scholarly journals P117 Surgical management of Ureteropelvic Junction Obstruction (UPJO) in Neonates amid COVID-19 pandemic; Review of Literature and a Cohort Study in Iran

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Alireza Sherafat ◽  
Mohammad Ali Ashraf ◽  
Sarina Ahmadian ◽  
Arni Sarian ◽  
Elham Ramezannezhad ◽  
...  
Keyword(s):  
Cohort Study ◽  
Surgical Management ◽  
Ureteropelvic Junction Obstruction ◽  
Ureteropelvic Junction ◽  
Surgical Approaches ◽  
Original Research ◽  
Review Of Literature ◽  
Laparoscopic Pyeloplasty ◽  
Open Pyeloplasty ◽  
Laparoscopic Assisted

Abstract Introduction The current study presents a systematic review of literature on surgical management of ureteropelvic junction obstruction (UPJO) alongside an ongoing cohort study of neonates presenting with high grades of hydronephrosis due to UPJO requiring urgent treatment in a developing country amid the COVID-19 pandemic. The aim of this study is to investigate the efficacy and cost effectiveness of laparoscopic-assisted pyeloplasty. Methods Patients’ demographics, clinical presentations and treatment outcomes are recorded. The cohort is classified into 3 groups based on type of surgical treatment offered including open, laparoscopic and laparoscopic-assisted pyeloplasty. All patients admitted with grade 3-4 hydronephrosis due to UPJO are included. Patients with UPJO as part of a complex multisystemic syndrome are excluded. Literature review was conducted from 2000/1/1 to 2020/1/1 to include all original research papers on surgical management of UPJO. The age group was limited to neonates (under 1 year-old). Results 32 articles were included in the review. 20 papers (62.5%) recommended open pyeloplasty, 10 papers (31.3%) recommended laparoscopic pyeloplasty and 2 papers (6.25%) recommended laparoscopic-assisted pyeloplasty. The cohort study is currently recruiting patients treated by the 3 surgical approaches. Conclusion The majority of studies are focusing on open pyeloplasty. However, as more surgeons are going through the learning curve of laparoscopic pyeloplasty, the trend is towards more laparoscopic management in the future. It is important to discover the advantages of laparoscopic-assisted approach as a new technique to improve the outcome and shorten the hospital stay amid the COVID-19 pandemic.

Surgery for Pediatric Ureteropelvic Junction Obstruction—Comparison of Outcomes in Relation to Surgical Technique and Operating Discipline in Germany

2018 ◽  
Vol 29 (01) ◽  
pp. 033-038 ◽  
Author(s):  
M. Klora ◽  
J. Zeidler ◽  
S. Eberhard ◽  
S. Bassler ◽  
S. Mayer ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Ureteropelvic Junction Obstruction ◽  
Length Of Hospital Stay ◽  
Ureteropelvic Junction ◽  
Treatment Modalities ◽  
Complication Rates ◽  
Laparoscopic Pyeloplasty ◽  
Small Children ◽  
The Mean ◽  
Open Pyeloplasty

Introduction Surgery for ureteropelvic junction obstruction (UPJO) is performed by both pediatric surgeons (PS) and urologists (URO). The aim of this study was to analyze treatment modalities for UPJO and results in relation to the surgical technique and the operating discipline in Germany. Materials and Methods Data of patients aged 0 to 18 years were extracted from a major public health insurance (covering ∼5.7 million clients) during 2009 to 2016 and were analyzed for sociodemographic variables, surgical technique, and treating discipline. Logistic regression analysis was performed for the risk of a complication within the first postoperative year. Results A total of 229 children (31.0% female) were included. Laparoscopic pyeloplasty (LP) was performed in 58 (25.3%) patients (8.6 ± 6.4 years), and open pyeloplasty (OP) was applied in 171 (74.7%; 4.6 ± 5.9 years). LP was the dominant technique in females (p < 0.02); males preferentially underwent OP (p < 0.02). Length of hospital stay was 4.3 days (p = 0.0005) shorter in LP compared with that in OP, especially in children ≤ 2 years (6.7 days, p = 0.007). PS operated on 162 children (70.7%), and URO performed surgery on 67 patients (29.3%). The mean age of children operated by PS (3.5 ± 4.7 years) was significantly younger compared with that operated by URO (10.8 ± 6.5 years, p < 0.0001). Complication rates were independent of surgical technique or treating specialty. Conclusion In Germany, UPJO was treated by LP in 25.3% of patients, which was associated with a shorter length of stay, especially in children ≤ 2 years. Complication rates were independent of the operating specialty and surgical technique. Therefore, LP should be further promoted for the treatment of UPJO in small children.

