24: Endopyelotomy for Ureteropelvic Junction Obstruction: What Success Rate can the Patient Expect?

Objective This study aimed to present our experience of concomitant management of renal calculi and recurrent ureteropelvic junction obstruction (UPJO) with percutaneous nephrolithotomy (PCNL) and antegrade balloon dilation. Methods We retrospectively reviewed 31 patients who underwent PCNL and antegrade balloon dilation for treatment of renal calculi and recurrent UPJO. The inclusion criterion was the presence of UPJO after failed pyeloplasty with ipsilateral renal calculi. Success was defined as achievement of both symptomatic and radiographic resolution of any stones and obstruction. Results All operations were successful without grade III or higher postoperative complications. A stone-free status was observed in all patients and the overall success rate of the procedure was 87.1% (27/31). The success rate of the procedure was significantly higher in patients with mild or moderate preoperative hydronephrosis (96%) than in those with high-grade preoperative hydronephrosis (50%). Moreover, the success rate of the procedure was lower in patients with poor preoperative renal function (0%) than in those with good or moderate renal function (93.1%). Conclusion Combined PCNL and antegrade balloon dilation management represents a safe and effective approach for patients with renal calculi and recurrent UPJO after failed pyeloplasty.

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Initial Experience with the Comprehensive Modified Laparoscopic Pyeloplasty Technique Based on Membrane Anatomy for Treating Ureteropelvic Junction Obstruction

Urologia Internationalis ◽

10.1159/000519929 ◽

2021 ◽

pp. 1-8

Author(s):

Guohao Wu ◽

Haomin Li ◽

Peifeng Zhong ◽

Dongjiang Chen ◽

Zhihua Zhang ◽

...

Keyword(s):

Success Rate ◽

Renal Pelvis ◽

Ureteropelvic Junction Obstruction ◽

Operating Time ◽

Ureteropelvic Junction ◽

Initial Experience ◽

Laparoscopic Pyeloplasty ◽

Double J Stent ◽

Estimated Blood Loss

Objective: The aim of the objective was to present our initial experience and evaluate the feasibility of the novel comprehensive modified laparoscopic pyeloplasty (CMLP) technique based on membrane anatomy. Materials and Methods: Forty-eight patients underwent CMLP from February 2016 to October 2020. CMLP involves the following: dissection of the ureter was based on the fascia or fusion fascia formed by embryonic development. The ureter was separated from the ureteral sheath, and the pelvis and ureter were incised with incomplete amputation. The first stitch was placed between the lower point of the spatulated ureter and the lowest corner of the renal pelvis to ensure correct orientation of the anastomosis; anastomosis of the renal pelvis and ureter was performed using the touchless technique. Results: All CMLPs were completed successfully without conversion. The mean overall operating time was 230.96 min. The median estimated blood loss was 50.00 (interquartile range 20.00–57.50) mL. The average postoperative hospital stay was 9.31 days. The average follow-up time was 24.73 months. No major complications occurred. In 1 case, revision laparoscopic pyeloplasty was performed, but the obstruction persisted after double J stent removal, so ultimately, the double J stent required regular replacement. Another asymptomatic patient with hydronephrosis experienced failed treatment and is still under follow-up. The overall success rate was 95.83% (46/48). The success rate in patients with recurrent ureteropelvic junction obstruction (UPJO) was 87.5% (7/8). Conclusions: CMLP is a practical and effective treatment option for UPJO with a high success rate. An advantage of CMLP is the clear surgical field.

