scholarly journals RETROPERITONEAL LAPAROSCOPIC DISMEMBERED PYELOPLASTY FOR URETEROPELVIC JUNCTION OBSTRUCTION (UPJO)

2017 ◽  
Vol 24 (1) ◽  
Author(s):  
Nanda Daniswara ◽  
Jupiter Sibarani
Keyword(s):  
Operative Time ◽  
Ureteropelvic Junction Obstruction ◽  
Left Kidney ◽  
Flank Region ◽  
Urethral Catheter ◽  
Ureteropelvic Junction ◽  
Good Patient ◽  
Left Flank ◽  
Double J Stent ◽  
Ureteral Stenting

Objective: To share our experience of retroperitoneal laparoscopic dismembered pyeloplasty as the treatment of Ureteropelvic Junction Obstruction (UPJO) in Department of Urology, Hasan Sadikin Hospital Bandung. Material & Methods: Boy 8 years old came for a chance to relieve mass at both flank region especially at left flank region. From the ultrasonography there were bilateral hydronephrosis. We decided to urethrocystoscopy, bilateral ureteral catether insertion, bilateral retrograd pyelography guided with c-arm and left retroperitoneal laparoscopic dismembered pyeloplasty. Results: Operative time was 240 minutes and blood loss was about 200cc. Double J Stent was used for ureteral stenting. Parenteral ketorolac was given as needed to control the pain. The Visual Analogue Scale (VAS) post operative day 1 until 4 were6, 4,, 2, 2 respectively. Urethral catheter was removed at post operative day 2 and drain was removed at post operative day 3. Operating wound was good. Patient was hospitalization until post operative day 4. Left nephrostomy was removed at postoperative day 7 after there was no leakage, confirmed with left antegrad pyelography. From post operative ultrasonography we found that hydronephrosis at left kidney became almost normal. Conclusion: In our opinion that the retroperitoneal laparoscopic dismembered pyeloplasty is an alternative treatment for UPJO. This procedure depends on experience and pristine surgical tehnique from the surgeon

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.

scholarly journals Use of double-J ureteric stents post-laparoscopic pyeloplasty to treat ureteropelvic junction obstruction in hydronephrosis for pediatric patients: a single-center experience

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091878
Author(s):  
Haobo Zhu ◽  
Jun Wang ◽  
Yongji Deng ◽  
Liqu Huang ◽  
Xiaojiang Zhu ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Ureteropelvic Junction Obstruction ◽  
Stent Migration ◽  
Ureteropelvic Junction ◽  
Laparoscopic Pyeloplasty ◽  
Clinical Variables ◽  
Single Center Experience ◽  
Post Surgery ◽  
Ureteric Stents ◽  
Double J Stent

Objectives We aimed to investigate the safety concerns associated with placing double-J ureteric stents post-laparoscopic pyeloplasty surgery for congenital ureteropelvic junction obstruction (UPJO) and hydronephrosis. Methods A total of 1349 patients with postoperative double-J stent placement at our center were included. Clinical variables for enrolled patients were collected by two independent authors. We compared clinical variables and the efficacy of stenting post-laparoscopic pyeloplasty. Results The mean age of the patients was 4.23 ± 2.39 years. A total of 58.49% of patients were diagnosed with left UPJO with hydronephrosis and 33.95% were diagnosed with right UPJO. Furthermore, 7.56% of patients had bilateral UPJO. In all cases, 96.96% of indwelling double-J stents were successfully removed 4 weeks post-surgery. A total of 3.04% of the patients still required further management, including stent migration to the renal pelvis (0.37%), stent migration to the bladder (0.30%), prolapse of the stent through the ureter (0.15%), blockage of stents (1.85%), and fouling of stents (0.37%). Conclusions Double-J ureteric stents used after laparoscopic pyeloplasty for treating UPJO in hydronephrosis for pediatric patients is a safe, feasible, and beneficial method, which can be recommended for routine procedures. However, caution should be practiced for follow-up and removal using this method.

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

2021 ◽  
pp. 1-8
Author(s):  
Guohao Wu ◽  
Haomin Li ◽  
Peifeng Zhong ◽  
Dongjiang Chen ◽  
Zhihua Zhang ◽  
...  
Keyword(s):  
Success Rate ◽  
Renal Pelvis ◽  
Ureteropelvic Junction Obstruction ◽  
Operating Time ◽  
Ureteropelvic Junction ◽  
Initial Experience ◽  
Laparoscopic Pyeloplasty ◽  
Double J Stent ◽  
Estimated Blood Loss

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.

