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Objective To evaluate the feasibility and safety of transumbilical laparoendoscopic sin-gle-site dismembered pyeloplasty ( U-LESS-P ) for the treatment of ureteropelvic junction obstruction (UPJO). Methods Between Mar.2011 and Mar.2012, U-LESS-P was performed in 8 consecutive pa-tients with UPJO by one experienced laparoscopic surgeon .The patients included 5 males and 3 females, with an average age of 28 (16-45) years.Of the 8 patients, six presented with flank pain , and two were a-symptomatic and discovered incidentally by health check .Of the 8 patients, seven had UPJO on the left side and one on the right side .The diagnosis was established by renal ultrasonography , diuretic renal scan , intra-venous urography (IVU) or/and computed tomography urography (CTU).Renal ultrasonography, IVU and ( or) CTU showed hydronephrosis and UPJO in the affected side , while diuretic renal scan demonstrated re-nal function deteriorated .No patients had undergone abdominal surgery previously .A 2-2.5 cm umbilical in-cision was made for single-port access .The procedures were performed using 30°5 mm or 10 mm laparoscope with a combination of conventional and bent laparoscopic instruments . Results All procedures were com-pleted successfully .None was converted to open surgery or traditional laparoscopic surgery .The mean opera-tive time was 153 (117-190) min, and the average estimated blood loss about 20 (10-40) ml.The mean time to resume oral diet was 1.5 days.The drainage remained 2-7 days.The mean hospital stay was 6 (4-8) days.With the follow-up of 3-6 months, symptom-free was investigated in all 8 cases.Ultrasonography , diuretic renal scan and IVU showed decreased or disappeared hydronephrosis .No operative complication , such as anastomotic stoma stenosis , was founded . Conclusions U-LESS-P is a safe and effective proce-dure for the treatment of UPJO , with the advantages of decreased operative morbidity , postoperative rapid re-covery and improved cosmetic result .
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Objective To report a retroperitoneal laparoscopic surgery for ureteropelvic junction obstruction (UPJO) by double renal veins.Methods A 28-year-old male patient with left low back pain for 6 months was diagnosed as left hydronephrosis and UPJO.A ureteral stent had been placed 3 months before and failed to improve hydronephrosis,so the ureteral stent was pulled out.CT scan showed that left UPJ went through the two renal veins,suggesting UPJO.Nephrogram showed that left GFR and right GFR were 35 ml/min and 34 ml/min,respectively.These results indicated mechanical obstruction of left upper urinary tract.The patient underwent retroperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty.Results The surgical procedure was successful.Two left renal veins were found,and the ventral one was in front of ureter,compressing the ureter.An aberrant renal artery went into left kidney with the ureter.0.5 cm stenosis of ureteropelvic junction was excised,and pyeloplasty was performed.A ureteral stent was placed into the ureter,then the pelvis and the ureter were sew up in front of the ventral renal vein.The surgical time was 240 min,and blood loss was 50 ml.Postoperative hospital stay time was 4 d.During 4 months' follow up,hydronephrosis was attenuated significantly.Conclusion Retroperitoneal laparoscopic surgery for UPJO with aberrant two renal vein might be a minimally-invasive and effective procedure.
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Objective To evaluate the surgical techniques and clinical applications of single-port transumlilical laparoscopic dismembered pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO). Methods From August 2009 to March 2010, 15 patients were treated with single-port transumbilical laparoscopic dismembered pyeloplasty. There were 12 males and 3 females,aged 12 to 55 years with an average age of 20 years, who were diagnosed by diuretic renography,IVU, and MRU et al. A single umbilical incision of 3. 5cm was made for single-port trocar and a flexible-tip 0°digital video-laparoscope was used in all cases. The procedures were performed according to the methods used in classical laparoscopic dismembered pyeloplasty with general instruments. ResultsAll operations were performed successfully without conversion to open surgery. The mean operative time was 90 (75-145) min, and the mean hospital stay length was 6 days. No organs injury occurred during operation, and no urine leakage was found afer operation. The symptoms of low back pain disappeared and hydronephrosis reduced apparently or dispeared without any anastomotic stenosis after follow-up of 4-6 months. Conclusions Single-port transumbilical laparoscopic dismembered pyeloplasty is feasible, effective and safe for the treatment of UPJO.
