant difference was observed in the incidence of postoperative hydronephrosis. However, the incidence of right hydronephrosis tended to be high overall, especially in the Wallace group. No patients in either group required repair surgery or ureteral stent placement. CONCLUSIONS In patients undergoing RICIC, there was no difference in postoperative renal function or the incidence of hydronephrosis between Wallace and Bricker anastomosis. Symptomatic hydronephrosis was not observed in either group. The present study showed that each method was equally effective and safe.
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Affiliation(s)
- Fumiya Kadoriku
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yutaro Sasaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kyotaro Fukuta
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Mitsuki Nishiyama
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Seiya Utsunomiya
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Saki Kobayashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Keito Shiozaki
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshiteru Ueno
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kosuke Seto
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Ryotaro Tomida
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshito Kusuhara
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Ryoichi Nakanishi
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuyo Yamamoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hirofumi Izaki
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Junya Furukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Faidley KN, Botkin HE, Loeffler BT, Mott SL, Hansen SC, Hill EK, Erickson BA. Longitudinal Outcomes of Malignant Ureteral Obstruction Secondary to Ovarian Cancer: Predictors of Resolution and the Role of Surgical Management. Urology 2024; 186:101-106. [PMID: 38350551 DOI: 10.1016/j.urology.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/29/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To review the management of ovarian cancer (OCa) associated hydronephrosis (HN). Specifically, we aim to identify optimal management of HN in the acute setting, predictors of HN resolution, and the role of surgery (tumor debulking/(+/-)ureterolysis/hysterectomy). MATERIALS/METHODS The study cohort included OCa patients managed at our institution from 2004-2019 that developed OCa-associated HN. Initial HN management was recorded as none, retrograde ureteral stent (RUS) or percutaneous nephrostomy tube (PCN). Primary outcomes included (1) HN management failure, (2) HN management complications, and (3) HN resolution. Patient, cancer, and treatment predictors of outcomes were assessed using logistic regression and fine-Gray competing risk models. RESULTS Of 2580 OCa patients, 190 (7.4%) developed HN. HN was treated in 121; 90 (74.4%) with RUS, 31 (25.6%) with PCN. Complication rates were similar between PCN and RUS (83% vs 85.1%; P = .79; all Clavian Grade I/II). Initial HN treatment failure occurred in 28 patients, predicted by renal atrophy (hazard ratios (HR) 3.27, P <.01). HN resolution occurred in only 52 (27%) patients and was predicted by lower International Federation of Gynecology and Obstetrics (FIGO) stage (FIGO III/IV HR 0.42, P <.01) and surgical tumor debulking/ureterolysis (HR 2.83, P = .02). CONCLUSION Resolution of HN associated with malignant obstruction from OCa is rare and is most closely associated with tumor debulking and International Federation of Gynecology and Obstetrics (FIGO) stage. Initial endoscopic treatment modality was not significantly associated with complications or resolution, though RUS failures were slightly more common. Ureteral reconstruction at time of debulking/ureterolysis is potentially underutilized.
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Affiliation(s)
- Kathryn N Faidley
- Department of Urology, University of Iowa, Carver College of Medicine, Iowa City, IA
| | - Hannah E Botkin
- Department of Urology, University of Iowa, Carver College of Medicine, Iowa City, IA
| | | | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA
| | - Samuel C Hansen
- Department of Urology, University of Iowa, Carver College of Medicine, Iowa City, IA
| | - Emily K Hill
- Department of Obstetrics and Gynecology, University of Iowa, Carver College of Medicine, Iowa City, IA
| | - Bradley A Erickson
- Department of Urology, University of Iowa, Carver College of Medicine, Iowa City, IA.
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Robinson EJ, Bayne A. Pyeloplasty may reverse the effect of growth delay from ureteropelvic junction obstruction in infants. Int Urol Nephrol 2024; 56:1227-1233. [PMID: 37991603 DOI: 10.1007/s11255-023-03870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To determine if children with UPJO demonstrate a clinically significant change in somatic growth following pyeloplasty. METHODS We retrospectively evaluated the growth chart data of infants with SFU grade 3 or 4 congenital hydronephrosis at our institution from 2015 to 2022. Of those, 35 patients underwent pyeloplasty and 66 had no surgical intervention. Patients met criteria if they had SFU 3 or 4 hydronephrosis and MAG3 renal scan. If patients underwent surgery, height and weight percentiles were recorded from the pre-op and 6-16-month follow-up visits. In non-surgery patients, measurements were taken near the median age of surgery in the intervention group and 6-16 months later. Interval changes in group height and weight percentiles are compared for significant changes. RESULTS The surgery and non-surgery groups did not differ in terms of gender (71% vs 74% Male), starting age (296 vs 244 days), starting weight (58th vs 52nd percentile), or time between measurements (255 vs 260 days), though the surgery group had significantly less height in the pre-operative period (43rd vs 55th percentile, p = 0.050) and were more likely to have delayed drainage on renal scan (83% w/delay vs 35%). The surgery group showed a significant increase in height (18.9 percentiles; 95% CI 11-27) and weight (6.0 percentiles; 95% CI 0.50-12) after intervention. CONCLUSIONS Patients with congenital hydronephrosis due to UPJO that underwent pyeloplasty showed a significant increase in weight and height at 6-16 months postoperatively compared to those that were managed with close observation. This suggests UPJO might lead to growth delay in infants.
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Affiliation(s)
- Eric J Robinson
- Department of Urology, Kaiser Permanente, Los Angeles, CA, USA.
| | - Aaron Bayne
- Department of Urology, Oregon Health and Science University, Portland, OR, USA
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Shao G, Sun Z, Zhou Z, Wang W, Li A. Efficacy of laparoscopic pyeloplasty for pediatric hydronephrosis caused by symptomatic versus asymptomatic endogenous ureteropelvic junction obstruction: a retrospective analysis. J Int Med Res 2024; 52:3000605241232968. [PMID: 38460542 PMCID: PMC10924756 DOI: 10.1177/03000605241232968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/29/2024] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE To retrospectively compare the differences in the surgical efficacy and prognosis of laparoscopic pyeloplasty for hydronephrosis caused by symptomatic versus asymptomatic ureteropelvic junction obstruction (UPJO) in children and determine whether clinical symptoms affect the surgical outcome and prognosis. METHODS Children who underwent laparoscopic pyeloplasty in our hospital from January 2018 to December 2022 were retrospectively analyzed. The children were divided into symptomatic and asymptomatic groups according to their main symptoms. The primary outcomes were the surgical success rate, change in renal parenchymal thickness, and change in renal pelvis anteroposterior diameter. The secondary outcomes were postoperative complications, reoperation rate, operative duration, intraoperative blood loss, and drainage tube indwelling time. RESULTS In total, 224 children with UPJO were enrolled; 148 (66.1%) were symptomatic and 76 (33.9%) were asymptomatic. The symptomatic group showed a significantly greater mean change in renal parenchymal thickness, significantly higher surgical success rate, and significantly lower postoperative complication rate. CONCLUSIONS In the present study, asymptomatic children had a lower surgical success rate, less postoperative imaging improvement, and more postoperative complications than symptomatic children. The presence or absence of clinical symptoms may affect the surgical outcome and prognosis.
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Affiliation(s)
- Guanghui Shao
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zhihao Sun
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zhihang Zhou
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Weizhen Wang
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Aiwu Li
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China
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Tao C, Cao Y, Mao C. Analysis of the Therapeutic Efficacy of Laparoscopic Treatment for Fibroepithelial Polyps of the Ureter in Children. J Endourol 2024; 38:219-227. [PMID: 38185850 DOI: 10.1089/end.2023.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Objective: The aim of this study is to assess the efficacy and safety of laparoscopic surgery in the treatment of pediatric ureteral fibroepithelial polyp (FEP) patients. Our hypothesis is that laparoscopic surgery can effectively treat FEPs while minimizing patient discomfort and complications. Our research aims to evaluate the clinical outcomes of the surgery, including postoperative symptom relief, improvement in kidney function, and risk of postoperative complications. Methods: The clinical records of 34 patients who underwent ureteral polyp surgery at the Department of Urology at Anhui Provincial Children's Hospital between May 2014 and February 2023 were retrospectively analyzed. All patients underwent laparoscopic surgery. Among the 34 pediatric patients, there were 31 males and 3 females, with 2 on the right side and 32 on the left side. Of these cases, 24 polyps were located at the ureteropelvic junction, while seven were found in the upper segment of the ureter and three in its middle segment. Patients' ages ranged from 4 years and 3 months to 15 years, with a median age of 8 years and 6 months. All children presented with varying degrees of hydronephrosis, and preoperative clinical symptoms included ipsilateral flank or abdominal pain, hematuria, and other discomfort. Preoperative examinations mainly comprised ultrasound, intravenous pyelography, CT, or magnetic resonance urography imaging studies, as well as diuretic renography. All pediatric patients underwent laparoscopic excision of the polyp segment of the ureter, followed by renal pelvis ureteroplasty or ureter-to-ureter anastomosis. Results: All patients underwent surgery without conversion to open surgery. The surgical duration ranged from 72 to 313 minutes, with an average of 179.5 minutes. The average intraoperative blood loss was 14 mL. Postoperatively, one patient experienced leakage at the anastomotic site; however, no other significant complications occurred during or after the procedure. Postoperative histopathology confirmed the presence of FEPs in the ureter for all cases. All patients experienced a favorable postoperative recovery, with hospitalization periods ranging from 3 to 16 days and an average stay of 8.6 days. A Double-J stent was inserted in all patients for a duration of 1 to 2 months after surgery, and upon removal, follow-up color Doppler ultrasound revealed reduced hydronephrosis within 1 to 3 months. Follow-up examinations were conducted at intervals ranging from 3 to 108 months postsurgery, with an average follow-up time of 42.2 months, during which no recurrence of ureteral polyps or symptoms such as pain and hematuria was observed. Conclusions: The findings of this study demonstrate that laparoscopic excision of the polyp segment of the ureter, renal pelvis ureteroplasty, and ureter-to-ureter anastomosis represent safe and effective treatment modalities for pediatric FEPs in the ureters. This technique offers several advantages, including minimal invasiveness, rapid recovery, and definitive therapeutic efficacy, which effectively alleviate clinical symptoms and improve hydronephrosis.
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Affiliation(s)
- Chengpin Tao
- Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Yongsheng Cao
- Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Changkun Mao
- Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
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Anton Sagayanathan P, Goai XY, Loganathan A, Pridgeon S. Intrinsic ureteric obstruction secondary to endometriosis: a rare clinical entity causing obstructive uropathy and renal failure. BMJ Case Rep 2024; 17:e258026. [PMID: 38373806 PMCID: PMC10882363 DOI: 10.1136/bcr-2023-258026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
Ureteral endometriosis is rare and can be a silent clinical entity, which can potentially lead to serious complications such as obstructive uropathy, sepsis and renal failure. A high clinical suspicion is required especially in childbearing age groups due to non-specific presentation such as renal colic, recurrent urinary tract infection (UTI), renal failure or asymptomatic hydronephrosis.A woman in her 40s presented with febrile UTI and flank pain. She reportedly suffered from recurrent UTIs in the past. Initial workup revealed an infected, obstructed left renal collecting system with gross hydronephrosis and hydroureter to the distal ureter on a significant gynaecological background of severe endometriosis requiring hysterectomy in the past.CT showed chronic obstructive changes and soft tissue nodules within the renal pelvis with no radio-opaque stones. She underwent emergent ureteric stent insertion. Functional imaging demonstrated only 1% contribution of the left kidney with a preserved estimated glomerular filtration rate of 65 mL/min/1.73 m2Endoscopic evaluation of ureters found extensive soft tissue lesions throughout the dilated left collecting system with biopsy-confirmed endometriosis. Subsequently, she underwent laparoscopic nephroureterectomy due to extensive ureteric involvement and chronically obstructed non-functioning kidney. Histopathology demonstrated completely obstructing ureteral endometriosis.Ureteric obstruction secondary to endometriosis can be due to extrinsic or intrinsic disease. In addition to initial assessment with CT urogram MRI may be helpful to evaluate soft tissue thickening. Endoscopic assessment with ureteroscopy and biopsy is required for tissue diagnosis. Surgery is often the treatment of choice, ranging from ureteroureterostomy, ureteroneocystostomy or nephroureterectomy in severe cases.Ureteral endometriosis is a rare clinical entity, clinicians should remain vigilant about common presentations of this rare entity, early diagnosis and prompt treatment is crucial to prevent progression to renal failure.