Laparoscopic pyeloplasty versus open pyeloplasty for recurrent ureteropelvic junction obstruction in children

2016 ◽  
Vol 12 (6) ◽  
pp. 401.e1-401.e6 ◽  
Author(s):  
A.M. Abdel-Karim ◽  
A. Fahmy ◽  
A. Moussa ◽  
H. Rashad ◽  
M. Elbadry ◽  
...  
Keyword(s):  
Ureteropelvic Junction Obstruction ◽  
Ureteropelvic Junction ◽  
Laparoscopic Pyeloplasty ◽  
Open Pyeloplasty

scholarly journals The Role of Percutaneous Endopyelotomy for Ureteropelvic Junction Obstruction

2007 ◽  
Vol 89 (2) ◽  
pp. 153-156 ◽  
Author(s):  
NJ Rukin ◽  
DA Ashdown ◽  
P Patel ◽  
S Liu
Keyword(s):  
Ureteropelvic Junction Obstruction ◽  
Operating Time ◽  
Primary Treatment ◽  
Ureteropelvic Junction ◽  
Salvage Procedure ◽  
Success Rates ◽  
Laparoscopic Pyeloplasty ◽  
Retrospective Audit ◽  
Open Pyeloplasty

INTRODUCTION Over the last 20 years, the surgical management of ureteropelvic junction obstruction (UPJO) has been revolutionised by the development of endourological instrumentation and several minimally invasive procedures including: antegrade or retrograde endopyelotomy, retrograde balloon dilatation, and laparoscopic pyeloplasty. Currently, in our department, we offer percutaneous antegrade endopyelotomy (PAE) as primary treatment of UPJO in adults, believing it offers less morbidity, better cosmetic results, and quicker operating time compared with open pyeloplasty. PATIENTS AND METHODS We performed a retrospective audit of our results for the 14 patients who underwent percutaneous antegrade endopyelotomy between January 2000 and May 2004. RESULTS Mean operative time was 53 min (range, 30–80 min), mean in-patient stay was 3.8 days (range, 2–7 days), and there were no major postoperative complications for this series with mean follow-up of 31.8 months (range, 12–52 months). Eleven out of the 14 patients (79%) showed radiological improvement on their 3-month MAG 3 (mercaptoacetyl-triglycyl) renogram, and 13 out of the 14 (93%) patients reported significant reduction or resolution of pain, compared with their preoperative state. CONCLUSIONS The majority of urologists still offer open pyeloplasty as primary treatment for UPJO with laparoscopic pyeloplasty currently an evolving procedure in the UK. Our series reports comparable success rates for PAE compared to other series. Despite these results, we feel that the future role of percutaneous endopyelotomy will be as a salvage procedure following failed open or laparoscopic surgery. However, in patients with concurrent stone disease or requiring antegrade ureteric access, percutaneous endopyelotomy would be suitable as a primary treatment option.

scholarly journals «Miniature» Approach for Pyeloplasty in Children: Primary Use Experience Report

2020 ◽  
Vol 8 (1) ◽  
pp. 92-98
Author(s):  
S. T. Agzamkhodjaev ◽  
Z. B. Abdullaev ◽  
D. S. Yunusov ◽  
A. N. Tursunkulov
Keyword(s):  
Ureteropelvic Junction Obstruction ◽  
Alternative Methods ◽  
Ureteropelvic Junction ◽  
Laparoscopic Pyeloplasty ◽  
Intracorporeal Suturing ◽  
Minimal Invasiveness ◽  
Younger Age ◽  
Tissue Manipulation ◽  
Open Standard ◽  
Open Pyeloplasty

Currently, laparoscopic pyeloplasty is gaining popularity in pediatric urology due to less invasive compared to the open standard pyeloplasty. Nevertheless, there are basic “critical” remarks about this pyeloplasty technique in children, which involve some difficulties in comparing tissues and intracorporeal suturing due to the limited available space. In addition, a significant negative point of laparoscopic pyeloplasty is the duration of the operation, especially in the younger age group of children. Despite all the advantages associated with minimal invasiveness, there are alternative methods of surgical treatment, which show quite impressive results. In our practical work, we performed minimally invasive open pyeloplasty: with a miniature incision, in a child with ureteropelvic junction obstruction with a good result. In addition, this access provides a wide exposure of the ureteropelvic junction and easy tissue manipulation.

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

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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