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Introducción: En la actualidad existen múltiples opciones de tratamiento para la estenosis ureteropiélica (EUP). La pieloplastia abierta es el estándar de oro, con una tasa de éxito mayor a 90%. El objetivo de este estudio es describir nuestra experiencia en el manejo quirúrgico de la EUP. Material y Métodos: Estudio retrospectivo y descriptivo de los casos de EUP manejados quirúrgicamente en el periodo comprendido entre 1970 y 2002. Resultados: Se diagnosticaron 126 EUP en 114 pacientes. Los principales síntomas fueron: dolor en 105 pacientes (92.1%), infección de vías urinarias en 37 (32.4%) y hematuria en 24 (21%). Las patologías asociadas con mayor frecuencia fueron: urolitiasis en 34 casos, cruce vascular en 10, y riñón en herradura en 5. Se realizaron 123 procedimientos: 92 (74.8%) pieloplastias desmembradas, 13 (10.7%) pieloplastias tipo Foley Y-V, en 8 (6.5%) sólo liberación de vasos anómalos o bridas, 5 (4%) endopielotomías, 2 pieloplastias tipo Scardino-Prince (1.6%), 2 pacientes transplantados (1.6%), con anastomosis de la pelvis del injerto al uréter nativo y una anastomosis ureteroileal (0.8%) en un paciente con fibrosis retroperitoneal. El tiempo promedio de seguimiento fue de 33.2 meses. En 114 pacientes (92.7%) el procedimiento fue exitoso. Se documentó 17.9% de complicaciones globales, 2.4% correspondió a reestenosis asociadas a cruce vascular. Conclusión: La pieloplastia desmembrada es el procedimiento más utilizado en pacientes con EUP con adecuados resultados, preservación de la función renal, mejoría de los síntomas y baja morbilidad.
INTRODUCTION: Currently there are many therapeutic options for ureteropelvic junction obstruction (UPJO). Open pyeloplasty is the gold standard with a success rate of approximately 90%. We describe our experience in the treatment of UPJO. MATERIAL AND METHODS: We conducted a retrospective and descriptive study among our patients with UPJO surgically treated at the Department of Urology of our institution from 1970 to 2002. RESULTS: 126 UPJO were diagnosed in 114 patients. The most common symptoms at diagnosis were: pain in 105 patients (92.1), urinary tract infection (UTI) in 37 (32.4%) and hematuria in 24 (21%). The most common associated diseases were urolithiasis in 34 cases, crossing vessels in 10 and horseshoe kidney in 5. 123 procedures were undertaken: 92 (74.8%) dismembered pyeloplasties, 13 (10.7%) Foley Y-V pyeloplasties, in 8 (6.5%) release of crossing vessel, 5 (4%) endopyelotomies, 2 (1.6%) pyeloplasties Scardino-Prince, 2 patients with renal allograft in whom an anastomosis of renal pelvis to native ureter was performed and 1 (0.8%) ureter-ileal anastomosis in a patient with retroperitoneal fibrosis. The mean follow-up time was of 33.2 months. In 114 (92.7%) patients the procedure was successful. The overall complication rate was of 17.9% of which 2.4% were stricture recurrence associated with crossing vessels. CONCLUSION: Open dismembered pyeloplasty is the most common treatment procedure for UPJO at our institution. We report successful results, low morbidity, preservation of renal function and improving symptoms.
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Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Kidney Pelvis , Ureteral Obstruction/surgery , Retrospective StudiesABSTRACT
Objective To compare the efficacies of mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy and routine retroperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction(UPJ) obstruction.MethodsThe clinical data of 47 patients with UPJ obstruction,who underwent dismembered pyeloplasty from January 2004 to November 2006 in our hospital,were retrospectively analyzed.Of the patients,22 were treated by mini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy(group A),in whom a 4-cm incision was made under the costal margin at the posterior axillary line;and the other 25 cases underwent retroperitoneal laparoscopic dismembered pyeloplasty(group B).The clinical data of the two groups,including the operation time,blood loss,average airway resistance and partial pressure of carbon dioxide,recovery of intestinal function,length of drainage and hospital stay,incidence of urinary leakage,and remission rate of hydronephrosis and improvement of GFR,were statistical analyzed by SPSS 13.0.ResultsNo intra-operative complications occurred in either group.Compared with Group B,Group A had shorter operation time [(92.9?16.3) min vs(155.8?18.6) min,t=-12.251,P=0.000],more blood loss [(18.9?6.3) ml vs(13.6?6.7)ml,t=2.782,P=0.008],lower average airway resistance [(15.6?2.6) cm H2O vs(26.9?4.3) cm H2O,t=-10.715,P=0.000] and partial pressure of carbon dioxide [(36.0?6.9) cm H2O vs(51.6?6.7) cm H2O,t=-7.855,P=0.000].No statistical differences were detected in the recovery of intestinal function,postoperative length of drainage and hospital stay,incidence of urinary leakage,and remission rate of hydronephrosis and improvement of GFR.ConclusionMini-incision dismembered pyeloplasty assisted by retroperitoneal laparoscopy is a safe,effective,and minimally invasive therapy for UPJ obstruction.