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Affiliation(s)
| | - Xin Yi Goai
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | | | - Simon Pridgeon
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia
- James Cook University, Townsville, Queensland, Australia
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Boswell TC, Davis-Dao CA, Williamson SH, Chamberlin JD, Nguyen T, Chuang KW, Stephany HA, Wehbi EJ, Khoury AE. Endoscopic treatment of primary obstructive megaureter with high pressure balloon dilation in infants. J Pediatr Urol 2024; 20:67-74. [PMID: 37783596 DOI: 10.1016/j.jpurol.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION AND OBJECTIVE Ureteral reimplantation of the dilated ureter in infants is challenging; however, some patients with primary obstructive megaureter (POM) in this age group require intervention due to clinical or radiological progression. We sought to determine if high pressure balloon dilation (HPBD) can serve as a definitive treatment for POM in children under one year of age, or as a temporizing measure until later reimplantation. MATERIALS AND METHODS All patients from a single institution who underwent HPBD between October 2009 and May 2022 were retrospectively reviewed. Patients were excluded if older than 12 months or diagnosed with neurogenic bladder, posterior urethral valves, or obstructed refluxing megaureter. Patients with prior surgical intervention at the ureterovesical junction were excluded. Indications for surgery included progressive hydroureteronephrosis or urinary tract infection (UTI). Balloon dilation was performed via cystoscopy with fluoroscopic guidance, followed by placement of two temporary ureteral stents. Primary outcomes were improvement or resolution of megaureter and rates of subsequent reimplantation. Secondary outcomes included total number of anesthetics and postoperative UTIs. RESULTS Fifteen infants with median age of 7.6 months (IQR 3.8-9.7) underwent HPBD. Twelve (80%) patients were detected prenatally and 3 (20%) after a UTI. Indication for surgery was progressive hydroureteronephrosis in 10 patients (67%) and UTI in five (33%). All had SFU grade 3 or 4 hydronephrosis on preoperative ultrasound and median distal ureteral diameter was 13 mm. Median follow up was 2.9 years. Twelve (80%) succeeded with endoscopic treatment: 7 patients had an undetectable distal ureter on ultrasound at last follow-up, 5 were improved with median distal ureteral diameter of 7 mm. Three patients (20%) required ureteral reimplantation due to progressive dilation, all with grade 4 hydronephrosis and distal ureteral diameters were 11, 15, and 21 mm. Six patients (40%) required two anesthetics to complete endoscopic treatment. Among those, 4 patients required initial stent placement for passive dilation followed by a second anesthetic for HPBD weeks later. Two patients underwent repeat HPBD following postoperative proximal migration of the ureteral stents. All 15 patients had an additional anesthetic for removal of stents. Five patients (33%) were treated for a symptomatic UTI (4 febrile, 1 afebrile) with the stents indwelling but there were no UTIs in the group following stent removal. CONCLUSION Balloon dilation is a practical option for treatment of POM in infants, and in most cases (80%) avoids subsequent open surgery (over median 2.9 years of follow-up).
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Affiliation(s)
- Timothy C Boswell
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA
| | - Carol A Davis-Dao
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA
| | - Sarah H Williamson
- Division of Urology, Children's Hospital of the King's Daughter, Norfolk, VA, USA; Department of Urology, Eastern Virginia Medical School, Norfolk VA, USA
| | - Joshua D Chamberlin
- Division of Pediatric Urology, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Tiffany Nguyen
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA
| | - Kai-Wen Chuang
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA
| | - Heidi A Stephany
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA
| | - Elias J Wehbi
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA
| | - Antoine E Khoury
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA.
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Zhang B, Li L, Zhang G, Wang J, Cao B, Li Z. Application of ultrasound-guided percutaneous nephrostomy in the treatment of a solitary kidney with hydronephrosis due to renal tuberculosis. Abdom Radiol (NY) 2024; 49:535-541. [PMID: 37936009 PMCID: PMC10830733 DOI: 10.1007/s00261-023-04068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To investigate the value of ultrasound-guided percutaneous nephrostomy and nephrostomy tube replacement for treating a solitary kidney with hydronephrosis due to renal tuberculosis. METHODS Clinical data of patients with a solitary kidney with hydronephrosis caused by renal tuberculosis who underwent ultrasound-guided percutaneous nephrostomy in our hospital from January 2011 to December 2022 were retrospectively analyzed. The associated success rate and complications were statistically analyzed, pre- and post-catheterization changes in serum creatinine and blood urea nitrogen levels were compared, success rate and complications of nephrostomy tube replacement in patients with long-term catheterization were statistically analyzed, and the impact of long-term catheterization on patient life was investigated. RESULTS Overall, 32 patients aged 17-75 years (average age: 44.1 ± 16.9 years) underwent ultrasound-guided percutaneous nephrostomy. Sixty-three punctures were performed; the puncture success rate was 100%. The levels of serum creatinine and blood urea nitrogen of patients decreased after catheterization, and the differences between the pre-catheterization and post-catheterization were significant (P < 0.05). There were 1, 3, and 12 cases of serious, minor, and fistula-related complications, respectively. The mean duration of the indwelling catheter was 56.7 ± 36.2 (range, 13-120) months. The number of nephrostomy tube replacements was 344 times, and the success rate was 100%. All patients could take care of the puncture point by themselves. CONCLUSION Ultrasound-guided percutaneous nephrostomy and nephrostomy tube replacement have a high success rate and few complications, which can improve the renal function of patients. It is of great value for treating a solitary kidney with hydronephrosis caused by renal tuberculosis.
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Affiliation(s)
- Bingsong Zhang
- Department of Ultrasound, Eighth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Lei Li
- Department of Ultrasound, Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Gengchen Zhang
- Department of Ultrasound, Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jinshan Wang
- Department of Ultrasound, Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bingsheng Cao
- Department of Ultrasound, Eighth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Zhuo Li
- Department of Ultrasound, Eighth Medical Center of Chinese PLA General Hospital, Beijing, China.
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Daboos M, Lamiri R, Aziza B, Marzougui M, Kechiche N, Sahnoun L, Abdelaziz M, Abdelmaboud M, Azab A, Shaban M. Laparoscopic assisted dismembered pyeloplasty versus open pyeloplasty in UPJO with poorly function kidney in pediatrics. Int Urol Nephrol 2024; 56:381-388. [PMID: 37751052 PMCID: PMC10808368 DOI: 10.1007/s11255-023-03799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The management of UPJO with poor function kidney, less than 10%, has been the subject of debate for more than a decade. Some authors have recommended nephrectomy, while others favor renal salvage (pyeloplasty). We report our experience with laparoscopic assisted pyeloplasty in pediatric patients with poorly functioning kidneys in comparison with an open approach. MATERIALS AND METHODS A retrospective study was conducted to review 65 patients who were diagnosed with hydronephrosis and had impaired renal function due to UPJO. The study was conducted in the pediatric surgery departments of Al-Azhar University Hospital and Fattouma Bourguiba University Hospital of Monastir over a period of 20 years. Limited to pediatric patients with UPJO with ≥ Grade III hydronephrosis, antero-posterior pelvic diameter ≥ 20 mm, as well as a renal function equal to or less than 10%, was corrected by laparoscopic assisted or open pyeloplasty. RESULTS There were 40 cases in group A who underwent laparoscopic assisted pyeloplasty, and 25 cases in group B who underwent open pyeloplasty. There were no complications or difficulties during the operation. The mean operative time in group A was 90 ± 12 min, while in group B, it was 120 ± 11 min. The renal assessment parameters significantly improved in both groups. In group A, the mean split renal function was 7.9 ± 1.3% and increased to 22.2 ± 6.3%. In group B, the mean split renal function was 8.1 ± 1.1% and increased to 24.2 ± 5.1%. However, the differences between both groups in terms of pre-operative and post-operative renal functions were statistically insignificant. CONCLUSION Laparoscopic assisted pyeloplasty is an effective treatment for patients with poorly functioning kidneys, especially those with less than 10% function. While this surgical procedure requires shorter operative times, it yields functional outcomes that are comparable to open approach.
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Affiliation(s)
- Mohammad Daboos
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.
| | - Rachida Lamiri
- Department of Pediatric Surgery, University of Monastir, Monastir, Tunisia
| | - Bochra Aziza
- Department of Pediatric Surgery, University of Monastir, Monastir, Tunisia
| | - Mohamed Marzougui
- Department of Pediatric Surgery, University of Monastir, Monastir, Tunisia
| | - Nahla Kechiche
- Department of Pediatric Surgery, University of Monastir, Monastir, Tunisia
| | - Lassaad Sahnoun
- Department of Pediatric Surgery, University of Monastir, Monastir, Tunisia
| | - Mohamed Abdelaziz
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt
| | - Mohamed Abdelmaboud
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt
| | - Ahmed Azab
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt
| | - Mahmoud Shaban
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt
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Patrick Mershon J, Ray S, Dason S, Baradaran N. Left Ureterocalycostomy With Ileal Interposition for Retroperitoneal Fibrosis in Patient With Erdheim-Chester Disease. Urology 2024; 184:e253-e255. [PMID: 38006955 DOI: 10.1016/j.urology.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Erdheim-Chester disease (ECD) is a rare progressive non-Langerhans' cell histiocytic multisystem disorder with a broad spectrum of clinical manifestations, including infiltrative perinephric with ureteral involvement resulting in hydronephrosis, renal atrophy, and eventual renal failure. OBJECTIVE To present a patient with ECD with bilateral renal/ureteral involvement managed with bilateral percutaneous nephrostomy tubes (PCNT) and trametinib who underwent bilateral robotic upper tract reconstruction, the first such published report. The video demonstrates only the left-sided repair, which posed specific challenges and demonstrates reconstructive techniques useful in complex upper tract repairs with limited tissue availability. MATERIALS AND METHODS A 35-year-old male initially presented with baseline creatinine of 1.62 and split renal function; 30% right and 70% left by Lasix renogram. Extra-genitourinary manifestations of disease included cardiac hypertrophy and skin ulcers/lesions. Bilateral retrograde pyeloureterography showed proximal ureteral obliteration ∼4 cm bilaterally. Multiple management options were discussed including PCNTs, but patient elected for definitive repair. He was seen by Cardiology and Anesthesia and deemed to be optimized. He held his trametinib for 1week before surgery. We demonstrate a difficult ureteral dissection with fibrotic hilum preventing separation. Simultaneous ureteroscopy identified the distal extent of stricture which was excised, leaving a ∼15 cm gap. Downward nephropexy was performed with ultrasound guidance to identify an inferior calyx. Partial nephrectomy was then performed without vascular control due to hilar fibrosis. Ileal interposition was chosen to bridge the remaining ∼8 cm gap. Proximal ileo-calyceal and distal ileo-ureteral anastomoses were performed. We then placed a 30 cm × 7 Fr double-J ureteral stent in standard fashion. The ileum was secured to the renal pelvis to maintain a straight lie and an omental flap was secured in place. RESULTS Immediate postoperative course was complicated by partial small bowel obstruction leading to a negative exploratory laparotomy and a subsequent episode of urosepsis. The patient is now voiding well without stents or PCNTs, without infections and with improving renal function, now with GFR (glomerular filtration rate) of 62 from 43 preoperatively. With aggressive hydration, patient has had no obstruction of the distal ureter with mucus. MRI Abdomen/Pelvis 6months later showed irregularity of the calyces with stable mild hydronephrosis. The patient continues to be medically managed on trametinib for his underlying disease, with surveillance for recurrent fibrosis and obstruction which has not yet occurred. CONCLUSION Robotic ureterolysis and ureterocalycostomy with possible bowel interposition is a reasonable option for upper tract reconstruction in select patients with ECD.
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Affiliation(s)
- John Patrick Mershon
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Shagnik Ray
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Shawn Dason
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nima Baradaran
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
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Selvi I, Dönmez Mİ, Değirmenci E, Zoroğlu H, Ziylan O, Oktar T. Voiding Cystourethrogram Before Pyeloplasty: To Do or Not To Do? Urology 2024; 184:182-188. [PMID: 37866651 DOI: 10.1016/j.urology.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To assess the incidence of concomitant vesicoureteral reflux (VUR) in unilateral cases of ureteropelvic junction obstruction (UPJO) and to identify factors that predict VUR. METHODS Files of 381 pediatric patients who underwent unilateral pyeloplasty between 2000 and 2017 were retrospectively reviewed. A total of 270 patients with available data and ≥5 years of follow-up were eligible for this study. Demographic parameters, preoperative hydronephrosis grade, renal pelvis anteroposterior diameter (APD), renal parenchymal thickness (PT), split renal functions on MAG-3 scan and VUR status were noted. The patients were divided into two groups: those with concomitant VUR (group I, n: 24, 8.9%) and those without VUR (group II, n: 246, 91.1%). RESULTS Among 270 patients (205 boys, 75.9%) with a median age of 4 months (2-98), 197 (72.9%) had antenatal hydronephrosis. Median follow-up was 11 years (5-22). Among 24 patients with concurrent VUR, 6 (25%) had grade II VUR, whereas grade III-V VUR was detected in 18 (75%). Of these, 12 (50%) had ipsilateral VUR, 3 (12.5%) had contralateral, and 9 (37.5%) had bilateral VUR. In a median 137-month follow-up, spontaneous VUR resolution was observed in 6 (25%) patients, whereas 15 (62.5%) patients underwent endoscopic subureteral injection and 3 (12.5%) patients ureteroneocystostomy, respectively. Preoperative APD [35.5, (Inter Quantile Range) IQR (27.6-36.0) vs 26.5 IQR (25.0-35.0), P = .004] were significantly higher in group I, whereas group I had significantly lower PT [3.7, IQR (3.4-6.4) vs 5.8 IQR (4.4-6.1), P = .026]. Predictive factors for concomitant VUR were presentation with febrile UTI (odds ratio (OR): 2.769, P = .048), PT <3.95 mm (OR: 1.367, P = .043), and APD >28.8 mm (OR: 1.035, P = .001). CONCLUSION Our results indicated that concomitant VUR and UPJO might be detected in 1 out of every 11 patients undergoing pyeloplasty, while some type of surgical intervention for VUR was required in 75% of these patients. Thus, voiding cystourethrogram prior to pyeloplasty may be limited in those presenting with febrile urinary tract infection, having higher APD and lower PT on preoperative urinary ultrasonography.
