ABSTRACT
Objective To determine the efficacy and long-term outcome of pyeloureteroplasty in the ureteropelvic junction obstruction (UPJO) patients with poor kidney function(＜ 10％).Methods The data of UPJO patients with poor kidney function treated from January 2006 to September 2016,was retrospectively analyzed.The renal function ＜ 10％ undergoing pyeloureteroplasty were included.Ipsilateral vesicoureteric reflux,ureterovesical junction obstruction and renal dysplasia were excluded.39 patients was enrolled.There were 31 boys and 8 girls.The mean age at surgery was 3.1 years old (range 7 months-14 years).There were 36 primary UPJO and 3 extrinsic vessel cases.Twenty-seven cases of UPJO in left side,9 cases in right side,and 1 case in bilateral side.The preoperative examination included ultrasound,intravenous pyelography (IVU) and 99 mTc DTPA renography.Mean anteroposterior diameter of pelvis was (5.5 ± 2.4) cm before operation (range 3.4-7.4cm);IVU showed non visualized kidney or rim sign.The ill kidneys' mean renal function was (3.25 ± 2.78) ％ (range 0-9％).Results Open pyeloureteroplasty were performed in the 38 patients,additional nephrectomy was required in 1 because of repeated urinary infection,while the other patients had good prognosis,nephrostomy was kept until 2-3 days' successful clipping.Laparoscope pyeloplasty were performed in one patient with double-J.The patient had urinary infection post operation and was cured.The postoperative examination included ultrasound,intravenous pyelography and 99mTc DTPA renography were performed after 3-6 months.Mean anteroposterior diameter of pelvis was (3.2 ± 1.9) cm (range 2.1-4.5 cm);Intravenous urography showed visualized kidney;Mean renal function was (18.16 ± 13.17)％ (9％-27％).There was significant difference between preoperational and postoperational evaluation of renography and pelvis (P ＜ 0.05).There was no correlation between the changed renal function and age (P ＞ 0.05).The mean follow-up time was 10.2 months (range 6-25 months).Conclusions Pyeloureteroplasty could be safe and feasible for the UPJO patients with renal function less than 10％,and could improve the renal function.
ABSTRACT
Objective To investigate the characteristic of extrinsic vessel ureteropelvic junction obstruction (UPJO).Methods From January 2006 to September 2016,37 cases of extrinsic vessel UPJO were retrospective studied.The patients'mean age at surgery was 8.4 years old (range 3-14 years),with 33 boys and 4 girls (left UPJO 27 cases,right 10 cases).There were 3 cases found hydronephrosis during pregnancy and 29 had recurrent abdominal pain.Mean antemposterior diameter of pelvis was (3.1 ±1.2) cm,and renal parenchyma thickness was (0.6-± 0.4) cm.The preoperative ultrasound did not detcet extrinsic vessel,while intravenous pyelography (IVP) showed significant dilation of calyx in extrinsic vessel UPJO.Results All the patients were performed with pyeloureteroplasty,the ureter lumens were found stenosis in 13 cases by pathology,while the remaining cases were not.Mean follow-up time from last operation was 9.3 months (6 to 24 months).Only 1 patient had postoperative complication,which was urinary tract infection and cured by antibiotic therapy.No one need second operation.Three to 6 months after operation,the anteroposterior diameter of pelvis was (1.5-± 1.4) cm which was significantly lower than preoperative (P ＜ 0.05),and renal parenchyma thickness was (0.7 ± 0.33) cm,which was not significantly different with preoperative (P ＞ 0.05).IVP showed the patency of the anastomosis and good function of kidney.Conclusions The preoperative diagnosis of extrinsic vessel UPJO was difficult,the diagnostic rate of extrinsic vessel UPJO could be improved if we found the characteristics of abdominal pain history,ultrasound and IVP.Extrinsic vessel UPJO might be accompanied by the lumens stenosis,so pyeloureteroplasty was recommended.
