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

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.

Laparoscopic Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction: Our Preliminary Experience

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

scholarly journals Evaluation of Renal Function After Percutaneous Nephrostomy in Obstructive Uropathy Due to Ureteropelvic Junction Obstruction

2020 ◽  
Vol 17 (1) ◽  
pp. 36-41
Author(s):  
Md Faisal Islam ◽  
SM Mahbub Alam ◽  
Md Babrul Alam ◽  
MA Awal ◽  
Md Amanur Rasul
Keyword(s):  
Renal Function ◽  
Specific Gravity ◽  
Filtration Rate ◽  
Ureteropelvic Junction Obstruction ◽  
Obstructive Uropathy ◽  
Percutaneous Nephrostomy ◽  
Ureteropelvic Junction ◽  
Upj Obstruction ◽  
Split Renal Function ◽  
The Mean

Objective: The present prospective study was conducted to evaluate the renal function after percutaneous nephrostomy (PCN) in obstructive uropathy due to ureteropelvic junction obstruction. Patients of UPJ obstruction irrespective of sex upto 15 years of age and split renal function (SRF) of the affected kidney <10% were enrolled in the study. Methods: The present prospective study was carried out at the Department of Urology, Dhaka Medical College Hospital from January 2007 to December 2008. The patients having ureteropelvic junction (UPJ) obstruction with poor renal function were the study population. Patients of either sex up to 15 years of age and split renal function < 10% (unilateral and / bilateral) were enrolled in the study. Patients with other anatomical abnormality of urinary system, concomitant pathologies like stone, pyonephrosis or previous surgical intervention of kidney and/or ureter were excluded from the study. Baseline variables were flank mass, flank pain, side of hydronephrosis, split renal function (SRF), glomerular filtration rate (GFR), specific gravity of urine at the time of PCN. Postoperative follow up variables (at 2, 4 and 6 weeks) were split renal function (SRF), glomerular filtration rate (GFR), specific gravity urine draining through nephrostomy tube, volume of urine through nephrostomy tube and complications. Data were collected using a structured questionnaire (research instrument) containing all the variables of interest. Data were processed and analysed using SPSS (Statistical Package for Social Sciences). The test statistics used to analyse the data were descriptive statistics and Repeated measure ANOVA. For all analytical tests, the level of significance was set at 0.05 and p < 0.05 was considered significant. Result: The mean age of the patients was 8.6 ± 3.9 years and the lowest and highest ages were 3 months and 15 years respectively. The poorly functioning kidneys demonstrated a steady increase in SRF from 3.6% at baseline to 23% after 6 weeks PCN (p < 0.001). SRF of all children except 4 improved significantly during the period. The mean GFR of poorly functioning kidneys was 3.5ml/min/1.73 sq-meter at baseline which increased to 28.4 ml/min/1.73 sq-meter at the end of week 6. The GFR of 34 children improved (> 10 ml/min/1.73 sq-meter at the 6 week of treatment. Four cases (10.5%) did not improve. The specific gravity of urine significantly increased from 1.009 at baseline to 1.019 after 6 weeks. The volume of urine at 2nd week was 338 ml/24hour which sharply increased to 363 ml/24 hours at week 4 and nearly 386 ml/24hours after 6 weeks of PCN (p < 0.001). Conclusion: Present study recommends that as the likelihood of recovery of a severely damaged kidney (SRF < 10%) with UPJO following PCN is fairly satisfactory; none of the children with poorly functioning kidney should undergo nephrectomy without subjecting them to a PCN trial. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.36-41

Outcome of Percutaneous Nephrostomy in Children With Ureteropelvic Junction Obstruction

2020 ◽  
Vol 20 (2) ◽  
pp. 61-64
Author(s):  
Mohammad Mahfuzur Rahman Chowdhury ◽  
Rifat Zaman ◽  
Md Amanur Rasul ◽  
Akm Shahadat Hossain ◽  
Shafiqul Alam Chowdhury ◽  
...  
Keyword(s):  
Renal Function ◽  
Low Dose ◽  
Ureteropelvic Junction Obstruction ◽  
Percutaneous Nephrostomy ◽  
Ureteropelvic Junction ◽  
College Hospital ◽  
Medical College ◽  
Split Renal Function

Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively. Results: All the patients had severe hydronephrosis during diagnosis and 14 patients with unilateral UPJO were improved after PCN drainage and underwent pyeloplasty. The rest four patients that did not show improvement in the SRF and total volume of urine output underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF was increased to 26.4% ±8.6% (mean± SD) after four weeks and pyeloplasty was performed. At three and six months follow-up, SRF value was 29.2% ±8.5% and 30.8.2% ±8.8% respectively. Conclusion: Before planning of nephrectomy in poorly functioning kidneys (SRF < 10%) due to congenital UPJO, PCN drainage should be done to asses improvement of renal function. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.61-64

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

2015 ◽  
Vol 9 (11-12) ◽  
pp. 775 ◽  
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.

Comments on a case of ureteropelvic junction obstruction with late progression in an adult female

2021 ◽  
Vol 88 (3) ◽  
pp. 247-250
Author(s):  
Carlo Gandi ◽  
Angelo Totaro ◽  
Riccardo Bientinesi ◽  
Emilio Sacco
Keyword(s):  
Renal Function ◽  
Natural History ◽  
Conservative Treatment ◽  
Gold Standard ◽  
Ureteropelvic Junction Obstruction ◽  
Ureteropelvic Junction ◽  
Case Description ◽  
Diuretic Renogram ◽  
History Of

Introduction: Ureteropelvic junction obstruction is a pathology typically diagnosed in childhood. Nevertheless, some clinically silent cases may be unnoticed until adulthood. Case description: We report the case of a 53-year-old female with hydronephrosis due to ureteropelvic junction stenosis diagnosed in the adulthood, who subsequently developed obstruction with progressive worsening of renal function without symptoms. Conclusion: The natural history of ureteropelvic junction obstruction is still obscure. Diuretic renogram is the gold standard for diagnosis and follow-up of ureteropelvic junction obstruction, but is weak in predicting the evolution of the disease, especially in patients with vague symptoms. Conservative treatment of adult patient with equivocal ureteropelvic junction obstruction seems reasonable, but requires a close clinical follow-up and strict patient compliance in order to promptly identify significant obstruction.

scholarly journals Concomitant management of renal calculi and recurrent ureteropelvic junction obstruction with percutaneous nephrolithotomy and antegrade balloon dilation

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052091125
Author(s):  
Chunxiao Wei ◽  
Tengteng Wang ◽  
Shaoan Chen ◽  
Xiangbin Ren ◽  
Xiude Chen
Keyword(s):  
Renal Function ◽  
Success Rate ◽  
Percutaneous Nephrolithotomy ◽  
Ureteropelvic Junction Obstruction ◽  
Balloon Dilation ◽  
Renal Calculi ◽  
Ureteropelvic Junction ◽  
High Grade ◽  
Free Status ◽  
Grade Iii

Objective This study aimed to present our experience of concomitant management of renal calculi and recurrent ureteropelvic junction obstruction (UPJO) with percutaneous nephrolithotomy (PCNL) and antegrade balloon dilation. Methods We retrospectively reviewed 31 patients who underwent PCNL and antegrade balloon dilation for treatment of renal calculi and recurrent UPJO. The inclusion criterion was the presence of UPJO after failed pyeloplasty with ipsilateral renal calculi. Success was defined as achievement of both symptomatic and radiographic resolution of any stones and obstruction. Results All operations were successful without grade III or higher postoperative complications. A stone-free status was observed in all patients and the overall success rate of the procedure was 87.1% (27/31). The success rate of the procedure was significantly higher in patients with mild or moderate preoperative hydronephrosis (96%) than in those with high-grade preoperative hydronephrosis (50%). Moreover, the success rate of the procedure was lower in patients with poor preoperative renal function (0%) than in those with good or moderate renal function (93.1%). Conclusion Combined PCNL and antegrade balloon dilation management represents a safe and effective approach for patients with renal calculi and recurrent UPJO after failed pyeloplasty.

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

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.

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.

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