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Affiliation(s)
- Ismail Selvi
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - M İrfan Dönmez
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey.
| | - Enes Değirmenci
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Hatice Zoroğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Orhan Ziylan
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Tayfun Oktar
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey; Koç University, School of Medicine, Department of Urology, Istanbul, Turkey
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Shalash B, Ernst M, Stout M, Asti L, McLeod DJ. Clearance While Upright on Initial Diuretic Renography Predicts the Need for Surgery in Children With Congenital Hydronephrosis. Urology 2024; 184:212-216. [PMID: 38040296 DOI: 10.1016/j.urology.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To improve the predictive ability of diuretic renography (DR) for surgical intervention in children with congenital hydronephrosis (CH) and concern for ureteropelvic junction obstruction. METHODS Children with CH born between 2007 and 2021 who underwent initial DR prior to 6months of life, had both clearance while upright (CUP) and T ½ reported, and did not have immediate surgical intervention after the first DR were retrospectively evaluated for surgical intervention during the period of clinical observation. Once the optimal cut-points were identified for CUP and T ½, they were used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS In total 65 patients were included in the final analysis with 33 (50.8%) undergoing surgical intervention (pyeloplasty) and 32 (49.2%) still on observation at last follow-up. The optimal cut-points for predicting surgical intervention were 28.1 minutes for T ½ and 22.4% for CUP. Applying the CUP cut-point of 22.4% we achieved a sensitivity of 60.6% (95% CI: 43.9-77.3), specificity of 96.9% (95% CI: 90.1-100.0), positive predictive value of 95.2% (95% CI: 86.1-100.0), and negative predictive value of 70.5% (95% CI: 57.0-83.9). CONCLUSION A low CUP accurately predicts surgical intervention in children with CH who are initially observed. Although there is no singular measure on DR that can with absolute certainty predict future clinical course, our data do suggest there is utility in incorporating CUP (if <22.4%) into the decision process. Further research is necessary to help guide the management of children with intermediate CUP values.
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Affiliation(s)
- Bayan Shalash
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH; The Ohio State University College of Medicine, Columbus, OH
| | - Michael Ernst
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH
| | - Megan Stout
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH; The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lindsey Asti
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, OH; The Ohio State University College of Medicine, Columbus, OH
| | - Daryl J McLeod
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH; The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, OH; The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH.
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He Y, Li Y, Sun J, Yang J, Song H, Zhang W. Ureteropelvic junction obstruction with polyps in children: clinical manifestations and supranormal preoperative differential renal function. Int Urol Nephrol 2024; 56:373-380. [PMID: 37833596 DOI: 10.1007/s11255-023-03827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To describe and analyze the clinical manifestation and pre-DRF of UPJO children with polyps and explore the possible influencing factors of supranormal pre-DRF. PATIENTS AND METHODS All patients undergoing primary Anderson-Hynes pyeloplasty for UPJO due to polyp were retrospectively reviewed. Patients' characteristics, parameters of ultrasound and dynamic renograms (DR) were recorded in elaborate. Pre-DRF in groups of different age, weight, gender, pain, grade of hydronephrosis, anterio-posterior pelvic diameter (APD), length of kidney and postoperative ultrasonic parameters were compared. RESULTS A total of 18 UPJO children with polyps were included. Five (27.78%) patients had SFU III grade of hydronephrosis. Seven (38.89%) patients were supranormal pre-DRF. All patients had pre-DRF > 40%. Drainage curve was delayed excretion in 12 (66.67%) patients and T1/2 < 20 min was in 4 (22.22%) patients. Among the 16 patients who underwent preoperative IVP examination, 15 (93.75%) patients had concentration of intrarenal pelvis contrast agent within 10 min. No significant difference in post-APD reduction rate and post-minPT increased was found between supranormal pre-DRF and non-supranormal pre-DRF groups. The supranormal pre-DRF was more likely to occur in young and low-weight children. CONCLUSION The preoperative renal function of UPJO patients with polyps was well preserved, and 38.89% of them had supranormal pre-DRF. Patients with supranormal pre-DRF can be managed with the same strategies as those with normal renal function.
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Affiliation(s)
- Yuzhu He
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Yi Li
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Jihang Sun
- Department of Imaging, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Jigang Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Hongcheng Song
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Weiping Zhang
- Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China.
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Meng W, Gao Y, Pan L, Zhao G, Chen Q, Bai L, Zheng R. Pelvic squamous cell carcinoma of unknown primary origin with hydronephrosis and ureteral stricture: A case report. Medicine (Baltimore) 2024; 103:e37057. [PMID: 38277516 PMCID: PMC10817135 DOI: 10.1097/md.0000000000037057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Cancer of unknown primary (CUP) is a very challenging disease, accounting for 2% to 9% of all new cancer cases. This type of tumor is a heterogeneous tumor whose primary site cannot be determined by standard examination. It has the characteristics of early metastasis, strong aggressiveness, and unpredictable mode of metastasis. Studies have shown that there is no consensus on the treatment of CUP and that there is a wide range of individual differences. In most cases, surgical removal of tumor is the most typical treatment for pelvic tumors. Herein, we report a case of a large pelvic tumor of unknown origin that had compressed the sigmoid colon and ureter and was completely removed by surgery. Postoperative diagnosis was pelvic metastatic squamous cell carcinoma. CASE SUMMARY A 68-year-old man with pelvic tumor who initially complained of recurrent low back pain and painful urination. The mass was initially diagnosed as a pelvic tumor of unknown origin. The patient underwent complete resection of the tumor by laparotomy. The tumor was pathologically diagnosed as squamous cell carcinoma. CONCLUSION Based on the treatment experience of this case, surgery alone cannot improve the poor prognosis of CUP. Since chemotherapy and immunotherapy have achieved promising efficacy in various cancers, and immunotherapy has the characteristics of low side effects and good tolerability, we recommend that patients with CUP should receive chemotherapy and/or immunotherapy for better survival outcomes.
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Affiliation(s)
- Wenjun Meng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuchen Gao
- Department of General Surgery, Beijing Mentougou District Hospital, Beijing, China
| | - Lu Pan
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guowei Zhao
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Qi Chen
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Lian Bai
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Rujun Zheng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Amer-Mestre M, Tubau V, Guldris-García R, Rossello JB, Ayala EP. Laparoscopic onlay-flap ureteroplasty using cecal appendix. Int Braz J Urol 2024; 50:108-109. [PMID: 38166229 PMCID: PMC10947650 DOI: 10.1590/s1677-5538.ibju.2023.0595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION The management of ureteral strictures longer than 1-2 cm must be treated by major surgery (1, 2). The strictures located at the distal part of the ureter can be managed by a ureteral reimplantation using a psoas hitch or a Boari flap depending on its proximity to the bladder (3). Those located at the proximal ureter can be treated by a pyeloplasty (4). The ureteric strictures in the mid-ureter are the ones that pose a greater challenge for the urologist because a ureteral substitution is needed, either using a segment of the intestine or a buccal mucosa graft (5, 6). Our main objective is to present the management and results at 36 months of a patient with a right mid-ureter stricture. MATERIAL AND METHODS A 63-year-old male with chronic kidney disease (CKD) and a right single functioning kidney was referred to our department with the diagnosis of a 3 cm stricture in the right mid-ureter. He had a long-term JJ-stent in place but in the last year we had to replace it three times precociously and he even needed the placement of a nephrostomy tube due to the obstruction of the JJ-stent. Accordingly, a permanent resolution was sought and a laparoscopic onlay-flap ureteroplasty using cecal appendix was performed. RESULTS The first step was to identify the cecal appendix. Then we identified and dissected the ureter. With the ureter dissected, we performed a ureteroscopy to pinpoint the stricture. Once we knew where the stricture was, we proceeded with the ureterotomy and preparation of the cecal appendix. The final step was to perform the ureteroplasty between the ureter and the cecal appendix placing a JJ-stent before the last stitches were done. Total operative time was 190 minutes without any intraoperative complication. The JJ-stent was removed 7 weeks later. The follow-up of the patient was done with regular blood test and ultrasound to rule out deterioration of the CKD and worsening of the residual hydronephrosis. With a follow-up of 36 months, the patient is stent free, he hasn't had any further intervention and neither the CKD nor the hydronephrosis haven't worsened. CONCLUSIONS Laparoscopic onlay-flap ureteroplasty using cecal appendix is a feasible and well tolerated procedure for patients with right mid-ureter stricture. However, we must bear in mind the difficulty of these cases and they should be performed in expert centers.
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Affiliation(s)
- Miquel Amer-Mestre
- Son Espases University HospitalDepartment of UrologyPalmaBalearic IslandsSpainDepartment of Urology, Son Espases University Hospital, Palma, Balearic Islands, Spain.
| | - Valenti Tubau
- Son Espases University HospitalDepartment of UrologyPalmaBalearic IslandsSpainDepartment of Urology, Son Espases University Hospital, Palma, Balearic Islands, Spain.
| | - Ricardo Guldris-García
- Son Espases University HospitalDepartment of UrologyPalmaBalearic IslandsSpainDepartment of Urology, Son Espases University Hospital, Palma, Balearic Islands, Spain.
| | - Javier Brugarolas Rossello
- Son Espases University HospitalDepartment of UrologyPalmaBalearic IslandsSpainDepartment of Urology, Son Espases University Hospital, Palma, Balearic Islands, Spain.
| | - Enrique Pieras Ayala
- Son Espases University HospitalDepartment of UrologyPalmaBalearic IslandsSpainDepartment of Urology, Son Espases University Hospital, Palma, Balearic Islands, Spain.
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Kim DH, Park HS, Bang JS, Shin HJ, Yoon BJ, Kim S, Jeong JC, Park S, Lee T. Routine Ureteral Stenting in Kidney Transplant Reduces Postoperative Hydronephrosis and Percutaneous Ureteral Interventions: A Single-Center Experience. EXP CLIN TRANSPLANT 2024; 22:9-16. [PMID: 38284370 DOI: 10.6002/ect.2023.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
OBJECTIVES The effect of routine ureteral stenting on postoperative hydronephrosis and percutaneous ureteral intervention in kidney transplant remains unknown. This study aimed to evaluate the effects of routine ureteral stenting on hydronephrosis and percutaneous ureteral intervention and the cost benefit of ureteral stenting in kidney transplant. MATERIALS AND METHODS We retrospectively analyzed patients who underwent kidney transplant at a tertiary institution between 2005 and 2021. We adopted a ureteral stentingprotocol in2017, anda comparisonwas performed with previous patients without stents. RESULTS In total, 539 patients underwent kidney transplant(271 with stents [51.3%], 268 without stents [49.7%]). Hydronephrosis was detected in 16 cases (5.9%) and 30 cases (11.2%) of groups with and without stents,respectively (P = .041). Among patients with hydronephrosis, the number of patients who underwent percutaneous ureteral intervention was significantly lower in the stent group than in the nostent group (1 [6.25%] vs 10 [33.33%]; P= .014).Twenty patients (3.71%) experienced major urologic complications (19 [7.1%] in the no-stent group, and 1 [0.4%] in the stent group; P = .001). No significant differences between the groups were shown in the incidence of urinary tract infections within 3 months of transplant (24 [8.9%] vs 22 [8.2%]; P = .846). No differences were shown between the groups in ureterovesical anastomosis time (24.4 vs 24.03 min; P = .699) or 1-year graft survival (97% vs 97.8%; P = .803). The healthcare cost was significantly lower in the stent group than in the no-stent group by $1702.05 ($15000.89 vs $16702.95; P < .001). CONCLUSIONS Routine ureteral stenting in kidney transplant significantly decreased the incidence of postoperative hydronephrosis and percutaneous ureteral intervention. Stenting did notlead to increased urinary tract infections and was cost-effective.
