Combination of Robotic Pyeloplasty and Percutaneous Renal Surgery for Simultaneous Treatment of Ureteropelvic Junction Obstruction and Calyx Stones

Introduction: Ureteropelvic junction obstruction (UPJO) and the simultaneous presence of kidney calyx stones represent a challenge for renal surgery. We present a novel technique for the simultaneous treatment of UPJO by robotic pyeloplasty in combination with the percutaneous endoscopic treatment of kidney calyx stones by flexible nephroscopy. Patients and Methods: Between January 2018 and February 2020, 4 patients were diagnosed with UPJO and simultaneous pelvic or calyceal stones. UPJO was treated by conventional robotic pyeloplasty. After opening the renal pelvis, a flexible 16-French cystoscope was introduced via the 12-mm assistant trocar into the renal pelvis. The kidney calyx stones (n = 1–15) were removed endoscopically through a flexible nephroscope using a Dormia helical basket. Before suturing the anastomosis of the renal pelvis, a ureter stent was inserted. Results: After the procedure, all patients were stone free. Using the Clavien-Dindo classification, no complications were noted. The mean size of the calculi was 6.69 mm (range: 1–25). Up to 15 calyx stones (mean 3.46) were removed per patient. A complete stone clearance confirmed by postoperative X-ray imaging was achieved in all patients. The mean operative time was 149 min (range: 130–178). Mean hospital stay was 7 days (7–8). The urethral stent was removed after 4–6 weeks. Conclusions: Robotic management of UPJO and simultaneous flexible nephroscopy for removal of calyceal stones is an effective treatment in 1 session. Combining robotic surgery with flexible percutaneous renal surgery is a feasible, safe, and effective method of the treatment of UPJO and concomitant calyceal stones.

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Laparoscopic Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction: Our Preliminary Experience

Bangladesh Journal of Urology ◽

10.3329/bju.v19i2.49364 ◽

2020 ◽

Vol 19 (2) ◽

pp. 59-63

Author(s):

Md Mahfuzur Rahman Chowdhury ◽

AKM Khurshidul Alam ◽

AKM Anwarul Islam ◽

Md Sajid Hasan ◽

Tms Hossain ◽

...

Keyword(s):

Renal Function ◽

Postoperative Pain ◽

Hospital Stay ◽

Operative Time ◽

Ureteropelvic Junction Obstruction ◽

Clinical Symptoms ◽

Ureteropelvic Junction ◽

Laparoscopic Pyeloplasty ◽

The Mean ◽

Urine Leakage

Objective: To evaluate prospectively the results obtained in 16 patients undergoing laparoscopic pyeloplasty through transperitoneal access. Materials and Methods: The study was conducted in the department of urology, BSMMU, Dhaka between the periods of March 2013 and June 2014, sixteen patients between 15 and 48 years old, were treated for ureteropelvic junction obstruction (UPJO) via a transperitoneal laparoscopy. All patients had clinical symptoms of urinary obstruction and hydronephrosis were confirmed by imaging methods. Anderson-Hynes dismembered pyeloplasty was performed in all patients. Patients were clinically and imaging evaluated in the postoperative period at 6 and 12 weeks. Results: Most of the patients were male (68.75%) and female were 31.25%. The mean operative time was 127.37 (±15.67) minutes ranged from 95 to 240 minutes. Pain score in first postoperative day and third postoperative day following pyeloplasty were 20.87 (±6.83) and 4.75 (±3.34) respectively. The mean hospital stay was 4.25 (±1.34) days. Anomalous vessels were identified in 4 patients, intrinsic stenosis in 12 patients. Postoperative urine leakage and UTI were seen 18.75%, 12.50% subject respectively. Split renal function and GFR were significantly improved (p<0.05) and improvement of renal functional outcome was 87.50%. Conclusion: Laparoscopic pyeloplasty had the advantages like less postoperative pain and shorter hospital stay. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.59-63

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Management of ureteropelvic junction obstruction in horseshoe kidneys by an assortment of laparoscopic options

Canadian Urological Association Journal ◽

10.5489/cuaj.3111 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 775 ◽

Cited By ~ 5

Author(s):

Pejman Shadpour ◽

H. Habib Akhyari ◽

Robab Maghsoudi ◽

Masoud Etemadian

Keyword(s):

Ureteropelvic Junction Obstruction ◽

Left Kidney ◽

Operation Time ◽

Ureteropelvic Junction ◽

Laparoscopic Pyeloplasty ◽

Referral Centre ◽

Laparoscopic Management ◽

The Mean ◽

Crossing Vessels

Introduction: We report our experience with laparoscopic management of ureteropelvic junction obstruction in horseshoe kidneys.Methods: Between February 2004 and March 2014, 15 patients with horseshoe kidneys and symptomatic ureteropelvic junction obstruction underwent laparoscopic management at our national referral centre. Depending on the anatomy and presence of obtrusive vessels or isthmus, we performed either dismembered, Scardino or Foley YV pyeloplasty, or Hellstrom vessel transposition. Patients were initially evaluated by ultrasonography, then diuretic scintiscan at 4 to 6 months, and followed by yearly clinical and sonographic exams.Results: This study included 11 male and 4 female patients between the ages of 4 to 51 year (average 17.7). The left kidney was involved in 12 patients (80%). Operation time was 129 minutes (range: 90–186), and patients were discharged within 2.8 days (range: 1–6). Although 8 (53.3%) patients had crossing vessels, of which 6 required transposing, the Hellstrom technique was solely used in 3 cases, of which notably 1 case failed to resolve and required laparoscopic Hynes within the next year. Eight cases underwent dismembered pyeloplasty, 2 Foley YV, 1 Scardino flap and 1 required isthmectomy and vessel suspension. At the mean follow-up of 60 (range: 18–120) months, the overall success rate was 93.3%.Conclusions: To our knowledge, this represents the largest report on laparoscopic pyeloplasty for horseshoe kidneys, providing the longest follow-up. Our findings confirm prior reports supporting laparoscopy and furthermore show that despite the prevalence of crossing vessels, transposition alone is seldom sufficient.

