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

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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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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456 APPLICATION OF URINARY CARBOHYDRATE ANTIGEN 19-9 AS A NON-INVASIVE METHOD FOR DETERMINING CONSERVATIVE OR SURGICAL MANAGEMENT OF CHILDREN WITH URETEROPELVIC JUNCTION OBSTRUCTION

The Journal of Urology ◽

10.1016/j.juro.2011.02.548 ◽

2011 ◽

Vol 185 (4S) ◽

Author(s):

Abdol-Mohammad Kajbafzadeh ◽

Saman S. Talab ◽

Azadeh Elmi ◽

Delaram Jan ◽

Parisa Mazaheri ◽

...

Keyword(s):

Surgical Management ◽

Ureteropelvic Junction Obstruction ◽

Carbohydrate Antigen ◽

Ureteropelvic Junction ◽

Non Invasive ◽

Invasive Method

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Comparative, Prospective, Case–Control Study of Open versus Laparoscopic Pyeloplasty in Children with Ureteropelvic Junction Obstruction: Long-term Results

Frontiers in Pediatrics ◽

10.3389/fped.2017.00010 ◽

2017 ◽

Vol 5 ◽

Cited By ~ 6

Author(s):

Lisandro A. Piaggio ◽

Juan P. Corbetta ◽

Santiago Weller ◽

Ricardo Augusto Dingevan ◽

Víctor Duran ◽

...

Keyword(s):

Ureteropelvic Junction Obstruction ◽

Case Control Study ◽

Case Control ◽

Ureteropelvic Junction ◽

Long Term Results ◽

Laparoscopic Pyeloplasty ◽

Open Versus ◽

Control Study ◽

Prospective Case Control Study

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

European Urology Supplements ◽

10.1016/s1569-9056(04)90037-1 ◽

2004 ◽

Vol 3 (2) ◽

pp. 11

Author(s):

E. Dobry ◽

P. Usai ◽

U.E. Studer ◽

H. Danuser

Keyword(s):

Ureteropelvic Junction Obstruction ◽

Ureteropelvic Junction ◽

Long Term Results ◽

Open Pyeloplasty

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Dynamic Renal Scintigraphy Results of Pediatric Patients Operated Due to Unilateral Ureteropelvic Junction Obstruction: A Novel Approach to Overestimated Ipsilateral Differentiated Renal Function

Journal of Dr Behcet Uz Children s Hospital ◽

10.5222/buchd.2021.25428 ◽

2021 ◽

Author(s):

Sabri Cansaran ◽

Ayşenur Celayir ◽

Serdar Moralıoğlu ◽

Osman Zeki Pektaş ◽

Oktav Bosnalı

Keyword(s):

Renal Function ◽

Ureteropelvic Junction Obstruction ◽

Ureteropelvic Junction ◽

General Group ◽

Factors Affecting ◽

Novel Approach ◽

Ultrasound Findings ◽

The Mean ◽

The Difference ◽

Anterior Posterior

Objective: The aim of this study was to scintigraphically investigate the preoperative and postoperative renal functions of patients operated due to ureteropelvic junction obstruction, discuss the factors affecting the indication of surgery and emphasize the important points to consider during scintigraphic examination. Method: We retrospectively analyzed pediatric cases who underwent pyeloplasty due to ureteropelvic junction obstruction. Patients operated for primary ureteropelvic junction obstruction whose preoperative and postoperative dynamic scintigraphy results could be obtained were included in the study. The patients were divided into two groups as those with <50% and ≥50% ipsilateral differentiated renal function. The difference between the groups was considered statistically significant when p<0.05. Results: The median ages of 36 cases in <50% DRF group and 24 cases in ≥50% DRF group were 7.7 months and 8.5 months, respectively. The mean ipsilateral differentiated renal function values of the main groups were significantly different from each other both in the preoperative and postoperative periods. The changes within the two main groups were also analyzed, yielding significant differences. Ipsilateral differentiated renal function changes on a general, group and subgroup basis, and preoperative ultrasound findings of the ipsilateral kidney in subgroups were revealed. Conclusion: Increased hydronephrosis degree and renal pelvis anterior-posterior diameter are closely related to overestimated ipsilateral kidney function. For deciding on surgery in patients with ureteral obstruction, scintigraphic examinations make sense with the help of US and the clinical condition of the patient.

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A comparative study on the Efficacy of Retroperitoneoscopic Pyeloplasty and Open Surgery for Ureteropelvic Junction Obstruction in Children

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.7.4205 ◽

2021 ◽

Vol 37 (7) ◽

Author(s):

Jianghua Jia ◽

Qingsong Meng ◽

Ming Zhang ◽

Jinchun Qi ◽

Dongbin Wang

Keyword(s):

Comparative Study ◽

Open Surgery ◽

Ureteropelvic Junction Obstruction ◽

Operation Time ◽

Ureteropelvic Junction ◽

Intraoperative Bleeding ◽

Conversion To Open Surgery ◽

Bleeding Volume ◽

Surgical Methods ◽

Significant Difference

Objectives: To compare the therapeutic effect of retroperitoneoscopic dismembered pyeloplasty and open ureteropelvic junction plasty on the ureteropelvic junction obstruction (UPJO) in children. Methods: After the retrospective analysis of clinical data, 78 children with ureteropelvic junction stenosis treated from January, 2012 to June, 2018 were divided into two groups: OP (open pyeloplasty) group (38 cases) and LP (laparoscopic dismembered pyeloplasty) group (40 cases) according to the surgical methods. The operation time, intraoperative bleeding volume, postoperative length of stay (LOS), postoperative complication rate, postoperative hydronephrosis improvement and other indicators were compared between the two groups. Results: All patients underwent surgery successfully, without conversion to open surgery in LP group. The incidence of postoperative urine leakage and the recovery of hydronephrosis between LP group and OP group 12 months after operation showed no statistically significant difference (P>0.05). The intraoperative bleeding volume, the incidence of postoperative retroperitoneal hematoma, and the postoperative LOS in LP group were lower than those in OP group, while the operation time was longer than that in the OP group, with statistically significant difference (P<0.05). Conclusion: Retroperitoneoscopic dismembered pyeloplasty had similar effect with open dismembered pyeloplasty, but faster recovery and fewer complications, so it has become the preferred treatment method for UPJO in children. doi: https://doi.org/10.12669/pjms.37.7.4205 How to cite this:Jia J, Meng Q, Zhang M, Qi J, Wang D. A comparative study on the Efficacy of Retroperitoneoscopic Pyeloplasty and Open Surgery for Ureteropelvic Junction Obstruction in Children. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4205 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The Role of Percutaneous Endopyelotomy for Ureteropelvic Junction Obstruction

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x155824 ◽

2007 ◽

Vol 89 (2) ◽

pp. 153-156 ◽

Cited By ~ 5

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.

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