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Affiliation(s)
- Dong-Hwan Kim
- >From the Department of Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea
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Sari Motlagh R, Ghoreifi A, Yanagisawa T, Kawada T, Kikic Z, Gill I, Daneshmand S, Djaladat H, Shariat SF. Survival of Patients with Chronic Kidney Disease Treated with Radical Cystectomy and Risk Factors of Glomerular Filtration Rate Loss Following Radical Cystectomy: Two Systematic Reviews and Meta-analyses of Interplay Between Radical Cystectomy and Renal Function. Eur Urol Focus 2024; 10:169-181. [PMID: 37442723 DOI: 10.1016/j.euf.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/18/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
CONTEXT There is no high-level evidence regarding the risk factors of glomerular filtration rate (GFR) loss following radical cystectomy (RC) and survival outcomes of patients with chronic kidney disease (CKD) undergoing RC. OBJECTIVE To identify the risk factors of CKD in patients treated with RC for bladder cancer and to assess overall and oncological survival of patients with CKD who underwent RC. EVIDENCE ACQUISITION According to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement, two systematic reviews were performed for studies published before September 30, 2022, assessing (1) risk factors of renal function (RF) decline following RC and (2) overall and oncological outcomes of CKD patients treated with RC. EVIDENCE SYNTHESIS A total of 21 and 17 studies were included for qualitative and quantitative syntheses, respectively. The first meta-analysis of ten studies (15 502 patients) identified these factors to be significantly associated with GFR loss following RC: advanced age, lower baseline RF, higher Charlson Comorbidity Index (CCI), diabetes mellitus, hypertension, postoperative hydronephrosis, ureteroenteric stricture, and locally advanced disease (hazard ratios [HRs] 1.03, 1.22, 1.5, 1.27, 1.24, 1.69, 1.92, and 5.13, respectively), while sex, preoperative hydronephrosis, perioperative chemotherapy, and diversion type were not. The second meta-analysis of seven studies (6900 patients) demonstrated significantly worse metastasis-free, cancer-specific, and overall survival in patients with higher CKD stages than in those with lower stages (HRs 1.54, 2.09, and 1.47, respectively). CONCLUSIONS Current evidence suggests that older age, lower baseline RF, higher CCI, diabetes mellitus, hypertension, postoperative hydronephrosis, ureteroenteric stricture, and locally advanced disease are associated with long-term GFR loss following RC. In addition, patients with higher stages of CKD have worse long-term overall and oncological outcomes following RC. These data may help in counseling and decision-making regarding therapy and preventive measures. PATIENT SUMMARY Several factors have been identified that can help identify patients at risk for glomerular filtration rate loss after radical cystectomy (RC). Chronic kidney disease is associated with poor cancer- and non-cancer-specific outcomes following RC.
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Affiliation(s)
- Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alireza Ghoreifi
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Zeljko Kikic
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Inderbir Gill
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Siamak Daneshmand
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hooman Djaladat
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
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22
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Zouari M, Dghaies R, Rhaiem W, Belhajmansour M, Krichen E, Hamad AB, Boukattaya M, Dhaou MB, Mhiri R. Risk factors for adverse outcomes after pediatric pyeloplasty: A retrospective cohort study. Int J Urol 2024; 31:45-50. [PMID: 37740658 DOI: 10.1111/iju.15305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE To identify the risk factors for adverse outcomes after pediatric pyeloplasty. METHODS We conducted a retrospective review of all children under the age of 14 years who underwent primary pyeloplasty for unilateral ureteropelvic junction (UPJ) obstruction at a single teaching hospital in Tunisia between January 1, 2013, and December 31, 2022. RESULTS A total of 103 patients were included. Median age of patients at surgery was 27 months (interquartile range [IQR], 13-44). On ultrasound, median renal pelvic anteroposterior diameter was 3.2 cm (IQR, 2.3-4), and the median renal cortex thickness (RCT) was 2.5 mm (IQR, 2-3.5). Median differential renal function (DRF) on preoperative radionuclide renal scan was 40% (IQR, 30-46). Postoperative adverse outcomes occurred in 28 patients (27.2%). These included 19 cases of urinary tract infections (UTIs), 11 cases of UPJ restenosis, four cases of UPJ leakage, two cases of urinoma, and two cases of diversion-related complications. Multivariate logistic regression analysis revealed two factors significantly and independently related to postoperative negative outcomes: RCT <3 mm and DRF > 50%. CONCLUSION Our study demonstrated that preoperative RCT on ultrasound of less than 3 mm and preoperative DRF on radionuclide renal scan of more than 50% were independent risk factors for adverse outcomes following pediatric pyeloplasty. These factors could be of interest in identifying, early on, patients who will develop postoperative negative outcomes, giving them more attention and support, and explaining the prognosis to the patient and family.
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Affiliation(s)
- Mohamed Zouari
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Rim Dghaies
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Wiem Rhaiem
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Manel Belhajmansour
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Emna Krichen
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Amel Ben Hamad
- Department of Neonatology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Mariem Boukattaya
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Riadh Mhiri
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
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Värelä S, Jakobsson C, Persson E, Börjesson A, Hagander L, Salö M. Supranormal differential renal function on MAG3 scan in children with ureteropelvic junction obstruction - Prevalence and pyeloplasty during follow-up. J Pediatr Urol 2023; 19:778.e1-778.e8. [PMID: 37726189 DOI: 10.1016/j.jpurol.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Children with suspected ureteropelvic junction obstruction (UPJO) may present with a paradoxical ipsilateral supranormal differential renal function (snDRF) on 99mTechnetium mercaptoacetyltriglycine scintigraphy (MAG3 scan). OBJECTIVE The aim was to investigate the prevalence of snDRF, the risk of pyeloplasty among children with UPJO and snDRF, and to explore the experience of snDRF among international pediatric urologists. METHODS A retrospective cohort study of children with suspected unilateral UPJO who underwent MAG3 scan at four hospitals in Sweden between 2005 and 2020. SnDRF was defined as DRF ≥55%. Normal DRF was defined as DRF 45-54%. Primary outcome was risk of pyeloplasty. Indications for pyeloplasty were loss of >10%-points of differential renal function (DRF), ipsilateral DRF <40%, or symptomatic UPJO. Logistic and cox regressions were performed in univariate and multivariable analyses, adjusting for age, gender, year, laterality, antenatal hydronephrosis, anterior-posterior diameter (APD), and kidney size. An international questionnaire regarding the management of snDRF was developed and distributed to pediatric urologists. RESULTS The prevalence of snDRF was 19%. SnDRF was more common in boys, children with antenatal hydronephrosis, children undergoing their first MAG3 scan at a younger age, and in the left kidney. After further exclusion of 70 children with DRF <45%, a total of 264 were included for longitudinal follow-up of median 6.6 (IQR 2.5-11.5) years. SnDRF was not associated with increased risk of pyeloplasty (adjusted OR 0.98 (95% CI 0.41-2.33), p = 0.96, and adjusted HR 1.00 (95% CI 0.53-1.91), p = 0.99) or time to pyeloplasty (1.1 years vs. 1.6 years, p = 0.40). Among the 79 surveyed pediatric urologists, a majority would not change clinical UPJO-management based on the presence or absence of ipsilateral snDRF. DISCUSSION There are only a few studies considering the need of pyeloplasty based on the presence of snDRF and this is the first survey among pediatric urologists on its management. With more included patients than previous studies, this study showed a snDRF prevalence of 19%, congruent with the findings of others. The underlying cause of snDRF is debated, but it cannot solely be explained as an artifact of hydronephrotic kidneys. Further studies on the clinical implications of snDRF are warranted, since DRF influences the decision to operate. CONCLUSION A fifth of all children with suspected UPJO presented with ipsilateral snDRF on initial MAG3 scan, and snDRF was not associated with a greater risk of pyeloplasty. Supported by a large group of international pediatric urology colleagues, this study concludes that the same clinical follow-up and management apply, regardless of presence of snDRF.
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Affiliation(s)
- Sanni Värelä
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden; Department of Surgery, Skåne University Hospital, Malmö, Sweden.
| | | | - Eva Persson
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
| | - Anna Börjesson
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden; Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Lars Hagander
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden; Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Martin Salö
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden; Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
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Luithle T, Obermayr F, Dittmann H, Engel C, Etzler A, Kosch F, Menke IT, Schäfer M, Schuster T, Younsi N, Fuchs J. Determination of tissue tracer transit of Technetium-99m-mercaptoacetyltriglycine diuretic renography in infants with suspected ureteropelvic junction obstruction - A multicenter prospective observational study. J Pediatr Urol 2023; 19:780.e1-780.e7. [PMID: 37718234 DOI: 10.1016/j.jpurol.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION There is an ongoing controversy regarding management of ureteropelvic junction obstruction in infants, with a shift towards a non-operative approach. However, precise predictors of outcome are lacking. Recent studies postulated a high prognostic value of Technetium-99m-mercaptoacetyltriglycine tissue tracer transit with regard to the development of an impaired differential renal function and its potential improvement following pyeloplasty. OBJECTIVE To evaluate the prognostic value of Technetium-99m-mercaptoacetyltriglycine tissue tracer transit for the occurrence of changes in differential renal function in infants with suspected unilateral ureteropelvic junction obstruction in a prospective observational multicenter study. STUDY DESIGN Infants below 3 months of age with a unilateral isolated hydronephrosis ≥ grade 3 received ultrasound and Technetium-99m-mercaptoacetyltriglycine diuretic renography at two different time points (timepoint 1 and timepoint 2). Data were analyzed at local centers and at the study center and were collected in an internet-based database system. Tissue tracer transit was determined for each diuretic renography, inter-observer variation for tissue tracer transit and standard parameters for judgement of differential renal function development were assessed. RESULTS Thirty-seven patients were analyzed. Median age was 11 weeks (7-15) at timepoint 1 and 26 weeks (19-33) at timepoint 2. A delayed tissue tracer transit at timepoint 1 was not associated with deterioration of differential renal function at timepoint 2 in both, locally (10/37 cases) and centrally (4/37) analyzed cases. However, sensitivity and specificity were poor. The intraclass correlation coefficient comparing local and central findings of tissue tracer transit and renal drainage demonstrated poor or fair agreement. Analysis of standard parameters for differential renal function development revealed a prognostic value only for the dichotomized anteroposterior renal pelvic diameter (APD, p = 0.03, 95%-CI 1.2-22.2). DISCUSSION Regarding the primary endpoint of our study, we could not confirm the hypothesis that delayed tissue tracer transit reliably predicts a subsequent decline in differential renal function in the cohort of patients studied. Whether the low age of the patients, technical problems in the correct assessment of tissue tracer transit by the investigator in early infancy, the study design, or the parameter itself played a role is debated. CONCLUSION In the presented setting tissue tracer transit was not useful as a predictive parameter for deterioration of differential renal function in infants with suspected unilateral ureteropelvic junction obstruction. Sensitivity and specificity of tissue tracer transit were not sufficient for risk stratification. Improved utility of tissue tracer transit as a marker might be achieved using a different study setting.
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Affiliation(s)
- Tobias Luithle
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
| | - Florian Obermayr
- Faculty of Medicine, University of Marburg, Baldingertrasse, 35043 Marburg, Germany.
| | - Helmut Dittmann
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Otfried-Müller-Str.14, 72076 Tuebingen, Germany.
| | - Corinna Engel
- Center for Pediatric Clinical Studies (CPCS), University Children's Hospital Tuebingen, Frondsbergstr. 23, 72070 Tuebingen, Germany.
| | - Andrea Etzler
- Department of Pediatric Surgery and Pediatric Urology, Klinikum Bremen-Mitte, St.-Jürgen-Str. 1, 28205 Bremen, Germany.
| | - Ferdinand Kosch
- Department of Pediatric Surgery, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76131 Karlsruhe, Germany.
| | - Ines Theresa Menke
- Department of Pediatric Surgery and Pediatric Urology, Medical Center Dortmund, Beurhausstr. 40, 44137 Dortmund, Germany.
| | - Mattias Schäfer
- Department of Pediatric Surgery and Pediatric Urology, Cnopf'sche Kinderklinik, St. Johannis-Mühlgasse 19, 90419 Nuremberg, Germany.
| | - Tobias Schuster
- Department of Pediatric Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany.
| | - Nina Younsi
- Center for Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Joerg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
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Zhao SZ, Li YH, Xu YC, Ke CX. Ureteral endometriosis: A uncommon cause of ureteral stricture and hydronephrosis. Asian J Surg 2023; 46:5832-5834. [PMID: 37666705 DOI: 10.1016/j.asjsur.2023.08.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023] Open
Affiliation(s)
- Shen-Zhao Zhao
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Province, Kunming, 650101, PR China.
| | - Yu-Hang Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Province, Kunming, 650101, PR China.
| | - Yong-Chun Xu
- Department of Urology, The People's Hospital of Shuangbai County, Chuxiong, Yunnan, PR China.
| | - Chang-Xing Ke
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Province, Kunming, 650101, PR China.
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Babu R, Venkatachalapathy E, Sai V. Re: Association of the Hydronephrosis Severity Score With Likelihood of Pyeloplasty. Urology 2023; 181:189. [PMID: 37598890 DOI: 10.1016/j.urology.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Ramesh Babu
- Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.
| | | | - Venkata Sai
- Department of Radiology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
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Muradi T, Turkyilmaz Z, Karabulut R, Sonmez K, Kaya C, Polat F, Basaklar AC. Our experience of operated pediatric ureteropelvic junction obstruction patients. Urologia 2023; 90:720-725. [PMID: 34519240 DOI: 10.1177/03915603211046161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Ureteropelvic junction obstruction (UPJO) may originate from extrinsic or intrinsic causes in children. The aim of this study is to present preoperative and postoperative data of our patients operated for UPJO. METHODS A total of 64 patients who underwent open pyeloplasty were investigated retrospectively. They were evaluated in terms of demographically, clinics, hydronephrosis, differential renal functions (DRFs), half-time tracer clearance (½TC), and histopathologic results. Patients' numerical results were stated as mean ± standard deviation (SD). RESULTS Male gender was more prevalent (n = 47, 73.4%) and mean age at surgery was 46.87 months. UPJO was located at the left side in 56.3% (n = 36), and at the right side in 39.1% (n = 25) of patients. It was bilateral in 4.7% (n = 3). Hydronephrosis was found antenatally in 68.8% (n = 44) of patients. The mean preoperative DRF was 49.7% (21-78%) and mean postoperative DRF was 49.2% (20-56%). Mean renal scintigraphic t1/2 was >20 min for all patients. The mean AP diameter was 21.58 mm (10-62 mm). Muscular hypertrophy was the most common pathological finding, mean length of excised segment was 10.26 mm (3-40 mm). Crossing vessel (CV) was detected in 17.18% (n = 11). The CV was statistically associated with increased age of operation, left side, and female gender. Statistically significant hydronephrosis was found in non-CV patients. Re-operation was required in seven patients (7.8%). CONCLUSIONS Intrinsic pathologies are more seen in the etiology of UPJO patients with antenatal diagnosis and this group needs operation at an earlier age. However, CV is found more commonly in patients who are diagnosed and operated at older ages.