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To elucidate whether dismembered pyeloplasty improves renal function, the authors studied 37 patients with ureteropelvic junction obstruction. Changes in various renal parameters pre-and postoperatively by 99mTc-DTPA diuretic renal scintigraphy(DTPA scan) and intravenous urography were evaluated. Subjects included 24 pediatric(mean age 9.7 years) and 13 adult(mean age 33 years) patients. Postoperative split renal function was improved in 79 % (l9/24) of pediatric patients and in 69%(9/13) of adult ones. While, the excretory slope was improved in 71%(17/24) of pediatric patients and in 77%( 10/13) of adult ones. Hydronephrosis on intravenous urogram was improved in 58% (14/24) and 54% (7/13), respectively between pediatric and adult patients. There was no statistically significant differences of improvement in split renal function and renographic washout curve between pediatric and adult patients. In summary, renal function was improved by dismembered pyeloplasty in both pediatric and adult patients.
Subject(s)
Adult , Humans , Hydronephrosis , UrographyABSTRACT
Ureteropelvic junction obstruction is one of the most common problems requiring surgical correction in children. Glomerular development, which continues at birth, may interfered with by obstruction. So the recognition and correction of ureteropelvic Junction obstruction at this early age are important. Fortunately, to date, the widespread use of maternal ultrasound has led to an increase in the detection of fetal obstructive uropathy. The operative technique varied according to the nature and severity of the abnormality, but the dismembered pyeloplasty that resect the adynamic segment completely is favored and very successful. We reported 17 cases underwent dismembered pyeloplasty in children due to severe hydronephrosis (over Grade IV) secondary to UPJ stricture, and obtained satisfactory results. Nephrostomy drainage of the kidney was used in l3 cases, and duration was within 2 weeks in most cases. Ureteral stent was used only in 4 cases associated with severe infection or repeated pyeloplasty. In 13 cases followed up over 3 months (Mean: 16 months), the good result was in 11 cases (84.6%) and fair in 2 cases(l5.4%).
Subject(s)
Child , Humans , Constriction, Pathologic , Drainage , Hydronephrosis , Kidney , Parturition , Stents , Ultrasonography , UreterABSTRACT
The dismembered Foley Y-plasty and Anderson-Hynes pyeloplasty are in principle the same operation for the correction of hydronephrosis secondary to obstruction at ureteropelvic junction. The differences between the former and the letter are that Anderson used a downward and continuous 0000 suture for a watertight closure, while Foley proposed upward and interrupted 0000 sutures about 2mm. apart for accurate tissue approximation and minimal interference with wound margin blood supply. We used downward and interrupted 0000 suture so-called modified dismembered pyeloplasty as mixed type, with a use of nephrostomy and stenting in 6 cases of hydronephrosis secondary to ureteropelvic obstruction during the period from January, l978 to June, l979. They were observed for 6 to l8 months and the results were as follows: 1) Hydronephrosis secondary to ureteropelvic obstruction was caused by congenital stricture in 4 kidneys, aberrant vessel in 1 kidney and congenital stricture with aberrant vessel in 1 kidney. 2) Of 2 cases of aberrant vessel, one was cut and the other not cut because of ischemia of corresponding lower pole. 3) In all case, Ureteral stenting was done with nephrostomy. But complication, such as urinary 1eakage, did not occurred in any cases. 4) On the follow up, the result was fair in 1 case and good in others.