Reflective Practice About Retroperitoneal Laparoscopy in Comparison to Open Surgery for Ureteropelvic Junction Obstruction Repair in Children Less Than 1 Year of Age
Anthony Kallas-ChemalyMatthieu PeycelonLiza AliC. Grapin‐DagornoE. CarricaburuPascale Philippe‐ChometteGoharig EnezianAnnabel Paye‐JaouenAlaa El‐Ghoneimi
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Introduction: The interest in laparoscopy in the treatment of ureteropelvic junction obstruction (UPJO) in children under 12 months of age remains controversial. The aim of this study is to evaluate feasibility and benefits of retroperitoneal laparoscopy (RL) compared to open surgery in this age group. Materials and Methods: Between January 2012 and May 2017, we performed 222 pyeloplasties: 144 by laparoscopy and 78 by open surgery. From 2012, the choice of operative technique was decided according to the laparoscopic experience of the surgeon; two surgeons operated laparoscopically on all children <12 months of age, while others operated using posterior lumbotomy (PL). The RL is standardized and performed by 3 trocars (5, 3, 3). Pre, per and postoperative parameters were analyzed retrospectively. Statistical tests: Pearson, Fisher, Student and Mann-Whitney. Results: During this 5-year period, 24 RL and 53 PL were included with a median follow-up of 27 months (5-63). In the LR group, postoperative drainage was performed by JJ (13 cases) and external stent (11 cases). No conversion has been listed in this group. In each group there was one failure that needed redo pyeloplasty. Duration of hospitalization and intravenous acetaminophen use were significantly lower in the RL group (2.8 vs. 2.3 days, p = 0.02, respectively) while operating time was significantly longer (163 vs. 85.8 min, p = 0.001). The postoperative complication rate was statistically identical in each group (urinary tract infection, wall hematoma, hematuria…). Conclusion: RL is feasible in children under 1 year of age in the hands of well-experienced surgeons with longer operative time but without added morbidity. Subject to the retrospective nature of our study, the RL seems to offer a benefit regarding duration of hospitalization and analgesics consumption.Keywords:
Pyeloplasty
Ureteropelvic junction
Open surgery
Congenital ureteropelvic junction obstruction is considered one of the common causes of prenatally diagnosed hydronephrosis , which if left untreated , it can lead to progressive renal impairment [1].UPJ obstruction is Congenital ureteropelvic junction obstruction is considered one of the common causes of prenatally diagnosed hydronephrosis , which if left untreated , it can lead to progressive renal impairment [1].UPJ
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Objective To evaluate the cure and effect in the treatment of ureteropelvic junction obstrution(UPJO)by dismembered pyeloplasty.Methods Clinical data of 21 cases with ureteropelvic junction obstruction were reviewed who were treated by dismembered pyeloplasty.Results 20 cases gained success by one operation.1 case had ureteropelvic junction(UPJ)stenosis,which was cured by a second operation.1 case had renal function prostration before operation,which was improved after operation.15 of 21 cases had been followed up and their hydronephrosis was improved and their UPJ became unobstructed.Conclusion Dismembered pyeloplasty is effective in the treatment of UPJO.
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Purpose:To sum up diagnostic and therapeutic experience of congenital hydronephrosis caused by ureteropelvic junction obstruction in the infant.Method:Clinical data of 22 cases of congenital hydronephrosis caused by ureteropelvic junction obstruction in the infants are reviewed in retrospect.Result:The accurate rate of diagnosis has been 90.9 %(20/22),the cured rate with operation has been 90%(18/20).Conclusions:B ultrasound is a usual method of congenital hydronephrosis caused by ureteropelvic junction obstruction in the infants.TV guided IVU is a major method in the mild congenital hydronephrosis caused by ureteropelvic junction obstruction in the infants,CT is a major method in the moderate and the severe congenital hydronephrosis caused by ureteropelvic juction obstruction in the infants.Anderson Hynes dismembered pyeloplasty is the first selective methods of operations.