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Affiliation(s)
- Teymursha Muradi
- Department of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Zafer Turkyilmaz
- Department of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ramazan Karabulut
- Department of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Kaan Sonmez
- Department of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Cem Kaya
- Department of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Fazli Polat
- Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Abdullah Can Basaklar
- Department of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
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Adriaenssens M, De Boe V. Congenital lower urinary tract obstruction with spontaneous fetal bladder rupture due to posterior urethral valves: a case report. J Med Case Rep 2023; 17:445. [PMID: 37875965 PMCID: PMC10598892 DOI: 10.1186/s13256-023-04163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/04/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Congenital lower urinary tract obstruction (LUTO) is a rare but significant condition affecting fetal urinary tract development. LUTO has a range of etiologies, with posterior urethral valves (PUV) being the most common cause. The prenatal diagnosis of LUTO plays a crucial role in recognizing the condition and guiding management decisions. Prenatal ultrasound serves as the primary tool for identifying LUTO, with key findings including megacystis, bladder wall thickening, oligohydramnios, hydronephrosis, and the 'keyhole sign' indicating dilatation of the posterior urethra. We present a case of congenital LUTO with a rare complication of spontaneous fetal bladder rupture and urinary ascites, treated by peritoneo-amniotic shunt placement. CASE PRESENTATION A 27-year-old pregnant Caucasian women was referred at 28 weeks of pregnancy due to the presence of megacystis and bilateral hydronephrosis on routine ultrasound and suspicion of LUTO. Repeat ultrasound at 29 weeks showed significant fetal ascites, oligohydramnios and resolution of megacystis and hydronephrosis, after which diagnosis of spontaneous bladder rupture was made. Despite ascites aspiration and amnio-infusion, there was persistent ascites and oligohydramnios. A peritoneo-amniotic shunt was placed with resolution of ascites and normalization of the amniotic fluid volume. At 35 weeks, relapse of the megacystis was observed with bilateral pyelectasis and oligohydramnios, possibly due to healing of the bladder rupture, after which elective cesarean section was planned. Cystography confirmed spontaneous healing of the bladder rupture and the presence of posterior urethral valves, which were resected in the neonatal period with cold knife incision. Total follow-up of 8 years continued to show positive ultrasonographic results and good renal function, but the child suffers from bladder dysfunction, manifesting as overactive bladder disease. CONCLUSIONS LUTO might lead to important renal dysfunction and pulmonary hypoplasia in case of increasing disease severity. Spontaneous bladder rupture might improve renal prognosis, acting as a pop-off mechanism by decompression of the urinary tract. However, fetal bladder rupture is rare and only few cases have been reported. Prenatal intervention can be considered for moderate or severe LUTO, but the benefit for long-term outcome remains uncertain and further studies are needed.
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Affiliation(s)
- Max Adriaenssens
- Department of Urology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - Veerle De Boe
- Department of Urology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Yang W, Tang W, Zheng X, Zhang M, Lu X, Chen Z, Ji C, Guo H. Combination of robot-assisted laparoscopy and ureteroscopy for the management of complex ureteral strictures. BMC Urol 2023; 23:161. [PMID: 37828507 PMCID: PMC10571485 DOI: 10.1186/s12894-023-01333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND To summarize the efficacy of combined robot-assisted laparoscopy and ureteroscopy in treating complex ureteral strictures. METHODS Eleven patients underwent combined robot-assisted laparoscopy and ureteroscopy for ureteral strictures between January 2020 and August 2022. Preoperative B-ultrasound, glomerular filtration rate measurement, and intravenous pyelography showed different degrees of hydronephrosis in the affected kidney and moderate to severe stenosis in the corresponding part of the ureter. During the operation, stricture segment resection and end-to-end anastomosis were performed using the da Vinci robot to find the stricture point under the guidance of a ureteroscopic light source in the lateral or supine lithotomy position. RESULTS All the patients underwent robot-assisted laparoscopy and ureteroscopy combined with end-to-end ureterostenosis. There were no conversions to open surgery or intraoperative complications. Significant ureteral stricture segments were found in all patients intraoperatively; however, stricture length was not significantly different from the imaging findings. Patients were followed up for 3-27 months. Two months postoperatively, the double-J stent was removed, a ureteroscopy was performed, the ureteral mucosa at the end-to-end anastomosis grew well, and the lumen was patent in all patients. Furthermore, imaging examination showed that hydronephrosis was significantly improved in all patients, with grade I hydronephrosis in three cases and grade 0 hydronephrosis in eight cases. No recurrence of ureteral stricture was observed in patients followed up for > 1 year. CONCLUSION Robot-assisted laparoscopy combined with ureteroscopy is an effective method for treating complex ureteral strictures and can achieve accurate localization of the structured segment.
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Affiliation(s)
- Wenjin Yang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China
| | - Weinan Tang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210008, China
| | - Xi Zheng
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Mengjie Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Xinyi Lu
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China
| | - Zeqing Chen
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Changwei Ji
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China.
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China.
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Weaver JK, Logan J, Broms R, Antony M, Rickard M, Erdman L, Edwins R, Pominville R, Hannick J, Woo L, Viteri B, D'Souza N, Viswanath SE, Flask C, Lorenzo A, Fan Y, Tasian GE. Deep learning of renal scans in children with antenatal hydronephrosis. J Pediatr Urol 2023; 19:514.e1-514.e7. [PMID: 36775719 DOI: 10.1016/j.jpurol.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Antenatal hydronephrosis (ANH) is one of the most common anomalies identified on prenatal ultrasound, found in up to 4.5% of all pregnancies. Children with ANH are surveilled with repeated renal ultrasound and when there is high suspicion for a ureteropelvic junction obstruction on renal ultrasound, a mercaptuacetyltriglycerine (MAG3) Lasix renal scan is performed to evaluate for obstruction. However, the challenging interpretation of MAG3 renal scans places patients at risk of misdiagnosis. OBJECTIVE Our objective was to analyze MAG3 renal scans using machine learning to predict renal complications. We hypothesized that our deep learning model would extract features from MAG3 renal scans that can predict renal complications in children with ANH. STUDY DESIGN We performed a case-control study of MAG3 studies drawn from a population of children with ANH concerning for ureteropelvic junction obstruction evaluated at our institution from January 2009 until June of 2021. The outcome was renal complications that occur ≥6 months after an equivocal MAG-3 renal scan. We created two machine learning models: a deep learning model using the radiotracer concentration versus time data from the kidney of interest and a random forest model created using clinical data. The performance of the models was assessed using measures of diagnostic accuracy. RESULTS We identified 152 eligible patients with available images of which 62 were cases and 90 were controls. The deep learning model predicted future renal complications with an overall accuracy of 73% (95% confidence inteveral [CI] 68-76%) and an AUC of 0.78 (95% CI 0.7, 0.84). The random forest model had an accuracy of 62% (95% CI 60-66%) and an AUC of 0.67 (95% CI. 0 64, 0.72) DISCUSSION: Our deep learning model predicted patients at high risk of developing renal complications following an equivocal renal scan and discriminate those at low risk with moderately high accuracy (73%). The deep learning model outperformed the clinical model built from clinical features classically used by urologists for surgical decision making. CONCLUSION Our models have the potential to influence clinical decision making by providing supplemental analytical data from MAG3 scans that would not otherwise be available to urologists. Future multi-institutional retrospective and prospective trials are needed to validate our model.
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Affiliation(s)
- J K Weaver
- Division of Urology Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - J Logan
- Division of Urology, Children's Hospital of Philadelphia, PA, USA; Department of Biostatistics, Epidemiology and Informatics and Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - R Broms
- Division of Urology, Children's Hospital of Philadelphia, PA, USA
| | - M Antony
- Division of Urology, Children's Hospital of Philadelphia, PA, USA
| | - M Rickard
- Division of Urology for Sick Children, Toronto, ON, Canada
| | - L Erdman
- Division of Urology for Sick Children, Toronto, ON, Canada
| | - R Edwins
- Division of Urology Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - R Pominville
- Division of Urology Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - J Hannick
- Division of Urology Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - L Woo
- Division of Urology Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - B Viteri
- Division of Nephrology, Children's Hospital of Philadelphia, PA, USA
| | - N D'Souza
- Division of Urology, Children's Hospital of Philadelphia, PA, USA
| | - S E Viswanath
- Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - C Flask
- Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - A Lorenzo
- Division of Urology for Sick Children, Toronto, ON, Canada
| | - Y Fan
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - G E Tasian
- Division of Urology, Children's Hospital of Philadelphia, PA, USA; Department of Biostatistics, Epidemiology and Informatics and Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Liu C, Chen R, Lu B, Tang H. Splenic rupture mimicking acute abdomen caused by giant hydronephrosis: A thorny case. Asian J Surg 2023; 46:4483-4484. [PMID: 37179186 DOI: 10.1016/j.asjsur.2023.04.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Affiliation(s)
- Chenming Liu
- Shaoxing People's Hospital, Shaoxing, 312000, China; Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Ruanchang Chen
- Shaoxing People's Hospital, Shaoxing, 312000, China; School of Medicine, ShaoXing University, Shaoxing, 312000, China
| | - Baochun Lu
- Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Haijun Tang
- Shaoxing People's Hospital, Shaoxing, 312000, China.
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Li Q, DU L, Ma ZY, Xue WY, Wang YX, Qi JC. [A comparative study of transcolonic and paracolic laparoscopic pyeloplasty in children with UPJO]. Zhonghua Nan Ke Xue 2023; 29:928-933. [PMID: 38639664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Comparing the laparoscopic pyeloplasty via the mesocolon and para-colonic gutter approach for the treatment of pediatric pelvi-ureteric junction obstruction (UPJO) induced simple hydronephrosis, and analyzing the potential factors influencing surgical outcomes. METHODS Clinical data of 71 children with UPJO who underwent laparoscopic pyeloplasty at the Department of Urology of the Second Hospital of Hebei Medical University from January 2020 to January 2023 were analyzed. The patients, aged 0.25 to 18 years, were divided into two groups: 30 cases underwent the transcolonic route (mesangial group) and 41 cases underwent the transcolonic paragutter route (paragrow group). RESULTS showed that both surgical approaches had similar outcomes in terms of operation completion, smooth process, absence of laparotomy, operation time, intraoperative blood loss, postoperative feeding time, and postoperative drainage tube indwelling time, total hospitalization cost, surgical effect, and satisfaction. Common complications such as postoperative fever and abdominal pain were managed with drug treatment or observation, with no need for secondary surgery or fatal complications. Factors such as age, body mass index, preoperative symptoms, severity of hydronephrosis, and ABO blood group classification did not impact the surgical outcome. CONCLUSIONS There was no statistically significant difference between laparoscopic pyeloplasty and another surgical method in terms of various surgical outcomes for children with ureteropelvic junction obstruction. Factors such as age, body mass index, preoperative symptoms, severity of hydronephrosis, and ABO blood group classification did not have a significant impact on the surgical outcome.