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 Normal black kidney

2014 ◽  
Vol 8 (3-4) ◽  
pp. 282 ◽  
Author(s):  
Aliasghar Yarmohamadi ◽  
Ali Reza Akhavan Rezayat ◽  
Bahram Memar ◽  
Hamid Reza Rahimi
Keyword(s):  
Renal Function ◽  
Left Kidney ◽  
Flank Region ◽  
Underlying Disease ◽  
The Other ◽  
Pathological Changes ◽  
Left Flank ◽  
Operating Room Table ◽  
Lipofuscin Pigment ◽  
Histopathologic Analysis

A black kidney has 3 major differential diagnoses: hemosiderosis, lipofuscin pigment and melanotic renal cell carcinoma. Excluding lipofuscin, the other 2 are accompanied by an abnormal renal function. We report on a 25-year-old man who intended to donate a kidney to his cousin. On the operating room table when we incised the left flank region and exposed the kidney, we found a firm and black kidney so the operation was cancelled due to potential vascular injuries. Days after the incomplete procedure, we reviewed the donor’s biochemistry and imaging to reassess his renal function, but the results showed quite normal renal function again. The result of the Ham test was also negative. Two weeks later, we began the operation, removed the same left kidney and found that it was in the same condition as it was before. We took the opportunity to send needle biopsies of the kidney for histopathologic analysis. The analysis showed a melanotic kidney without pathological changes in glomeruli and interstitium and vessels. A black kidney may result in hemosiderin, lipofuscin or melanin deposits in the kidney, which can confirm the diagnosis; however, special tests for underlying disease and renal function should be considered. Some causes of black kidney lead to abnormal function, but our patients’s kidney returned to normal.

scholarly journals A comparison between laparoscopic and robotic-assisted laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction

2020 ◽  
Author(s):  
Niwat Lukkanawong ◽  
Masashi Honda ◽  
Shogo Teraoka ◽  
Yusuke Kimura ◽  
Tetsuya Yumioka ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Operative Time ◽  
Ureteropelvic Junction Obstruction ◽  
Laparoscopic Group ◽  
Ureteropelvic Junction ◽  
Laparoscopic Pyeloplasty ◽  
Robotic Group ◽  
Robotic Assisted ◽  
Drain Removal ◽  
Significant Difference

Abstract Background The aim of this study is to compare the results of laparoscopic pyeloplasty and robotic-assisted laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. Methods Between March 2008 and May 2019, the patients who underwent retroperitoneal laparoscopic or robotic-assisted laparoscopic pyeloplasty in our institution were retrospectively reviewed. Results Thirteen patients underwent laparoscopically, and 12 patients underwent robotic surgery. The significant difference was found in median operative time between laparoscopic group (296 minutes) and robotic group (199 minutes) (P = 0.001). The median time for drain removal in laparoscopic group was longer than robotic group (3 vs 2 days, respectively, P = 0.029). Conclusions Laparoscopic and robotic-assisted laparoscopic pyeloplasty is safe and excellent success rates in patients with ureteropelvic junction obstruction. However, our experience study suggested that robotic surgery improves a total operative time, decreases drain removal time and less intraoperative blood loss than laparoscopic approach.

Combination of Robotic Pyeloplasty and Percutaneous Renal Surgery for Simultaneous Treatment of Ureteropelvic Junction Obstruction and Calyx Stones

2021 ◽  
pp. 1-5
Author(s):  
Clemens Hüttenbrink ◽  
Peter Kelm ◽  
Tilman Klein ◽  
Florian Distler ◽  
Abishek Pandey ◽  
...  
Keyword(s):  
Renal Pelvis ◽  
Operative Time ◽  
Ureteropelvic Junction Obstruction ◽  
Ureteropelvic Junction ◽  
Renal Surgery ◽  
Simultaneous Treatment ◽  
X Ray Imaging ◽  
Robotic Pyeloplasty ◽  
Mean Size ◽  
The Mean

Introduction: Ureteropelvic junction obstruction (UPJO) and the simultaneous presence of kidney calyx stones represent a challenge for renal surgery. We present a novel technique for the simultaneous treatment of UPJO by robotic pyeloplasty in combination with the percutaneous endoscopic treatment of kidney calyx stones by flexible nephroscopy. Patients and Methods: Between January 2018 and February 2020, 4 patients were diagnosed with UPJO and simultaneous pelvic or calyceal stones. UPJO was treated by conventional robotic pyeloplasty. After opening the renal pelvis, a flexible 16-French cystoscope was introduced via the 12-mm assistant trocar into the renal pelvis. The kidney calyx stones (n = 1–15) were removed endoscopically through a flexible nephroscope using a Dormia helical basket. Before suturing the anastomosis of the renal pelvis, a ureter stent was inserted. Results: After the procedure, all patients were stone free. Using the Clavien-Dindo classification, no complications were noted. The mean size of the calculi was 6.69 mm (range: 1–25). Up to 15 calyx stones (mean 3.46) were removed per patient. A complete stone clearance confirmed by postoperative X-ray imaging was achieved in all patients. The mean operative time was 149 min (range: 130–178). Mean hospital stay was 7 days (7–8). The urethral stent was removed after 4–6 weeks. Conclusions: Robotic management of UPJO and simultaneous flexible nephroscopy for removal of calyceal stones is an effective treatment in 1 session. Combining robotic surgery with flexible percutaneous renal surgery is a feasible, safe, and effective method of the treatment of UPJO and concomitant calyceal stones.

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.

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