Our experience of operated pediatric ureteropelvic junction obstruction patients

Aims: Ureteropelvic junction obstruction (UPJO) may originate from extrinsic or intrinsic causes in children. The aim of this study is to present preoperative and postoperative data of our patients operated for UPJO. Methods: A total of 64 patients who underwent open pyeloplasty were investigated retrospectively. They were evaluated in terms of demographically, clinics, hydronephrosis, differential renal functions (DRFs), half-time tracer clearance (½TC), and histopathologic results. Patients’ numerical results were stated as mean ± standard deviation (SD). Results: Male gender was more prevalent ( n = 47, 73.4%) and mean age at surgery was 46.87 months. UPJO was located at the left side in 56.3% ( n = 36), and at the right side in 39.1% ( n = 25) of patients. It was bilateral in 4.7% ( n = 3). Hydronephrosis was found antenatally in 68.8% ( n = 44) of patients. The mean preoperative DRF was 49.7% (21–78%) and mean postoperative DRF was 49.2% (20–56%). Mean renal scintigraphic t1/2 was >20 min for all patients. The mean AP diameter was 21.58 mm (10–62 mm). Muscular hypertrophy was the most common pathological finding, mean length of excised segment was 10.26 mm (3–40 mm). Crossing vessel (CV) was detected in 17.18% ( n = 11). The CV was statistically associated with increased age of operation, left side, and female gender. Statistically significant hydronephrosis was found in non-CV patients. Re-operation was required in seven patients (7.8%). Conclusions: Intrinsic pathologies are more seen in the etiology of UPJO patients with antenatal diagnosis and this group needs operation at an earlier age. However, CV is found more commonly in patients who are diagnosed and operated at older ages.

Treatment of ureteropelvic junction obstruction and urolithiasis in children with minimally invasive surgery

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.

P117 Surgical management of Ureteropelvic Junction Obstruction (UPJO) in Neonates amid COVID-19 pandemic; Review of Literature and a Cohort Study in Iran

Introduction The current study presents a systematic review of literature on surgical management of ureteropelvic junction obstruction (UPJO) alongside an ongoing cohort study of neonates presenting with high grades of hydronephrosis due to UPJO requiring urgent treatment in a developing country amid the COVID-19 pandemic. The aim of this study is to investigate the efficacy and cost effectiveness of laparoscopic-assisted pyeloplasty. Methods Patients’ demographics, clinical presentations and treatment outcomes are recorded. The cohort is classified into 3 groups based on type of surgical treatment offered including open, laparoscopic and laparoscopic-assisted pyeloplasty. All patients admitted with grade 3-4 hydronephrosis due to UPJO are included. Patients with UPJO as part of a complex multisystemic syndrome are excluded. Literature review was conducted from 2000/1/1 to 2020/1/1 to include all original research papers on surgical management of UPJO. The age group was limited to neonates (under 1 year-old). Results 32 articles were included in the review. 20 papers (62.5%) recommended open pyeloplasty, 10 papers (31.3%) recommended laparoscopic pyeloplasty and 2 papers (6.25%) recommended laparoscopic-assisted pyeloplasty. The cohort study is currently recruiting patients treated by the 3 surgical approaches. Conclusion The majority of studies are focusing on open pyeloplasty. However, as more surgeons are going through the learning curve of laparoscopic pyeloplasty, the trend is towards more laparoscopic management in the future. It is important to discover the advantages of laparoscopic-assisted approach as a new technique to improve the outcome and shorten the hospital stay amid the COVID-19 pandemic.

Introduction of Pediatric Robot-Assisted Pyeloplasty in A Low-Volume Centre

(1) Background: This study investigated the introduction of pediatric robot-assisted pyeloplasty in a low-volume centre with reference to open pyeloplasty with regards to operative times, length of stay (LOS) and outcomes and cost analysis. (2) Methods: Data from 10 consecutive robot-assisted pyeloplasties was compared retrospectively to an age and weight matched cohort of open pyeloplasties operated on during two previous years. Operative times were analyzed in conjunction with LOS, outcomes and cost-analysis from patient records. (3) Results: Operative times remain longer in robot-assisted pyeloplasties (168 (IQR 68) vs. 141 (IQR 51) min), but patients are discharged from the hospital earlier and may return to daily activities earlier. In our hospital, the difference in LOS levels to some degree the cost difference between operations. (4) Conclusions: Robot-assisted pyeloplasty can be safely and economically introduced and maintained in a low-volume centre.