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Affiliation(s)
- Qian Li
- Department of Urology,The Second Hospital of Hebei Medical University, Shi Jiazhuang, Hebei 050000, China
| | - Lei DU
- Department of Urology,The Second Hospital of Hebei Medical University, Shi Jiazhuang, Hebei 050000, China
| | - Zi-Yue Ma
- Department of Urology,The Second Hospital of Hebei Medical University, Shi Jiazhuang, Hebei 050000, China
| | - Wen-Yong Xue
- Department of Urology,The Second Hospital of Hebei Medical University, Shi Jiazhuang, Hebei 050000, China
| | - Ya-Xuan Wang
- Department of Urology,The Second Hospital of Hebei Medical University, Shi Jiazhuang, Hebei 050000, China
| | - Jin-Chun Qi
- Department of Urology,The Second Hospital of Hebei Medical University, Shi Jiazhuang, Hebei 050000, China
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Ou Y, Zhang G, Zhu X, Yin H, Gou X, Deng Y. Evaluation of risk factors, treatment options, and prognostic-related factors in patients with benign ureteral strictures: An 8-year single-center experience. Int J Urol 2023; 30:847-852. [PMID: 37287392 DOI: 10.1111/iju.15211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the etiology, therapeutic effect, and prognosis-related factors of benign ureteral strictures. METHODS We analyzed the date of 142 patients with benign ureteral strictures from 2013 to 2021. Ninety-five patients received endourological treatment and 47 patients underwent reconstruction. Preoperative, intraoperative, and postoperative information were compared and analyzed. Symptomatic improvement and radiographic blockage alleviation defined therapeutic success. RESULTS Stone-related factors caused 85.2% of cases. The overall success rate of endourological treatment was 51.6% versus 95.7% of reconstruction (p < 0.01). However, endourological treatment was better in terms of postoperative hospital stay time, operation time, and intraoperative blood loss (p < 0.001). In endourological group, patients with stricture length ≤2 cm, mild-to-moderate hydronephrosis, proximal or distal stricture had a higher success rate. Multivariate regression analysis showed that the surgical method was the only independent risk factor affecting success and recurrence. Reconstruction success rate was higher than endourological treatment (p = 0.001, OR 0.057, 95% CI (0.011-0.291)), and recurrence rate was also lower (p = 0.001, HR 0.074, 95% CI (0.016-0.338)). No obvious recurrence was seen in reconstruction, and the median recurrence time in endourological treatment was 51 months. CONCLUSIONS Stone-related factors are an important cause of benign ureteral strictures. Reconstruction is the gold standard treatment due to its high success rate and low recurrence rate. Endourological therapy is also preferred as the initial treatment in proximal or distal ureter with length ≤2 cm and mild-to-moderate hydronephrosis. Further close follow-up is required after treatment.
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Affiliation(s)
- Yangjie Ou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Guoqing Zhang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xin Zhu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Hubing Yin
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xin Gou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuanzhong Deng
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Högberg L, Värelä S, Anderberg M, Salö M. Sex differences in children operated with pyeloplasty for pelvoureteric junction obstruction. Pediatr Surg Int 2023; 39:270. [PMID: 37682361 PMCID: PMC10491548 DOI: 10.1007/s00383-023-05543-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE Pelvoureteric junction obstruction (UPJO) is a common cause of hydronephrosis in children but no previous studies have evaluated differences between boys and girls operated with pyeloplasty. This study aimed to evaluate potential differences between sexes in children operated with pyeloplasty for PUJO in terms of presentation, surgery, and long-term results. METHODS Data was retrospectively collected from all children operated on with pyeloplasty between January 2002 and December 2020. Data contained several variables covering presentation, surgery, and long-term results. RESULTS In total, 194 patients were included of which 126 (64.9%) were boys. There were no significant differences in prenatal findings, pelvic dilation on ultrasound, function of the affected kidney, surgical method, obstruction type, resolution of hydronephrosis, or improvement of function. Boys presented with pain more often than girls (47.4 vs 25.0%, p < 0.01) while girls were more prone to infections preoperatively (17.2 vs 7.0%, p = 0.04). All nine patients requiring reoperation were boys (p = 0.03). CONCLUSION Girls with UPJO seem to experience infections as presenting symptoms more often than boys, while boys significantly more often present with pain. There is also a higher percentage of boys needing reoperation.
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Affiliation(s)
- Linnea Högberg
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Sanni Värelä
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, 221 85, Lund, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Magnus Anderberg
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, 221 85, Lund, Sweden
| | - Martin Salö
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden.
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, 221 85, Lund, Sweden.
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Sharifiaghdas F, Saberi N. Mechanical Ablation of the Posterior Urethral Valve Omitting Thermal Energy: A Brief Report. Iran J Med Sci 2023; 48:510-515. [PMID: 37786465 PMCID: PMC10541541 DOI: 10.30476/ijms.2022.95313.2660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/15/2022] [Accepted: 09/20/2022] [Indexed: 10/04/2023]
Abstract
Management of the posterior urethral valve (PUV) is a clinical challenge in pediatric urology. We report the results of a modified valve ablation method without using a pediatric resectoscope and thermal energy. Patients were selected from children with PUV who were referred to the pediatric urology clinic of Shahid Labbafinejad Hospital, Tehran, Iran, and have undergone endoscopic valve ablation surgery between May 2019 to May 2021. Ten male patients with PUV underwent mechanical valve ablation without the use of the conventional pediatric resectoscope, and thermal energy was replaced by a 6F semi-rigid urethroscope and 3Fr ureteral catheter. Patients were assessed both pre-and postoperatively using serum creatinine, urinary tract ultrasound imaging, and voiding cystourethrography. The mean age was 23.88±30.13 months (range= 25 days to 8 years). Four out of 10 patients (40%) had elevated serum creatinine, and seven had unilateral or bilateral hydroureteronephrosis (70%). No major complications were reported according to Clavien-Dindo Classification System. The level of serum creatinine, the grade of hydroureteronephrosis, and the ratio of the prostatic urethra to anterior urethra diameter in postoperative voiding cystourethrography were decreased. A decrease in serum creatinine level occurred in patients after valve ablation, but this decrease was not statistically significant (P=0.059). The decrease in hydroureteronephrosis grade on the right (P=0.006) and left (P=0.022) was statistically significant. There was no evidence of urethral stenosis or need for repeating resection. It can be concluded that our mechanical valve ablation method might be a safe and effective technique for PUV ablation.
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Affiliation(s)
- Farzaneh Sharifiaghdas
- Department of Urology, School of Medicine, Shahid Beheshti University of Medical Sciences, Shahid Labafinejad Hospital, Urology and Nephrology Research Center, Tehran, Iran
| | - Narjes Saberi
- Department of Urology, Isfahan Kidney Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Laminette PJ, Trout NJ, Noonan B, Viani E. Ureteroneocystostomy for treatment of struvite urolithiasis in a ferret. J Am Vet Med Assoc 2023; 261:1-4. [PMID: 37217174 DOI: 10.2460/javma.23.01.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the clinical outcome of a ferret undergoing a ureteroneocystostomy for treatment of urolithiasis. ANIMAL A 10-month-old spayed female ferret. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES The ferret was evaluated for straining to urinate and defecate, hematochezia, and a rectal prolapse. Plain radiographs revealed large cystic and ureteral calculi. Clinicopathologic analyses indicated the ferret was anemic with an elevated creatinine concentration. Exploratory laparotomy defined bilateral ureteral calculi that were unable to be successfully moved into the bladder. A cystotomy was performed to remove a large cystic calculus. Serial abdominal ultrasonographic examinations showed progressive hydronephrosis of the left kidney and persistent pyelectasia of the right kidney secondary to bilateral ureteral calculi. This confirmed a left ureteral obstruction secondary to the distal calculus while the right ureter remained patent. TREATMENT AND OUTCOME A ureteroneocystostomy was performed to allow for left renal decompression. The ferret recovered well despite worsening hydronephrosis of the left kidney in the perioperative period. The ferret was discharged from the hospital 10 days after initial evaluation. At 3-week follow-up, abdominal ultrasonography confirmed resolution of hydronephrosis and ureteral dilation of the left kidney and ureter. CLINICAL RELEVANCE A ureteroneocystostomy successfully allowed renal decompression and ureteral patency in a ferret with urolithiasis. To the authors' knowledge, this is the first time this procedure has been reported in a ferret for treatment of a ureteral calculus obstruction and may result in good long-term outcome.
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Dhani FK, Daryanto B, Seputra KP. Survival Outcome of Urinary Diversion in Advanced Cervical Cancer Patients with Hydronephrosis. Asian Pac J Cancer Prev 2023; 24:2641-2646. [PMID: 37642049 PMCID: PMC10685218 DOI: 10.31557/apjcp.2023.24.8.2641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Urinary diversion is the treatment of choice for cervical cancer patients with urinary tract obstruction. The aim of this study is to determine the survival rate among advanced cervical cancer patients with hydronephrosis who undergo urinary diversion and factors that affect patient survival. METHODS Clinical data of cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) Stage-IIIB or advanced cervical cancer were not surgical candidates admitted to Saiful Anwar Hospital, Malang from May 2016 to August 2022 were retrospectively analyzed. The parameters including age, cancer stage, comorbidity, cancer treatment at diagnosis, hydronephrosis treatment, grade, site, and survival, were analyzed using the IBM SPSS Statistics version 21. The significance level was set up to 0.05. RESULT One hundred eighteen patients were included in this study. Most patients were under 60 (84.75%) and presented with stage IIIB (79.66%). Diabetes mellitus type 2 (8.47%), hypertension (7.63%), acute kidney injury (16.10%), and chronic kidney disease (36.78%) were comorbidities discovered in patients. More than half of patients received chemotherapy (54.24%). Ureteral stents were inserted in 85.59% of patients. Patients with moderate hydronephrosis were the most common, accounting for 67.80% of all cases. Patients with bilateral hydronephrosis outnumber those with unilateral by 91.53% to 8.47%. The survival rate did not differ significantly between ureteral stents (median survival was 11.00 months) and percutaneous nephrostomies (median survival was 15.00 months), p=0.749. In univariate analysis, age, cancer stage, and hydronephrosis stage were associated with worse 1-year survival. In multivariate analysis, age, DM type 2, cancer staging and hydronephrosis staging were associated with worse 1-year survival. CONCLUSION In advanced cervical cancer patients, urinary diversion techniques such as ureteral stents and percutaneous nephrostomy offer similar survival rates. In addition, age, cancer stage, DM type 2, and hydronephrosis site are strong predictors of a worsening survival rate in patients.
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Affiliation(s)
| | - Besut Daryanto
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Saiful Anwar Hospital, Malang, Indonesia.
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Mao CK, Deng QF, Chu H, Peng B, Liu X, Yu X, Tao CP, Yang C, Zhang T, Zhou XL, Cao YS. Unintended placement of a double-J stent in the contralateral renal pelvis during laparoscopic pyeloplasty for pediatric hydronephrosis: a case report. Eur Rev Med Pharmacol Sci 2023; 27:7688-7692. [PMID: 37667946 DOI: 10.26355/eurrev_202308_33422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
BACKGROUND The double-J stent (DJS) is a commonly used ureteral stent in urological surgeries, which provides support and drainage. However, the DJS may result in various complications such as infection, hematuria, stone formation, stent occlusion, and migration. Normally, one end of the DJS is located in the renal pelvis, and the other end in the bladder. In this case report, we describe the rare occurrence of a misplaced DJS during laparoscopic pyeloplasty, which was unintentionally placed in the contralateral renal pelvis. CASE REPORT A 4-month-old male infant was diagnosed with left hydronephrosis. After confirmation of the diagnosis, laparoscopic left pyeloplasty was performed with the placement of a DJS. The patient did not experience any discomfort, such as nausea, vomiting, refusal to feed, crying and restlessness, or fever, after the operation, and was discharged on postoperative day 4. The patient returned to the hospital for DJS removal 6 weeks after the operation. However, the kidneys, ureters, and bladder (KUB) X-ray examination showed that the DJS was unintentionally placed in the contralateral ureter and renal pelvis. The stent was confirmed and removed under cystoscopy. Postoperative examination of the DJS showed that there was a hole in the side of the middle of the stent for urine drainage, with no obstruction or contralateral hydronephrosis. CONCLUSIONS Misplacement of a DJS in the contralateral renal pelvis during laparoscopic pyeloplasty is a rare but potentially serious complication. Surgeons should be cautious when placing the stent and confirm its placement with imaging studies. Patients should be closely monitored for postoperative complications and prompt intervention should be taken if necessary.
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Affiliation(s)
- C-K Mao
- Department of Urology, Anhui Provincial Children's Hospital, Anhui Province, Hefei, China.
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Batra VS, Singh M, Kathuria S, Jain S, Rasool S, Gupta M, Pandey H, Sharma A. Minimally invasive ureterolysis and intraperitonealization of ureter for idiopathic retroperitoneal fibrosis; single center analysis of an erratic disease. Urologia 2023; 90:535-541. [PMID: 35730727 DOI: 10.1177/03915603221104047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Idiopathic retroperitoneal fibrosis is a known cause of obstructive uropathy. Ureterolysis is done when medical management fails or the presentation is at an advanced stage. Conventionally ureterolysis without omental wrap has been considered incomplete. Our Institute has experience of laparoscopic or robotic ureterolysis with intraperitonealization of the ureter alone and no other adjunctive procedure. This study retrospectively assesses the result of the procedure with patients presenting with varying severity of disease. METHODS From 2008, all patients who underwent laparoscopic or robotic ureterolysis were analyzed retrospectively for pre-operative management, operative findings, and post operative outcomes. RESULTS We operated and released nine renal units in seven patients. Two of the nine cases were performed robotically completely and the rest was performed by laparoscopic approach. Median follow up was 60 months. All patients documented resolution of symptoms. The mean post-operative creatinine at 1 year was significantly decreased to 1.47 ± 0.49 mg/dl in comparison to preoperative creatinine (p < 0.05). The postoperative mean ESR decreased significantly from a preoperative value of 58.2 ± 19.41 mm to 15.8 ± 17.23. The nuclear scan revealed unobstructed drainage and radiological imaging revealed resolution of hydronephrosis and fibrosis in all. The mean GFR on the nuclear scan after 3 and 12 months of surgery was 36.3 ± 4.33 and 40 ± 3.77, respectively. Thus, there was significant increase noted in GFR at 3 and 12 months in comparison to preoperative GFR (p < 0.05). CONCLUSION Laparoscopic/robotic ureterolysis with intraperitonealization alone is secure and durable procedure for idiopathic retroperitoneal fibrosis needing surgical release.
