35 Long-term results ≥ 5 years after open pyeloplasty or antegrade endopyelotomy for ureteropelvic junction obstruction

The goals for management of ureteropelvic junction obstruction (UPJO) and ureteral stricture are to resolve obstruction, restore continuity, and preserve renal function while minimizing morbidity. The management of UPJO can be challenging and represents a spectrum of options that vary in the invasiveness and effective. These options include observation, long-term internal or external urinary drainage, and endoscopic or minimally invasive management. Mismanagement can potentially results in deterioration of loss of kidney function. This chapter discusses the foundations for successful management of UPJO and ureteral strictures. It also highlights the special clinical situations related to this disease entity and discusses the key advances in the field. This review contains 8 figures, 4 tables, and 73 references. Key Words: Boari flap, dismembered pyeloplasty, endopyelotomy, psoas hitch, pyeloplasty, ureteropelvic junction obstruction, ureteral obstruction, ureteral reconstruction, ureteral stricture, uretero-ureterostomy

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Ureteropelvic Junction Obstruction with Concurrent Renal Pelvic Calculi in the Pediatric Patient: A Long-term Followup

The Journal of Urology ◽

10.1016/s0022-5347(01)65802-6 ◽

1996 ◽

Vol 156 (2S) ◽

pp. 741-743 ◽

Cited By ~ 44

Author(s):

D.A. Husmann ◽

D.S. Milliner ◽

J.W. Segura

Keyword(s):

Pediatric Patient ◽

Ureteropelvic Junction Obstruction ◽

Ureteropelvic Junction

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Treatment of ureteropelvic junction obstruction and urolithiasis in children with minimally invasive surgery

Urologia Journal ◽

10.1177/03915603211026101 ◽

2021 ◽

pp. 039156032110261

Author(s):

Lorenzo Masieri ◽

Simone Sforza ◽

Alekseja Manera ◽

Luca Lambertini ◽

Alfonso Crisci ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Pediatric Patients ◽

Ureteropelvic Junction Obstruction ◽

Ureteropelvic Junction ◽

Tertiary Referral Center ◽

Flexible Cystoscope ◽

Effective Option ◽

Open Pyeloplasty

Background: Ureteropelvic Junction Obstruction (UPJO) is the most common congenital ureteral anomaly. Nowadays, according to the increasing incidence of urolithiasis, 20% of children with UPJO presents urolithiasis. Open pyeloplasty was the standard treatment before the introduction of minimally invasive surgery (MIS). Nevertheless, only scattered experiences on MIS were previously described and universal agreement on the treatment of UPJO plus urolithiasis is still missing. Objective: The study aim was to describe our experience with a series of pediatric patients affected by UPJO and urolithiasis treated with robot-assisted pyeloplasty (RAP) and endoscopic removal of stones using a flexible cystoscope and a stones basket in a singular tertiary referral center. Material and methods: We retrospectively reviewed our data from pediatric patients affected by UPJO and urolithiasis undergoing RAP between April 2013 and December 2019. The analysis was conducted on seven patients. All procedures were performed by one expert robotic surgeon and one endoscopic surgeon skilled in the management of urolithiasis. Results: The mean age was 7 years (IQR 4–16). The median stone area was 77.7 mm two (IQR 50.2–148.4). Most of them (71.4%) presented preoperative symptoms. The median operative time was 110 min (IQR 104–125) with a console time of 90 (IQR 90–105). The median length of stay was 5 days (IQR 4–5). Median follow-up was 16 months (IQR 10–25). Conclusion: RAP with concomitant flexible ureteroscope is a safe and effective option for the simultaneous management of UPJO with urolithiasis with excellent outcomes in children.

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Factors affecting the effectiveness and success of retrograde holmium laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction in adults

Urologia Journal ◽

10.1177/0391560320904259 ◽

2020 ◽

pp. 039156032090425

Author(s):

Ibrahim Kartal ◽

Sertaç Çimen ◽

Nihat Karakoyunlu ◽

Fatih Sandıkçı ◽

Aşır Eraslan ◽

...

Keyword(s):

Ureteropelvic Junction Obstruction ◽

Operation Time ◽

Primary Treatment ◽

Ureteropelvic Junction ◽

Long Term Results ◽

Factors Affecting ◽

Invasive Method ◽

Grade Ii ◽

Procedural Success ◽

Procedural Outcomes

Purpose: To evaluate the factors affecting the effectiveness, safety, and success of retrograde holmium:yttrium–aluminum–garnet laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction in adults. Methods: Adult patients who underwent retrograde holmium:yttrium–aluminum–garnet laser endopyelotomy as the primary treatment of ureteropelvic junction obstruction between January 2012 and June 2016 at our clinic were retrospectively analyzed. Success was defined as the relief of symptoms and the resolution of obstruction, as assessed via radiography. Factors affecting success were analyzed, such as the clinical characteristics, procedural outcomes, complications, and the type of ureteroscopy used in the procedure. Results: Procedural success was achieved in 29 (74.4%) out of 39 patients, with a mean age of 38.3 ± 12.3 years during a median follow-up duration of 44 (33–65) months. Failure occurred at a median of 4.5 (3–22) months. It was detected that the presence of primary obstruction, ipsilateral kidney function being >30% of normal, and the length of obstruction being <1 cm positively affected procedural success ( p = 0.009, p = 0.011, and p = 0.019, respectively). In the postoperative period, two Grade I and four Grade II complications were observed according to the Clavien–Dindo classification. There was a difference only in the operation time between semirigid (24) and flexible ureteroscopes (15), with the operation time being shorter with the use of a semirigid ureteroscope than with the use of a flexible uteroscope ( p < 0.001). Conclusion: Retrograde holmium:yttrium–aluminum–garnet laser endopyelotomy is a minimally invasive method that can be used effectively and safely as the primary treatment of patients with ureteropelvic obstruction, when long-term results are also taken into consideration. The decision of performing laser endopyelotomy should be made after a detailed evaluation of the characteristics of the patient as well as of the obstruction.

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