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DOES STENT SIZE INFLUENCE THE SUCCESS RATE IN ANTEGRADE ENDOPYELOTOMY OF PRIMARY URETEROPELVIC JUNCTION OBSTRUCTION? PRELIMINARY RESULTS OF TWO CONSECUTIVE SERIES

The Journal of Urology ◽

10.1097/00005392-199904010-00295 ◽

1999 ◽

pp. 73

Author(s):

Hansjorg Danuser ◽

Werner W. Hochreiter ◽

Daniel K. Ackermann ◽

Urs E. Studer

Keyword(s):

Success Rate ◽

Ureteropelvic Junction Obstruction ◽

Ureteropelvic Junction ◽

Consecutive Series ◽

Preliminary Results

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Endopyelotomy for primary ureteropelvic junction obstruction: risk factors determine the success rate

Current Opinion in Urology ◽

10.1097/00042307-199807000-00041 ◽

1998 ◽

Vol 8 (4) ◽

pp. 342

Author(s):

Christopher R. Chapple

Keyword(s):

Risk Factors ◽

Success Rate ◽

Ureteropelvic Junction Obstruction ◽

Ureteropelvic Junction

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Laparoscopic pyeloplasty: the updated McMaster University experience

Canadian Urological Association Journal ◽

10.5489/cuaj.806 ◽

2013 ◽

Vol 2 (4) ◽

pp. 388 ◽

Cited By ~ 6

Author(s):

Jihao Dong ◽

Jaime Wong ◽

Ahmad Al-Enezi ◽

Anil Kapoor ◽

J. Paul Whelan ◽

...

Keyword(s):

Hospital Stay ◽

Success Rate ◽

Ureteropelvic Junction Obstruction ◽

Operating Time ◽

Ureteropelvic Junction ◽

Success Rates ◽

Laparoscopic Pyeloplasty ◽

Renal Scan ◽

Hospital Stays ◽

The Mean

Objective: The open Anderson–Hynes procedure has an overall success rate of 90% for ureteropelvic junction obstruction. Laparoscopic pyeloplasty (LP) was developed to reduce morbidity and hospital stay while preserving the excellent results. We report on the results of our experience with laparoscopic pyeloplasty.Methods: Between January 2001 and May 2006, 77 consecutive patients underwent LP performed by one of 4 surgeons at our institution. Patients were reassessed with ultrasound (U/S) or intravenous pyelogram (IVP) at 6 weeks. Diuretic renal scan and U/S or IVP were performed at 6 months, and subsequent follow-up included a U/S or IVP as well as clinical assessment. Patients were assessed for pain and hydronephrosis on radiologic imaging, clearance on diuretic renal scan (T1/2) and differential renal function.Results: We evaluated 73 patients. The mean patient age was 38 years (range 16–71 yr), the mean operating time was 218 minutes (range 110–409 min), and the mean blood loss was 57 mL (range 25–250 mL). Mean hospital stay was 3.0 days (range 2–7 d). The success rate was 90.4%, and failures were mainly due to poor function after surgery (3 patients). Pyelolithotomy was performed concomitantly on 6 patients, which on average extended operative time by 36 minutes.Conclusion: Our success rates are consistent with the LP experience of other centres and are comparable with rates for the open technique. Patients had short hospital stays, and complications were negligible. With experienced surgeons, LP should be the first-line treatment for ureteropelvic junction obstruction.

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Modified Laparoscopic and Robotic Flap Pyeloplasty for Recurrent Ureteropelvic Junction Obstruction with a Long Proximal Ureteral Stricture: The “Wishbone” Anastomosis and the “Ureteral Plate” Technique

Urologia Internationalis ◽

10.1159/000512994 ◽

2021 ◽

pp. 1-8

Author(s):

Sida Cheng ◽

Xinfei Li ◽

Kunlin Yang ◽

Shengwei Xiong ◽

Ziao Li ◽

...

Keyword(s):

