Pediatric Minimally Invasive Pyeloplasty

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

scholarly journals Surgical approaches for treatment of ureteropelvic junction obstruction – a systematic review and network meta-analysis

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Annemarie Uhlig ◽  
Johannes Uhlig ◽  
Lutz Trojan ◽  
Marc Hinterthaner ◽  
Alexander von Hammerstein-Equord ◽  
...  
Keyword(s):  
Ureteropelvic Junction Obstruction ◽  
Treatment Options ◽  
Operating Time ◽  
Surgical Techniques ◽  
Ureteropelvic Junction ◽  
Surgical Approaches ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Success Rates ◽  
Urinary Leakage

Abstract Background Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach. Methods A systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques. Results A total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05–0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31–0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41–0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22–0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min–163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min–164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min–151.58 min, p = 0.003). Conclusions Multiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.

scholarly journals Meta-Analysis of the Efficacy of Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction via Retroperitoneal and Transperitoneal Approaches

2021 ◽  
Vol 9 ◽  
Author(s):  
Fengming Ji ◽  
Li Chen ◽  
Chengchuang Wu ◽  
Jinrong Li ◽  
Yu Hang ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Operative Time ◽  
Ureteropelvic Junction Obstruction ◽  
Meta Analysis ◽  
Ureteropelvic Junction ◽  
Cochrane Library ◽  
Complication Rates ◽  
Success Rates ◽  
Laparoscopic Pyeloplasty ◽  
Exclusion Criteria

Objective: This study aimed to evaluate the clinical efficacy of laparoscopic pyeloplasty (LP) for ureteropelvic junction obstruction (UPJO) via retroperitoneal and transperitoneal approaches.Method: A systematic literature search on keywords was undertaken using PubMed, Cochrane Library, Embase, China Nation Knowledge (CNKI), and Wanfang. The eligible literature was screened according to inclusion and exclusion criteria. Meta-analysis was performed by using RevMan 5.0 software.Results: According to the inclusion and exclusion criteria, 12 studies were identified with a total of 777 patients. Four hundred eight patients were treated with retroperitoneal laparoscopic pyeloplasty (RLP), and 368 patients were treated with transperitoneal laparoscopic pyeloplasty (TLP). The meta-analysis results showed that the two approaches were similar in terms of presence of postoperative hospital stay, postoperative complication, the rate of conversion, and recurrence (p &gt; 0.05). The operative time in the TLP group was significantly shorter than the RLP group (MD = 16.6; 95% CI, 3.40–29.80; p = 0.01). The duration of drainage was significantly shorter (MD = −1.06; 95% CI, −1.92 to −0.19; p = 0.02), and the score of postoperative visual analog score (VAS) was significantly lower in the RLP group than in the TLP group (MD = −0.52; 95% CI, −0.96 to −0.08; p = 0.02).Conclusion: Both approaches have good success rates and low postoperative complication rates. RLP provides a shorter duration of drainage and lower VAS score, but it takes more operative time than TLP.

scholarly journals Minimally invasive surgical options for ureteropelvic junction obstruction: A significant step in the right direction

2009 ◽  
Vol 25 (1) ◽  
pp. 27 ◽  
Author(s):  
ChandraShekhar Biyani ◽  
JonJ Cartledge ◽  
AnthonyJ Browning ◽  
AdrianD Joyce ◽  
StephanieJ Symons ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Ureteropelvic Junction Obstruction ◽  
Ureteropelvic Junction ◽  
Minimally Invasive Surgical ◽  
Significant Step ◽  
Surgical Options ◽  
The Right

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

2021 ◽  
pp. 039156032110261
Author(s):  
Lorenzo Masieri ◽  
Simone Sforza ◽  
Alekseja Manera ◽  
Luca Lambertini ◽  
Alfonso Crisci ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Pediatric Patients ◽  
Ureteropelvic Junction Obstruction ◽  
Ureteropelvic Junction ◽  
Tertiary Referral Center ◽  
Flexible Cystoscope ◽  
Effective Option ◽  
Open Pyeloplasty

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.

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.

Open stone surgery for kidney stones

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.

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

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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