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Affiliation(s)
| | | | | | - Saurabh Jain
- Department of Urology, Sir Ganga Ram Hospital, Delhi, India
| | | | - Manu Gupta
- Department of Urology, Sir Ganga Ram Hospital, Delhi, India
| | | | - Ajay Sharma
- Department of Urology, Sir Ganga Ram Hospital, Delhi, India
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Nunes RSS, Suartz CV, Andrade HS, Jordão RD, Srougi V, Mitre AI, Nahas WC, Arap MA. Laparoscopic Ureterocalicostomy Technique. Int Braz J Urol 2023; 49:517-518. [PMID: 37267617 PMCID: PMC10482455 DOI: 10.1590/s1677-5538.ibju.2022.0521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/19/2023] [Indexed: 06/04/2023] Open
Abstract
PURPOSE Ureterocalicostomy is a technique that was first described by Neuwirt in 1948 (1) The laparoscopic access was initiated in 2003 by Cherullo et al. (2), following the established principles of open surgery. In 2004, Gill et al. had two patients with UPJO treated with laparoscopic ureterocalicostomy, with success (3). In 2014, Arap et. al. presented a case series with good results in adults and children in our service (4). There are factors that prepare the surgeon for an ureterocalicostomy, such as the renal cortex thickness, although the decision is mainly taken during the procedure (5). MATERIAL AND METHODS A 24 years-old female patient with right lumbar pain was referred to our institution. She already had a right open pyeloplasty two years ago. The CT scan presented a right hydronephrotic kidney, DMSA scan with 30% of relative function and a DTPA scan with an obstructive pattern. RESULTS A laparoscopic ureterocalicostomy was performed due to the intra-operative findings (inferior kidney pole thickness and challenging access to the uretero-pelvic junction). The overall time was 130 minutes with no complications. The patient was discharged in two days and the double J was withdrawn in four weeks. The CT scan within one year demonstrates a reduction of the hydronephrosis. She had no more lumbar pain. CONCLUSION In complex cases, the laparoscopic ureterocalicostomy proves to be a safe and efficient procedure, with a free tension-free anastomosis and the advantages of the laparoscopic access.
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Affiliation(s)
- Romulo S. S. Nunes
- Universidade de São PauloDepartamento de Videolaparoscopia em UrologiaSão PauloSPBrasilDepartamento de Videolaparoscopia em Urologia, Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Caio V. Suartz
- Universidade de São PauloDepartamento de Videolaparoscopia em UrologiaSão PauloSPBrasilDepartamento de Videolaparoscopia em Urologia, Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Hiury S. Andrade
- Universidade de São PauloDepartamento de Videolaparoscopia em UrologiaSão PauloSPBrasilDepartamento de Videolaparoscopia em Urologia, Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Ricardo D. Jordão
- Universidade de São PauloDepartamento de Videolaparoscopia em UrologiaSão PauloSPBrasilDepartamento de Videolaparoscopia em Urologia, Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Victor Srougi
- Universidade de São PauloDepartamento de Videolaparoscopia em UrologiaSão PauloSPBrasilDepartamento de Videolaparoscopia em Urologia, Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Anuar I. Mitre
- Universidade de São PauloDepartamento de Videolaparoscopia em UrologiaSão PauloSPBrasilDepartamento de Videolaparoscopia em Urologia, Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - William C. Nahas
- Universidade de São PauloDepartamento de Videolaparoscopia em UrologiaSão PauloSPBrasilDepartamento de Videolaparoscopia em Urologia, Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Marco A. Arap
- Universidade de São PauloDepartamento de Videolaparoscopia em UrologiaSão PauloSPBrasilDepartamento de Videolaparoscopia em Urologia, Universidade de São Paulo - USP, São Paulo, SP, Brasil
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Li B, Ramesh S, McGrath M, Braga LH. Association of the Hydronephrosis Severity Score With Likelihood of Pyeloplasty: A Large Prospective Database Analysis. Urology 2023; 177:162-168. [PMID: 37088315 DOI: 10.1016/j.urology.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To apply and reproduce this scoring system in our prenatal hydronephrosis population with ureteropelvic junction obstruction (UPJO)-like hydronephrosis (HN), specifically looking at determining better HHS cutoffs that would allow for stratification into three risk categories: spontaneous HN resolution, observation, and surgery. METHODS A prospectively collected prenatal hydronephrosis database was reviewed to extract UPJO-like HN patients. Children with vesicoureteral reflux, primary megaureter, bilateral HN, and other associated anomalies were excluded. Only patients who had an ultrasound and mercaptoacetyltriglycine renal scan at a minimum of 2-time points were included. Hydronephrosis Severity Score was calculated at the initial, interim, and last follow-up clinic visits. Scores were analyzed regarding its usefulness to determine which patients would have been more likely to undergo pyeloplasty. RESULTS Of 167 patients, 131 (78%) were male, 119 (71%) had left UPJO-like, and 113 (67%) had a pyeloplasty. The median age at baseline was 2months (interquartile range 1-4). According to initial (first clinic visit) Hydronephrosis Severity Score, 5/36 (14%) patients with a 0-4 score, 93/116 (80%) with a 5-8 score, and 15/15 (100%) with a 9-12 score underwent pyeloplasty, respectively (P < .01). CONCLUSION The proposed HHS system for UPJO-like HN patients is reproducible, however, cut-off values need to be reassessed to accurately reflect true risk categories, as the purpose of this system is to differentiate those who have HN severe enough to require intervention from those who can be managed nonsurgically. Changing risk groups to mild (0-3), moderate (4-6), and severe (7-12) allowed for better discrimination between patients who underwent surgical intervention from those who did not in our dataset.
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Affiliation(s)
- Bruce Li
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Smruthi Ramesh
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Melissa McGrath
- McMaster Pediatric Surgical Research Collaborative, McMaster University, Hamilton, Ontario, Canada
| | - Luis H Braga
- McMaster Pediatric Surgical Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Urology, McMaster University, Hamilton, Ontario, Canada.
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Black M, Slade A, Caras RJ, DeLeon GA, Large T, Shelton TM, Tong Y, Rivera M. Evaluation of Renal Function Recovery After Holmium Laser Enucleation of the Prostate in Patients with Chronic Kidney Disease. J Endourol 2023; 37:817-822. [PMID: 37212242 DOI: 10.1089/end.2023.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Introduction: Holmium laser enucleation of the prostate (HoLEP) has become a new surgical gold standard treatment for benign prostatic hyperplasia (BPH). It is known that untreated BPH can lead to bladder outlet obstruction (BOO). A positive correlation exists between BOO and chronic kidney disease (CKD), but stability or recovery of renal function after HoLEP remains unknown. We sought to describe changes in renal function after HoLEP in men with CKD. Methods: A retrospective study was conducted of patients who underwent HoLEP with glomerular filtration rates (GFRs) <60, CKD stages III to V. Pre- and postoperative GFRs were selected within 3 months before the operation and within 1 year postoperatively. The presence of an indwelling catheter, preoperative hydronephrosis, history of kidney stones, and prostate size were also reviewed. Data were analyzed in accordance with preoperative CKD stage. Results: Of the reviewed patients, 138 met inclusion criteria with CKD stages III to V. Each CKD group was without significant postoperative complications. There was a significant increase between pre- and postoperative GFR for patients in CKD stages III (n = 116) and IV (n = 17) (p < 0.0001 and p = 0.010, respectively). The mean increase between pre- and postoperative GFR for the CKD stages III and IV patients were 6.4 and 6.49, respectively. There was no correlation between presence of preoperative hydronephrosis, history of kidney stones, catheter dependency, nor prostate size on change in postoperative GFR (p > 0.05). Conclusion: These findings suggest that patients in CKD stages III or IV undergoing HoLEP experience an increase in GFR. It is noteworthy that there appears to be no decline in renal function postoperatively in any group. HoLEP represents an excellent surgical option for patients with preoperative CKD and may prevent further renal decline.
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Affiliation(s)
- Morgan Black
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Austen Slade
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ronald Joseph Caras
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Genaro A DeLeon
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas M Shelton
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yan Tong
- Department of Biostatistics, Indiana University School of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Du J, Zhan H, Chen J, Wang J, Fu S, Ding M, Luan T, Wei H, Yang C. The Influence of Preoperative Hydronephrosis on the Prognosis after Radical Cystectomy among Patients with Different Pathological Stages of Bladder Cancer. Urol Int 2023; 107:698-705. [PMID: 37271139 DOI: 10.1159/000531080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/06/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Preoperative hydronephrosis is closely associated with the prognosis of patients with bladder cancer. This study assesses the effect of preoperative hydronephrosis on the prognosis after radical cystectomy (RC) among patients with different pathological stages of bladder urothelial carcinoma. METHODS We retrospectively analyzed the clinical data of 231 patients who underwent RC because of bladder urothelial carcinoma at our institution from January 2013 to December 2017. The overall survival (OS) in patients with or without preoperative hydronephrosis was followed up and compared, and the prognostic role that preoperative hydronephrosis played in patients with different pathological stages of bladder cancer was analyzed. Multivariate analysis was performed with the help of Cox proportional hazards regression models, the postoperative survival was analyzed with the help of Kaplan-Meier plots and log-rank test, and the p values of multiple testing were corrected using the Bonferroni correction. RESULTS Of 231 patients, 96 were patients with preoperative hydronephrosis and 115 patients had died by the end of the follow-up. Survival analysis found the 3- and 5-year survival rates after radical surgery of patients with preoperative hydronephrosis were significantly lower than those of patients without preoperative hydronephrosis (p < 0.001). Multivariate analysis found preoperative hydronephrosis, T stage of tumor, and lymphatic metastasis were independent influencing factors of postoperative OS (p < 0.05). Survival analysis of subgroups according to pathological stages found in pT3-4N0M0 patients had a significant difference in postoperative survival between the group with preoperative hydronephrosis and the group without preoperative hydronephrosis (p < 0.0001). CONCLUSION The results indicate that preoperative hydronephrosis mainly affects postoperative OS in the patients whose pathological stage of bladder cancer is pT3-4N0M0.
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Affiliation(s)
- Jingwei Du
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Hui Zhan
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Jian Chen
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Jiansong Wang
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Shi Fu
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Mingxia Ding
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Ting Luan
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Hairong Wei
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Chengcai Yang
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
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Reed F, Recabal X, Echeverría P, Braga LH, Cherian A, Gatti JM, Garcia-Aparicio L, Perez-Bertolez S, de Badiola F, Bujons A, Moldes JM, Mushtaq I, López PJ. Are weight or age limits for pediatric laparoscopic pyeloplasty? Results of a multicentric study. World J Urol 2023; 41:1675-1679. [PMID: 36947174 DOI: 10.1007/s00345-023-04359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/21/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Anderson-Hynes pyeloplasty is the technique of choice for the treatment of pyeloureteral junction obstruction (PUJO) with an excellent success rate. Minimally invasive surgery has become the standard of care for the management of PUJO in children. Although it has been comparable to the open approach at all levels, its diffusion or employment in younger children has not been widely adopted. Our aim is to evaluate laparoscopic pyeloplasty outcomes from international academic centers in children under 1 year of age, focusing on feasibility and outcomes including possible complications. MATERIALS AND METHODS This is review of consecutive infants under 1 year of age who underwent laparoscopic pyeloplasty between 2009 and 2018 with more than 12 months of follow-up. Seven different training centers with different backgrounds participated in this study. Evaluation was carried out with ultrasound and renogram before and after surgery. Demographic data, perioperative characteristics, complications, and results are described and analyzed. RESULTS Over 9 years, 124 transperitoneal laparoscopic Anderson-Hynes pyeloplasties were performed on 123 children under 1 year of age; 88 males and 35 females, with 1 case of bilateral PUJO. Of the 124 renal units, 86 were left-sided. Mean age at surgery was 6.6 months (1 week-12 months), with 56% (n = 70) done before 6 months of age. Mean weight at surgery was 6.8 kg (3-12 kg), with 59% (n = 73) weighing less than 8 kg. Mean operative time (skin-to-skin) was 150 min (75-330 min). After a mean follow-up of 46 months (12-84 months), 12 (9%) patients developed complications, with only 1 needing a redo pyeloplasty also done laparoscopically. One child, with deterioration in renal function, underwent nephrectomy. CONCLUSION Laparoscopic pyeloplasty under 1 year of age and/or less than 12 kilos is feasible with lower complication rate. Furthermore, age younger than 6 months and weight less than 8 kg are no longer limiting factors for a successful pyeloplasty as shown by this multicentre study.
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Affiliation(s)
- Francisco Reed
- Hospital Exequiel González Cortés and Clínica Alemana, Santiago, Chile.