Functional, morphological and operative outcome after pyeloplasty in adult patients: Laparoscopic versus open

Objective: The aim of this study is determine and compare improvement of hydronephrosis, renal function, and operative outcome between laparoscopıc and open pyeloplasty in adults. Material and methods: Sixty-five adult patients with primary ureteropelvic junction obstruction (UPJO) underwent pyeloplasty between January 2014 and September 2020. Thirty-four patients had laparoscopıc pyeloplasty (LP), 31 patients had open pyeloplasty (OP). In this retrospective study demographics, differential renal function (DRF), hydronephrosis, anteroposterior diameter of pelvis renalis (APD) and operative outcomes: operation time, blood loss, complications, hospital stay, etiology, analgesic requirement, complications, and success rates were compared between two groups. Results: Improvement of APD is higher in OP group ( p: 0.001). Improvement of DRF ( p: 0.713) and hydronephrosis ( p = 1.000), success ( p: 0.407) and complication rate ( p: 0.661) are comparable between two groups. Median hospital stay, postoperative analgesia requirement and blood loss was less in LP group, mean operative time was shorter in OP group ( p: 0.001). Conclusion: Pain complaints are greatly reduced after pyeloplasty in adult patients but the drainage of kidney, DRF and hydronephrosis does not improve as much as desired. Improvement of APD is better and median operative time is less in OP, intraoperative blood loss, hospital stay, and analgesic requirement is less in LP group in our study.

Outcome of Laparoscopic Versus Open Pyeloplasty in the Treatment of Pelviureteric Junction Obstruction: A Comparative Study

Background: Ureteropelvic junction obstruction leads to progressive dilatation of the renal collecting system, and can result in pain and progressive deterioration of renal function but may be asymptomatic and result in complication such as pyelonephritis,calculus formation and deterioration of renal function may ensue if left untreated.Open pyeloplasty remains the gold standard against which new technique must be compared.we compared laparoscopic and open pyeloplasty in the treatment of pelviureteric junction obstruction. To see the outcome of laparoscopic pyeloplasty versus open A-H pyeloplasty in the management of pelviureteric junction obstruction. Methods and materials: A prospective quasi experimental study was done from july 2012 to December 2013 in which a total of 30 laparoscopic and 30 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally.Standard open A H pyeloplasty,spiral flap or VY plasty was done depending on anatomical consideration. Patients were followed with USG and IVU at three and six months interval.Perioperative parameters including operative time,analgesic use,hospital stay,and complication and success rates were compared. Results: Mean total operative time in LP group was 115±15 min compared to 75 ±15 in OP group, the postoperative analgesic requirement was sighnificantly less in LP group(mean 84.73±11mg) and OP group required mean of( 274.33±39.42mg).The mean blood loss in LP group was 118.26±110.74ml compared to open group 274.82±118.97ml.The postoperative hospital stay in LP was mean 4 days(2-7days) sighnificantly less than the open group mean of 8 days(7-9days). Conclusion: Lp has a minimal level of morbidity and short hospital stay compered to open approach.Although laparoscopic pyeloplasty has the disadvantages of longer operetive time and requires sighnificant skill of intracorporal knotting but it is here to stay and represents an emerging standard of care. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.182-187

Laparoscopic pyeloplasty for pelvi-ureteric junction obstruction: Our single center experience

Background: Open pyeloplasty is considered as the gold standard for the treatment of pelvi-ureteric junction obstruction. Laparoscopic pyeloplasty has added advantages with equivalent success rate and low complication rate. Objectives: The aim is to study our experiences in laparoscopic retroperitoneal and transperitoneal pyeloplasty. Methodology: Sixty-five patients with pelvi-ureteric junction obstruction were included in the study. The study was conducted between October 2016 and May 2019 at Kathmandu Medical College Teaching Hospital. Pelvi-ureteric junction obstruction was evaluated by ultrasound and intravenous or computed tomography urography. Clinical history, hospital stay, complications, success rate and functional outcome were analyzed. Statistical analysis was done using the Statistical Package for the Social Sciences,version 20.0 (SPSS Inc., Chicago, IL, USA). A p-value < 0.05 was taken as significant. Followup of the patients was carried out for six to twelve months clinically and radiologically. Results: Laparoscopic transperitoneal pyeloplasty was performed in 27 males and 8 females. Retroperitoneal pyeloplasty was performed in 30 cases (20 males and 10 females). The mean age was 20.26 ± 3.92 years for all cases. Operative time was longer in retroperitoneal group. There were four conversions in retroperitoneal group. Mean hospital stay was longer in retroperitoneal group with significant p-value<0.001. Success rate was almost similar in both groups with insignificant p-value of 0.46. Conclusion: Transperitoneal laparoscopic pyeloplasty group achieved better results than retroperitoneal pyeloplasty group in terms of hospital stay, complication and drain placement but with almost similar success rate.