Minimally Invasive Pyeloplasty in Horseshoe Kidneys with Ureteropelvic Junction obstruction: A case series

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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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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Open stone surgery for kidney stones

10.1093/med/9780199659579.003.0023 ◽

2017 ◽

Author(s):

Gastón M. Astroza ◽

Ghalib Jibara ◽

Michael E. Lipkin ◽

Glenn M. Preminger

Keyword(s):

Shock Wave ◽

Minimally Invasive ◽

Kidney Stones ◽

Open Surgery ◽

Ureteropelvic Junction Obstruction ◽

Minimally Invasive Therapy ◽

Ureteropelvic Junction ◽

Open Approach ◽

Invasive Therapy ◽

Wave Technology

The open approach for stone surgery is currently used infrequently in patients undergoing stone removal. Currently an associated anatomic abnormality, a failure of or a contraindication to minimally invasive therapy, or a large and complex stone are the infrequent indications for open surgery. For these indications, laparoscopic or robotic approaches have almost completely replaced open procedures in the hands of skilled laparoscopic surgeons. Pyelolithotomy was supplanted almost 20 years ago by the advent of percutaneous and shock wave technology. Currently, the only indications for this procedure are a failure of or contraindication to other techniques, or the presence of an associated abnormality such as ureteropelvic junction obstruction, which could then be managed simultaneously.

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Editorial Comment on: “Risk Factors and Management Options for the Adult Failed Ureteropelvic Junction Obstruction Repair in the Era of Minimally Invasive and Robotic Approaches: A Comprehensive Literature Review” by Chow et al.

Journal of Endourology ◽

10.1089/end.2020.0292 ◽

2020 ◽

Vol 34 (11) ◽

pp. 1119-1120

Author(s):

Phillip Mucksavage

Keyword(s):

Risk Factors ◽

Literature Review ◽

Editorial Comment ◽

Minimally Invasive ◽

Ureteropelvic Junction Obstruction ◽

Ureteropelvic Junction ◽

Management Options ◽

Comprehensive Literature Review

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Guidelines of the Italian Society of Videosurgery in Infancy for the minimally invasive treatment of the ureteropelvic-junction obstruction

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2019.232 ◽

2019 ◽

Vol 41 (2) ◽

Author(s):

Salvatore Fabio Chiarenza ◽

Cosimo Bleve ◽

Ciro Esposito ◽

Maria Escolino ◽

Fabio Beretta ◽

...

Keyword(s):

Minimally Invasive ◽

Congenital Abnormality ◽

Ureteropelvic Junction Obstruction ◽

In Utero ◽

Minimally Invasive Treatment ◽

Ureteropelvic Junction ◽

Ultrasound Screening ◽

Urinary System ◽

Invasive Treatment ◽

Pelvicalyceal System

The hydronephrosis, characterized by the dilation of the renal pelvicalyceal system with possible functional damage to the renal parenchyma, is the most common congenital abnormality of the urinary system detected in utero through the prenatal ultrasound screening. (...)

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