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Objective To summarize the experience on diagnosis and treatment of ureteropelvic junction obstruction(UPJO) with dismembered pyeloplasty.Methods The clinical data of 36 patients with UPJO were retrospectively analyzed.Within these 36 patients,there were 21 patients with ureteropelvic junction obstruction,8 patients with high ureteropelvic junction obstruction,4 patients with compression from crossing blood vessels,and 3 patients with compression from fiber cables.All the patients underwent dismembered pyeloplasty.Results All the patients were examined with B-ultrasonography and IVP and followed up from 12 to 64 months,with the average follow-up survey time of 36 months.Hydronephrosis completely disappeared or significantly subsided in 32(88.9%) patients.3(8.3%) patients with hydronephrosis had no significant change,and 1(2.8%) patient with hydronephrosis became more serious than before.Conclusions Dismembered pyeloplasty is a good choice for the patients with ureteropelvic junction obstruction.
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Purpose: Serial ultrasonography (US) is routinely performed after pyeloplasty in the setting of pediatric ureteropelvic junction obstruction (UPJO). We evaluated the adequacy of the follow-up US interval we are currently using, which calls for US at 1, 3, 6, 9, and 12 months following surgery. Materials and Methods: Between January 2002 and August 2005, 102 patients underwent dismembered pyeloplasty for unilateral UPJO. Within this group, we selected 95 patients with high grade hydronephrosis to participate in this study. The degree of hydronephrosis was graded according to the classification issued by the Society for Fetal Urology (SFU). Improvement was defined as at least one grade of reduction. Serial sonograms were performed at 1, 3, 6, 9, and 12 months postoperatively. Results: On follow-up US, 33.7%, 69.5%, 77.9%, 80.0%, and 83.2% of the patients showed improvement in their hydronephrosis at 1, 3, 6, 9, and 12 months, respectively. One patient presented with aggravation at 1 month. However, at 3 months, this patient had returned to the preoperative grade. There was no significant difference between the mean hydronephrosis grades at 6 and 12 months. No patient showed hydronephrosis aggravation at the 12-month follow-up examination. Conclusions: US at 1, 3, and 6 months revealed significant improvements in hydronephrosis. However, no significant change in hydronephrosis occurred beyond 6 months. Therefore, US performed between 6 and 12 months after pyeloplasty may be inefficient, and we propose follow-up US at the following time points: 1 month, 3 to 6 months, 12 months, and then annually. (Korean J Urol 2008;49:1018-1023)
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No AccessJournal of Urology1 Aug 1990The Postnatal Management of Hydronephrosis Diagnosed by Prenatal Ultrasound P.G. Ransley, H.K. Dhillon, I. Gordon, P.G. Duffy, M.J. Dillon, and T.M. Barratt P.G. RansleyP.G. Ransley , H.K. DhillonH.K. Dhillon , I. GordonI. Gordon , P.G. DuffyP.G. Duffy , M.J. DillonM.J. Dillon , and T.M. BarrattT.M. Barratt View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)39528-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail A total of 112 patients (142 kidneys) presented with hydronephrosis consistent with ureteropelvic junction obstruction that had been diagnosed by prenatal ultrasound. The kidneys were classified as having poor, moderate or good function based on isotope imaging at 3 months after birth. Of 9 kidneys that showed poor function 3 recovered sufficient function on pigtail drainage to justify preservation and these patients underwent pyeloplasty. Of 27 kidneys with moderate function 23 also underwent pyeloplasty and 14 of these demonstrated improvement in function postoperatively. Of the 100 kidneys in the good function group that were followed conservatively 23 underwent pyeloplasty during followup primarily because of an observed decrease in function. We propose that there is no indication for immediate pyeloplasty in infants with prenatally diagnosed hydronephrosis