- Pediatric Urology Service, Hospital Dr. Exequiel González Cortés and Clínica Alemana, Universidad de Chile, Av Gran Avenida 3300, San Miguel, Santiago, Chile.
| | | | | | | | | | | | | | | | | | | | | | | | - Pedro-José López
- Hospital Exequiel González Cortés and Clínica Alemana, Santiago, Chile
- McMaster University, Hamilton, Canada
- Great Ormond Street Hospital, London, England
- Children's Mercy Hospital, Kansa City, MO, USA
- Hospital Saint Joan de Deu, Barcelona, Spain
- Hospital Italiano, Buenos Aires, Argentina
- Fundación Puigvert, Barcelona, Spain
- Facultad Medicina, Servicio Pediatria y Cirugia Infantil, Universidad de Chile, Santiago, Chile
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Hodhod A, Fermin-Risso C, Farhad M, Cook AJ, Aburezq J, Eid H, Weber BA. Can we improve the usefulness of the diuretic renogram in the diagnosis of ureteropelvic junction obstruction (UPJO) in children? Introduction of mercaptoacetyltriglycine-suspected obstruction scoring system (MAG-SOS). J Pediatr Urol 2023; 19:311.e1-311.e8. [PMID: 36922332 DOI: 10.1016/j.jpurol.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Mercaptoacetyltriglycine (MAG-3) renogram is one of the gold standard diagnostic tools of ureteropelvic junction obstruction (UPJO); however, there is no widely agreed indications of pyeloplasty based on MAG-3 findings. In this study, we introduce a renogram scoring system that can help improve the prognostic value of MAG-3 renogram and in the decision making of pyeloplasty. PATIENTS AND METHODS We retrospectively reviewed consecutive pyeloplasties for antenatal hydronephrosis from 2010 to 2020. A control group was included of non-operatively managed SFU grade 3 and 4. The initial renal ultrasound and preoperative MAG-3 Lasix renogram were reviewed for differential renal function (DRF), type of renogram curve and tracer washout half-time (T1/2). A ROC curve was used to evaluate the cut-off points that can be associated with obstruction. A multivariate linear regression model was used to assess the best renogram parameter that can predict surgical intervention. RESULTS We included 188 patients with 209 renal units. The median age for pyeloplasty was 5.4 months. The mercaptoacetyltriglycine-Suspected Obstruction Scoring System (MAG-SOS) was associated with pyeloplasty (AUC = 0.97, P < 0.001) (Figure A). A score of 5 is 100% specific for obstruction. 78% of units required surgical intervention had a MAG-SOS score of≥5 while all units of the control group had a range of score 0-4. Using the multivariate analysis, the MAG-SOS system showed to the only independent predictor for pyeloplasty (HR = 0.03, p < 0.001). DISCUSSION This study has some limitations. Firstly, the retrospective nature of the cohort; however, all patients were reviewed by one investigator who was blinded to the line of management. This is a single institutional study; therefor, this MAG-SOS should be evaluated by other centers to ensure its efficiency. Lastly, the pyeloplasty decision was taken by 3 different urologists; nevertheless, all of them adopt the same indications which are similar to those of the Society for Pediatric Urology and the Canadian Urological Association guidelines. CONCLUSION The MAG-SOS system showed to be a useful tool that can predict pyeloplasty. A score of 5 has 100% specificity for patients having a pyeloplasty performed. Prospective studies are required to confirm the usefulness of this novel tool.
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Affiliation(s)
- Amr Hodhod
- Pediatric Urology, Alberta Children's Hospital, Calgary, AB, Canada.
| | | | - Mutaz Farhad
- Pediatric Urology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Anthony J Cook
- Pediatric Urology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Jarrah Aburezq
- Pediatric Urology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Hadeel Eid
- Pediatric Radiology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Bryce A Weber
- Pediatric Urology, Alberta Children's Hospital, Calgary, AB, Canada
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Yang C, Cao YS, Peng B, Chu H, Zhang ZQ. Influencing factors of laparoscopic pelvic urethroplasty in the treatment of children with hydronephrosis. Eur Rev Med Pharmacol Sci 2023; 27:4421-4427. [PMID: 37259722 DOI: 10.26355/eurrev_202305_32447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical efficacy of laparoscopic pyeloureteroplasty in the treatment of children suffering from hydronephrosis. PATIENTS AND METHODS Our pediatric department received 160 children with hydronephrosis from January 2019 through December 2021. These children were randomly assigned to either the control group or the study group with 80 cases in each group. The control group underwent traditional open pyeloureteroplasty, while the study group underwent laparoscopic pyeloureteroplasty. After assessing the results of both groups, the clinical outcomes were compared. RESULTS The study group had a significantly shorter operating time, lower intraoperative bleeding rate, and shorter hospital stay than the control group. On the first day after the operation, there was no significant difference between the control and study groups, and on the seventh day after the operation, the study group's OPS was significantly lower than that of the control group. A significant difference was observed after treatment between the study group and the control group in terms of the anteroposterior diameter of the renal pelvis. Both groups' GFR increased significantly with time, and the GFR of the study group was significantly greater than that of the control group at 3 months after the operation, but there was no significant difference at 6 months after the operation. Postoperative adverse effects did not differ significantly between the two groups. CONCLUSIONS Pediatric laparoscopic pyeloureteroplasty can reduce intraoperative bleeding, shorten operation time and hospital stay, alleviate postoperative pain, and promote the recovery of postoperative renal morphology and function in children with hydronephrosis, which merits further discussion.
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Affiliation(s)
- C Yang
- Department of Urology Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.
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Li J, Cao H, Peng K, Chen R, Sun X. Hydronephrosis in patients with cervical cancer: An improved stent-change therapy for ureteral obstruction Stent-change for ureteral obstruction in cervical cancer. Eur J Obstet Gynecol Reprod Biol 2023; 283:49-53. [PMID: 36773470 DOI: 10.1016/j.ejogrb.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/12/2022] [Accepted: 01/22/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Ureteral stent replacement is a routine treatment for hydronephrosis in patients with cervical cancer. We developed an improved ureteral stent-change operation for hydronephrosis in cervical cancer patients and compared its outcomes with traditional stent change procedures. STUDY DESIGN Clinical data of hydronephrosis in cervical cancer patients who were admitted to our hospital from August 2014 to October 2019 were analyzed. We retrospectively reviewed 131 cervical cancer patients, out of which 43 cases included patients in the improved operation group, whereas 88 patients with hydronephrosis followed the traditional ureteral stent-change operation for ureteral obstruction. The outcomes of the two procedures were compared using the propensity score matching method. RESULTS As opposed to the traditional ureteral stent change strategy, the patients in the improved group required shorter operation time (p = 0.001) and higher success rate (p = 0.004). The FIGO stage (p = 0.046), the level of ureteral obstruction (p = 0.027), radiotherapy history (p = 0.01), stent replacement times (≤2times or > 2times) (p = 0.001), and serum creatinine level (≤200 μmol/L or > 200 μmol/L) (p < 0.001) were significantly different between the two groups before propensity score matching. Propensity score matching analysis was used to eliminate the clinical differences of 43 patients in the traditional group; however, the span of visual hematuria during the surgical complications was not included (p = 0.026) in the results. CONCLUSION An improved ureteral stent change operation is an advanced treatment option for cervical cancer patients suffering from hydronephrosis. In contrast to traditional ureteral stent change techniques, our developed strategy lowers complications such as visual hematuria but improves the success.
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Affiliation(s)
- Jie Li
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Haiming Cao
- Department of Andrology, the Reproductive Medicine Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China.
| | - Kang Peng
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Renfu Chen
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiaolei Sun
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, China.
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Zhang X, Zhang Y, Li F, He W, Cao X. Total tubeless percutaneous nephrolithotomy without artificial hydronephrosis in preschool children: Three case reports. Medicine (Baltimore) 2023; 102:e33415. [PMID: 37000074 PMCID: PMC10063253 DOI: 10.1097/md.0000000000033415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/21/2023] [Accepted: 03/10/2023] [Indexed: 04/01/2023] Open
Abstract
RATIONALE Indwelling ureteral catheter, double J tube, or nephrostomy tube are routine procedures for percutaneous nephrolithotomy (PCNL) in children. There are a few cases in which PCNL has been performed in children without any additional instruments being left in place. PATIENT CONCERNS In this study, 3 children were treated for hematuria and complicated with different degrees of urinary tract infection. All of them were diagnosed as upper urinary tract calculi by abdominal computed tomography. DIAGNOSIS Three preschoolers were diagnosed with upper urinary tract calculi before surgery, one with no hydronephrosis and the other 2 with different degrees of hydronephrosis. INTERVENTIONS After preoperative evaluation, all the children successfully completed PCNL without indwelling ureteral catheter, double J tube, or nephrostomy tube. OUTCOMES The operation was successful and there were no residual stones observed during postoperative review. The operating times for the children were 33 minutes, 17 minutes, and 20 minutes, and the intraoperative bleeding volumes were 1 mL, 2 mL, and 2 mL. The catheter was removed on the second day after the operation, the postoperative review of the abdominal computed tomography or ultrasound did not indicate any stone residue, and there were no fever, bleeding, and other related complications after the operation. LESSONS We believe that total tubeless PCNL without artificial hydronephrosis can be achieved in the preschool population.
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Affiliation(s)
- Xicai Zhang
- School of Clinical Medicine of Jining Medical University, Jining, China
| | - Yonghe Zhang
- School of Clinical Medicine of Jining Medical University, Jining, China
| | - Fengyue Li
- Department of Urology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Wenbo He
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Xiande Cao
- Department of Urology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
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Zhang L, Xu H, Feng Y, Wang X, Du G, Wu R, Liu W. Outcome of Renal Function after Laparoscopic Pyeloplasty in Children with High-Grade Hydronephrosis. Urol Int 2023; 107:666-671. [PMID: 36958292 DOI: 10.1159/000529032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/22/2022] [Indexed: 03/25/2023]
Abstract
INTRODUCTION This study aimed to analyze the changes in differential renal function (DRF) after laparoscopic pyeloplasty in children with high-grade hydronephrosis and factors influencing DRF improvement. METHODS We reviewed the clinical data of unilateral ureteropelvic junction obstruction (UPJO) patients with SFU grade IV who underwent laparoscopic pyeloplasty between February 2018 and October 2020. The patients were divided into two groups: DRF improvement ≥5% (group 1) and DRF improvement <5% (group 2). Preoperative, operative, and postoperative parameters were included in the statistical analysis in both groups. RESULTS A total of 29 patients with a median age of 6 months were included. The preoperative DRF in group 1 was significantly lower than that in group 2 (36.97 ± 8.47% vs. 45.19 ± 5.22%, p = 0.004). Logistic regression and receiver operating characteristic analysis showed the preoperative DRF was the predictor for renal function improvement after pyeloplasty (p = 0.021) and had a significant predictive value (p = 0.004). CONCLUSION Nearly half of the patients with high-grade UPJO had improved renal function at 1 year follow-up after laparoscopic pyeloplasty. Preoperative DRF was a predictor of renal function improvement, and postoperative functional recovery was superior in children with lower preoperative DRF.
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Affiliation(s)
- Lingling Zhang
- Department of Minimally Invasive Urology, Jinan Children's Hospital, Jinan, China,
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China,
| | - Hongye Xu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yikun Feng
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Xiaoqing Wang
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Guoqiang Du
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Rongde Wu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Wei Liu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
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Sadghian M, Mousavi SA, Abedi SM, JafariSarouei M, Gooran M, Balmeh P, Mohammadjafari H. Comparison of early surgical and conservative therapy in children with ureteropelvic junction obstruction. Pediatr Surg Int 2023; 39:147. [PMID: 36879145 DOI: 10.1007/s00383-023-05434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Ureteropelvic junction obstruction is a relatively common urologic problem in children. Most cases present with pelvicaliceal dilatation in antenatal period. Historically most UPJO cases were treated with surgical procedures, but recently many of these children have been treated by nonsurgical observational plans. We compared the outcome of children with UPJO treated in surgical and observational ways. METHODS In a retrospective study, we assessed the medical history of patients diagnosed as UPJO, march 2011 to march 2021. The case definition was based on grade 3-4 hydronephrosis and obstructive pattern in dynamic renal isotopes can. Patients were put into two groups; Group 1 children were treated with a surgical procedure, and group 2 patients without any surgical procedure for at least a six months' period after diagnosis. We assessed long-term events and improvement of obstruction. RESULTS Seventy-eight children (mean age 7.32mo., 80% male) enrolled in the study, 55 patients in group one and 23 as group 2. Severe hydronephrosis was the problem of 96% of all patients significantly led to 20% in group 1 and 9% in group 2 (P < 0.001). Severe kidney involvement was observed at 91% in group 1 and 83% in group 2, decreased to 15% and 6%, respectively (P < 0.001). There were no significant differences in sonographic and functional improvement between the two intervention groups. Long-term prognostic issues; growth, functional impairment, and hypertension were not different between the two groups, but group 1 children experienced more recurrence of UTI than group 2 patients. CONCLUSION Conservative management is as effective as early surgical treatment in the management of infants with severe UPJO.
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Affiliation(s)
- Mahgol Sadghian
- Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Abdollah Mousavi
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Mohammad Abedi
- Department of Radiology and Nuclear Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahboubeh JafariSarouei
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maedeh Gooran
- Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, Iran
| | - Paniz Balmeh
- Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Mohammadjafari
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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