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The Surgical Correction of Ureteropelvic Junction Obstruction Using a Free Graft of Renal Pelvis Wall

The Journal of Urology ◽

10.1016/s0022-5347(17)61672-0 ◽

1970 ◽

Vol 104 (1) ◽

pp. 67-70 ◽

Cited By ~ 3

Author(s):

Robert J. Macauley ◽

William J. Frohbose

Keyword(s):

Renal Pelvis ◽

Ureteropelvic Junction Obstruction ◽

Surgical Correction ◽

Ureteropelvic Junction ◽

Free Graft

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Are robots the future? A case for robotic pyeloplasty as the gold standard treatment in ureteropelvic junction obstruction

Current Opinion in Urology ◽

10.1097/mou.0000000000000944 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Robert Beal ◽

Sabrina Sicilila ◽

Paola Riestra ◽

David M. Albala

Keyword(s):

Gold Standard ◽

Ureteropelvic Junction Obstruction ◽

Standard Treatment ◽

Ureteropelvic Junction ◽

Robotic Pyeloplasty ◽

The Future

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Pediatric Minimally Invasive Pyeloplasty

10.2310/uro.11076 ◽

2018 ◽

Author(s):

Julia Beth Finkelstein ◽

Pasquale Casale

Keyword(s):

Minimally Invasive ◽

Ureteropelvic Junction Obstruction ◽

Clinical Symptoms ◽

Ureteropelvic Junction ◽

Complication Rates ◽

Success Rates ◽

Robotic Technology ◽

Conversion To Open Surgery ◽

Robotic Pyeloplasty ◽

Minimal Rate

Ureteropelvic junction obstruction (UPJO) is a common urologic abnormality in children. The diagnosis is typically based on a combination of clinical symptoms, ultrasonographic findings of hydronephrosis without hydroureter, and sometimes diuretic renal scintigraphy. Acceptance of robotic technology is increasing among pediatric urologists, and robotic pyeloplasty is now commonly performed for children with UPJO, with success rates similar to open pyeloplasty and a more efficient learning curve than conventional laparoscopy. The Anderson-Hynes dismembered pyeloplasty is the standard approach for repair. When complex patient anatomy is encountered, alternative techniques can be used to tailor the procedure to the specific case. Overall, robotic pyeloplasty offers strong outcomes, low complication rates, and a minimal rate of conversion to open surgery. Although the initial cost of robotic technology may be high, human capital gain and indirect benefits from shortened hospitalizations, smaller incisions, and parental satisfaction may be valuable. This review contains 10 figures, 5 tables and 42 references Key words: Pediatrics, Minimally invasive surgery, Robotics, Ureteropelvic junction obstruction, Pyeloplasty, Urology

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The surgical correction of ureteropelvic junction obstruction using a free graft of renal pelvis wall

Journal of Pediatric Surgery ◽

10.1016/0022-3468(71)90359-9 ◽

1971 ◽

Vol 6 (2) ◽

pp. 191-192

Author(s):

B.M. Henderson

Keyword(s):

Renal Pelvis ◽

Ureteropelvic Junction Obstruction ◽

Surgical Correction ◽

Ureteropelvic Junction ◽

Free Graft

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

European Journal of Pediatric Surgery ◽

10.1055/s-0038-1668149 ◽

2018 ◽

Vol 29 (01) ◽

pp. 033-038 ◽

Cited By ~ 4

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.

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Outcomes of Retrograde Intra-Renal Surgery

Nepalese Medical Journal ◽

10.3126/nmj.v2i2.26478 ◽

2019 ◽

Vol 2 (2) ◽

pp. 220-223 ◽

Cited By ~ 1

Author(s):

Samir Shrestha ◽

Pukar Maskey

Keyword(s):

Postoperative Pain ◽

Hospital Stay ◽

Renal Stone ◽

Operative Time ◽

Renal Calculi ◽

Renal Surgery ◽

Surgical Morbidity ◽

Retrograde Intrarenal Surgery ◽

Stone Clearance ◽

The Mean

Introduction: Miniaturization of endoscopic instruments has gained wide popularity in the treatment of renal calculi. Retrograde intra-renal surgery and holmium laser in combination has already proven its superiority when compared to other modalities in the treatment of renal calculi. This study was conducted to assess the outcome of retrograde intra-renal surgery in renal stone disease.Materials and Methods: This retrospective study analyzed the outcome of retrograde intra-renal surgery in renal stone less than 2 cm size in the adults above 18 years of age from September 2018 to August 2019 at Patan Hospital, Nepal. The outcome was assessed descriptively on postoperative pain and fever, stone localization, stone size, stone clearance, urosepsis, operative time, hospital stay, mortality, need of the second procedure.Results: A total of 62 patients underwent retrograde intrarenal surgery, out of which 48 cases were included. The mean age of the study population was 32.4± 14 years (19-68 years). Similarly, the mean operative time was 68± 12 (48-124 minutes) and mean hospital-stay was 3.2± 1.1 days. Postoperative pain and fever were observed in 14 (29.16%) & 4(8.33%) patients respectively. Hematuria occurred in 6(12.50%) and urosepsis in 2(4.16%) of the patients. Complete stone clearance was achieved in 34(70.83%) and residual stones were present in 8(16.66%) and clinically insignificant radiological fragments were present in 6(12.50%) patients.Conclusions: Retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal calculi, with minimal post-surgical morbidity.

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