who demonstrate good function postnatally. © 1990 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byBraga L, McGrath M, Farrokhyar F, Jegatheeswaran K and Lorenzo A (2018) Society for Fetal Urology Classification vs Urinary Tract Dilation Grading System for Prognostication in Prenatal Hydronephrosis: A Time to Resolution AnalysisJournal of Urology, VOL. 199, NO. 6, (1615-1621), Online publication date: 1-Jun-2018.Assmus M, Kiddoo D, Hung R and Metcalfe P (2016) Initially Asymmetrical Function on MAG3 Renography Increases Incidence of Adverse OutcomesJournal of Urology, VOL. 195, NO. 4 Part 2, (1196-1202), Online publication date: 1-Apr-2016.Zhang S, Zhang Q, Ji C, Zhao X, Liu G, Zhang S, Li X, Lian H, Zhang G and Guo H (2018) Improved Split Renal Function after Percutaneous Nephrostomy in Young Adults with Severe 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Volume 144Issue 2 Part 2August 1990Page: 584-587 Advertisement Copyright & Permissions© 1990 by The American Urological Association Education and Research, Inc.MetricsAuthor Information P.G. Ransley More articles by this author H.K. Dhillon Supported by Action Research for the Crippled Child. More articles by this author I. Gordon More articles by this author P.G. Duffy More articles by this author M.J. Dillon More articles by this author T.M. Barratt More articles by this author Expand All Advertisement PDF downloadLoading ...
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Objective To evaluate the surgical procedures of treating ureteropelvic junction(obstruction)(UPJO).Methods Dismembered pheloplasty was performed in 12 cases,and continuity pyeloplasty in 6 cases.Results Sixteen of 18 cases had been followed up.Hydronephrosis was significant improved in 3 cases of 5 patients with continuity pyeloplasty.Significant improvement was seen in 10 cases of 11 cases received dismembered pyeloplasty.Conclusion Dismembered pyeloplasty is a good surgical technique for the treatment of UPJO.
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Purpose: Controversies persist on pyeloplasty follow-up, and the aim of this study was to assess the differences and interpretations in results of postoperative ultrasonography and diuretic renograms. Materials and Methods: The study population consisted of 46 patients who underwent pyeloplasty between 1997 and 2003. The average patient age was 7.0 months (range, 2-36 months). Serial changes in hydronephrosis were evaluated by consecutive ultrasonography at 1, 4, 10, and 24 months after pyeloplasty, and a diuretic Tc-MAG3 renal scan was performed 4 months after the surgery. Results: Ultrasonography showed that 11 (24%), 27 (59%), 35 (76%), and 39 (89%) patients had improved in hydronephrosis at 1, 4, 10, and 24 months after pyeloplasty, respectively. Diuretic renal scans showed that of 27 patients who showed improvements in hydronephrosis at 4 months after pyeloplasty, only 17 (63%) had improved excretion and 22 (81%) had preservation of different renal function (DRF). Among 19 patients with persistent or worsened hydronephrosis, 10 (53%) had improved excretion and 13 (68%) had preserved DRF. Conclusions: The results of ultrasonography and diuretic renal scan studies can differ in the same case after pyeloplasty. We recommend that improvements in hydronephrosis be assessed individually by ultrasonography, renal scans, and clinical status to determine surgical outcomes. (Korean J Urol 2009;50:596-601)
Ureteropelvic junction
Pyeloplasty
Kidney pelvis
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Citations (7)
Abstract Hydronephrosis due to pelvi-ureteric obstruction rarely presents in the neonatal period. When it does, the disease is advanced and it may be advisable to drain the obstructed kidney until the child is old enough and fit enough to withstand a pyeloplasty. In this paper 2 cases of neonatal hydronephrosis are reported and a satisfactory method of drainage is described.
Pyeloplasty
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Citations (2)
Ureteropelvic junction
Pyeloplasty
Kidney pelvis
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Citations (10)