Success Rate ◽

Ureteropelvic Junction Obstruction ◽

Ureteropelvic Junction ◽

Ureteral Stricture ◽

Effective Treatment Option ◽

Plate Technique ◽

Estimated Blood Loss ◽

Significant Difference ◽

The Mean

Objectives: The aim of the study was to present our modified flap pyeloplasty techniques for recurrent ureteropelvic junction obstruction (UPJO) with a long proximal ureteral stricture and compare outcomes of laparoscopic and robotic procedures. Materials and Methods: Between March 2018 and January 2020, 21 patients underwent modified laparoscopic or robotic flap pyeloplasty for recurrent UPJO with a long proximal ureteral stricture. Our surgical modifications included the “wishbone” anastomosis and “ureteral plate” technique. Demographic, perioperative, and follow-up data were recorded and compared retrospectively between the groups. Success was defined as subjective pain alleviation and hydronephrosis improvement. Results: Thirteen modified laparoscopic flap pyeloplasty (mLFP) and 8 modified robotic flap pyeloplasty (mRFP) were performed successfully without conversion. mRFP tended to have shorter overall operative time (142.4 vs. 179.1 min, p = 0.122) and anastomosis time (43.1 vs. 61.0 min, p = 0.093) than mLFP. No difference was found in estimated blood loss (p = 0.723) and pararenal draining time (p = 0.175) between the groups. The mean postoperative hospital stay of mRFP was significantly shorter than that of mLFP (5.0 vs. 8.2 days, p = 0.015). No major complications occurred. During the mean follow-up of 17.9 months, the overall success rate was 90.5%, and there was no significant difference between 2 groups. Conclusions: The modified flap pyeloplasty could be considered a practical and effective treatment option with a high success rate for recurrent UPJO with a long proximal ureteral stricture, and the robotic procedures showed advantages of higher efficiency and faster recovery.

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Comparison between open and laproscopic pyeloplasty in Al-Diwaniya Teaching Hospital

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v9ispl1.1374 ◽

2018 ◽

Vol 9 (SPL1) ◽

Author(s):

Ahmed Ali Al-Hamzawi

Keyword(s):

Hospital Stay ◽

Success Rate ◽

Teaching Hospital ◽

Gold Standard ◽

Open Surgery ◽

Operative Time ◽

Ureteropelvic Junction Obstruction ◽

Ureteropelvic Junction ◽

Laparoscopic Pyeloplasty ◽

Open Pyeloplasty

Background: Historically open pyeloplasty has been regarded as the gold standard for the surgical management of ureteropelvic junction obstruction (UPJO). The treatment of this condition has evolved considerably over the past two decades resulting in new surgical approaches. One of these approaches is laparoscopic pyeloplasty,this technique aimed to achieve the same results as open surgery,with lower rates of morbidity and complications. Aim of the study: To compare the operative time,hospital stay,analgesic use,perioperative complications,and success rate between laparoscopic and open pyeloplasty in Al Diwaniya Teaching Hospital. Patients & Methods: From October 2014 to October 2016,40 patients (26 males and 14 females) with Ureteropelvic junction obstruction who had been admitted to the urology unit of Al Diwaniya Teaching Hospital were enrolled in this study. Their ages ranged from 10 to 44 years with a mean age of 24 years. The patients were selected on the basis of standard indications for PUJO repair. The patients were assigned into two groups. Twenty patients underwent transperitoneal laparoscopic pyeloplasty and 20 patients underwent open surgery. The choice between the two types of operation was selected according to surgeon's preference (only surgeon who has enough experience with laparoscopic surgeries perform laparoscopic pyeloplasty,while the other performed open surgery). Preoperative evaluations were done using abdominal ultrasound and IVP. Laboratory tests included urinalysis,urine culture,blood urea,and serum creatinine. Blood group was determined. We compared the operative time,complications rates,hospital stay and success rate of the two groups.Mean operative time was 2 hours and 3 hours in open and laparoscopic pyeloplasty groups,respectively. Mean hospital stay was shorter (24 hours) in the laparoscopic group and (48 hours) in open group. Mean follow-up period was 9 months. Postoperative complication rates were 20 % and 30 % in laparoscopic and open pyeloplasty groups,respectively. Success rates were 95% and 90 % for open and laparoscopic pyeloplasty groups,respectively. Repeated surgery was performed in 2 patients of laparoscopy and 1 of open pyeloplasty groups due to recurrence of stricture.The safety and efficacy of laparoscopic pyeloplasty is comparable to that of open pyeloplasty,with better cosmetic results and shorter hospital stay,therefore laparoscopic pyeloplasty can replace open surgery and may be considered the gold standard technique for the treatment of ureteropelvic junction obstruction in expert hands.

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