Comparison of Drainage Methods After Pyeloplasty in Children: A 14-Year Study

Objective: To summarize our experiences with drainage methods after laparoscopic pyeloplasty with a 14-year study.Methods: We reviewed the data of the 838 children operated on for hydronephrosis due to congenital ureteropelvic junction obstruction (UPJO) between July 2007 and July 2020. Patients' demographics, perioperative details, postoperative drainage stents [including double-J stent, percutaneous trans-anastomotic (PU) stent, and trans-uretero-cystic external urethral stent (TEUS)], complications, hospital stay, and long-term follow-up outcomes were analyzed. Long-term follow-up was performed by outpatient visits and telephone follow-up. Moreover, we reviewed the details of nine cases of recurrence after laparoscopic pyeloplasty.Results: Comparison of preoperative general data among the three groups indicated that there was no statistical difference in age, gender, and surgical side of the three groups. Statistical differences were found in the incidence of postoperative complications from the three postoperative drainage method groups, especially the incidence of reoperations (p < 0.01): there were six cases (3.19%) of recurrences in the TEUS group, two cases (0.36%) in the DJ group, and one case (0.93%) in the PU group. In the six recurrent cases from the TEUS group, four cases (44.4%) were found to have stenosis, and two cases (22.2%) have iatrogenic valvular formation.Conclusion: Not all three types of drainage methods are suitable for drainage after pyeloplasty. Based on our findings, TEUS is not recommended.

Initial Experience with the Comprehensive Modified Laparoscopic Pyeloplasty Technique Based on Membrane Anatomy for Treating Ureteropelvic Junction Obstruction

Objective: The aim of the objective was to present our initial experience and evaluate the feasibility of the novel comprehensive modified laparoscopic pyeloplasty (CMLP) technique based on membrane anatomy. Materials and Methods: Forty-eight patients underwent CMLP from February 2016 to October 2020. CMLP involves the following: dissection of the ureter was based on the fascia or fusion fascia formed by embryonic development. The ureter was separated from the ureteral sheath, and the pelvis and ureter were incised with incomplete amputation. The first stitch was placed between the lower point of the spatulated ureter and the lowest corner of the renal pelvis to ensure correct orientation of the anastomosis; anastomosis of the renal pelvis and ureter was performed using the touchless technique. Results: All CMLPs were completed successfully without conversion. The mean overall operating time was 230.96 min. The median estimated blood loss was 50.00 (interquartile range 20.00–57.50) mL. The average postoperative hospital stay was 9.31 days. The average follow-up time was 24.73 months. No major complications occurred. In 1 case, revision laparoscopic pyeloplasty was performed, but the obstruction persisted after double J stent removal, so ultimately, the double J stent required regular replacement. Another asymptomatic patient with hydronephrosis experienced failed treatment and is still under follow-up. The overall success rate was 95.83% (46/48). The success rate in patients with recurrent ureteropelvic junction obstruction (UPJO) was 87.5% (7/8). Conclusions: CMLP is a practical and effective treatment option for UPJO with a high success rate. An advantage of CMLP is the clear surgical field.

Complications of Standard Percutaneous Nephrolithotomy versus Tubeless Percutaneous Nephrolithotomy

Objective: To compare grade I complication as per Clavien-Dindo classification in patients undergoing standard (with tube) verses tubeless percutaneous nephrolithotomy. Study design: Hospital based randomized control study. Place and Duration of Study: Urology Clinic, Sindh Institute of Urology & Transplantation Karachi from 3rd June 2016 to 2nd December 2016. Methodology: Seventy four patients (37patients) in each group were enrolled. In group 1 patients, a 20 F nephrostomy tube were placed in the kidney over the guide wire, which was removed later. Group II patients had antegrade placement of a Double-J stent without nephrostomy and the wound compressed for 5min. The demographic like age, gender and complications grade I complications according to Clavian-Dindo classification were noted. Results: The mean age was 49.42±7.06 years. There were 46 (62.16%) males and 28 (37.84%) females. There was no significant difference in stone clearance rate between the groups; 91.9% in standard percutaneous nephrolithotomyg roup and 94.6% in tubeless percutaneous nephrolithotomy group. Need for analgesics for pain control was high in standard percutaneous nephrolithotomy group 86.5% versus 64.9% in tubeless percutaneous nephrolithotomy group (p=0.03). Frequency of urine leakage was 18.9% in standard percutaneous nephrolithotomy group and only 2.7% in tubeless percutaneous nephrolithotomy group (p=0.02). Conclusion: Tubeless percutaneous nephrolithotomy procedure has fewer complications as per Clavien-Dindo classification regarding need for analgesics and urine leakage. In suitable cases, the tubeless procedure can be safely used as the standard for percutaneous nephrolithotomy. Keywords: Percutaneous nephrolithotomy (PCNL), Clavien-Dindo classification, Complication

A case report of forgotten double J stent with giant calculus formation from the renal pelvis to the bladder

Double j stent is commonly used in urological procedures. Its main purpose is to afford the sufficient drainage from the renal pelvis to the urinary bladder. Following increased usage of double-J stent, several consequences associated to it have been reported. In this work, we report on a case of “forgotten” double j stent for 1 year in a 32-year-old male patient who visited emergency department with bilateral flank pain, fever, and vomiting for a duration of 3 days. A double-J stent was detected in the plain abdominal X-ray. It was also observed that a 20 × 15 mm stone has impacted the left renal pelvis. Therefore, two operations were performed successfully until the full recovery of the patient. Hence; the main aim of this paper is to increase awareness about the potential complications of “forgotten” double J Stent.

Evaluation of Galdakao-modified Valdivia Position in Combined Simultaneous Access to Upper and Lower Urinary Tract Pathologies

Background Simultaneous retrograde and antegrade endoscopic combined intrarenal surgery in modified supine lithotomy positions offer significant progress in the endoscopic management of urolithiasis. The operative time has been significantly reduced. Aim of the Work To evaluate the Galdakao-modified Valdivia position in simultaneous handling of upper and lower urological pathologies in the same units. Patients and Methods The evaluation for the Galdakao-modified Valdivia position regarding the benefits in different upper and lower urological diseases was the aim of our prospective randomized clinical trial that will started on April 2017 and ended by April 2019. Results The study has included 60 patients comprising males and females. Conclusion We believe that GMSV provided a great versatility in the treatment for urolithiasis along the whole urinary tract, ante-retrograde access, treatment of uretero-ileal strictures in patients with urinary diversions or neobladders, missed double j stent, bilharizoma of the ureter and bladder mass involving the ureteric orifice. Also, the advantage provided by this approach to the surgeon, patient and anesthetist may lead to widespread adaptability of this technique in the management of complex urolithiasis.