ABSTRACT
Objective To investigate the characteristic of extrinsic vessel ureteropelvic junction obstruction (UPJO).Methods From January 2006 to September 2016,37 cases of extrinsic vessel UPJO were retrospective studied.The patients'mean age at surgery was 8.4 years old (range 3-14 years),with 33 boys and 4 girls (left UPJO 27 cases,right 10 cases).There were 3 cases found hydronephrosis during pregnancy and 29 had recurrent abdominal pain.Mean antemposterior diameter of pelvis was (3.1 ±1.2) cm,and renal parenchyma thickness was (0.6-± 0.4) cm.The preoperative ultrasound did not detcet extrinsic vessel,while intravenous pyelography (IVP) showed significant dilation of calyx in extrinsic vessel UPJO.Results All the patients were performed with pyeloureteroplasty,the ureter lumens were found stenosis in 13 cases by pathology,while the remaining cases were not.Mean follow-up time from last operation was 9.3 months (6 to 24 months).Only 1 patient had postoperative complication,which was urinary tract infection and cured by antibiotic therapy.No one need second operation.Three to 6 months after operation,the anteroposterior diameter of pelvis was (1.5-± 1.4) cm which was significantly lower than preoperative (P ＜ 0.05),and renal parenchyma thickness was (0.7 ± 0.33) cm,which was not significantly different with preoperative (P ＞ 0.05).IVP showed the patency of the anastomosis and good function of kidney.Conclusions The preoperative diagnosis of extrinsic vessel UPJO was difficult,the diagnostic rate of extrinsic vessel UPJO could be improved if we found the characteristics of abdominal pain history,ultrasound and IVP.Extrinsic vessel UPJO might be accompanied by the lumens stenosis,so pyeloureteroplasty was recommended.
ABSTRACT
Objective To summarize the complications of the single-port transumbilical laparoscopic pyeloureteroplasty.Methods From August 2009 to December 2014, 162 surgical procedures were performed in our institute with the single-port transumbilical laparoscopic pyeloureteroplasty.Medical records of each procedure were retrospectively evaluated.139 patients were male and 23 female, aged from 1 month to 14 years and the median age of 2 years.127 patients were operated on the left side and 32 on the right side.3 patients were operated on the bilateral side.All children were supplemented with preoperative ultrasound, renal dynamic imaging and MRU to identify the ureteropelvic junction obstruction.Intraoperative and postoperative complications were graded according to the Satava and Clavien classifications respectively.Major complications were defined as Satava grade Ⅱ or higher, and Clavien grade Ⅲ or higher.Results There was no injury of vascular or visceral organs and no blood transfusion, and there was no serious intraoperative complications.One hundred and forty-three cases were followed up, and 23 cases (16.1％)presented with postoperative fever (＞ 38 ℃C) (Clavien Ⅰ), 2 cases (1.4％) with urinary extravasation diagnosed by perirenal fluid collection(Clavien Ⅰ).All these cases recovered after being given symptomatic treatment.7 cases (4.9％) presented with postoperative repeated urinary infection (Clavien Ⅱ).5 cases received postoperative reoperation due to the obstruction of the anastomic site (Clavien Ⅲ b), and 2 cases were under debridement as the greater omentum was drawn out along with the negative pressure drainage tube(Clavien Ⅲ a).In summary, the incidence of severe postoperative complications was 4.9％.Conclusions Though there existed some postoperative complications of the single-port transumbilical laparoscopic pyeloureteroplasty, the incidence of serious complications was low and the overall prognosis could be good.
ABSTRACT
Objective To explore the feasibility and safety of laparoscopic pyeloplasty in the treatment of neonatal renal pelvis ureteraljunction obstruction(PUJO),and to analyze its preliminary experience.Methods From Jun.2009 to Apr.2012,11 neonates(9 boys and 2 girls) were recruited in this study.They were all detected by prenatal ultrasound and renal pelvis anteroposterior diameter was more than 3 cm.One week after birth,emission computed tomography(ECT) showed that split function of hydronephrotic kidneys were lower than 40％.All patients underwent laparoscopic dismembered pyeloplasty.Results All successful underwent laparoscopic dismembered pyeloplasty,no conversion to open surgery or additional Trocar,no intraoperative complications.The mean time of operation was 80 min,and blood loss was less than 10 mL,the mean postoperative hospital stay was 9 days.All patients were followed up for 6 to 36 months with ultrasound and ECT.The thickness of renal parenchyma increased,and 8 kidneys turned almost normal,the other's renal pelvis anteroposterior diameter was about 1.5 cm,renal pelvis anteroposterior was significantly reduced,and the scar was not obvious.Conclusions Laparoscopic ureteroplasty in the treatment of neonatal hydronephrosis is safe and feasible,and it is worthy of application in a large scale.Qperators need mastering laparoscopic suture technology,and then apply the technique from older children to neonates gradually.
ABSTRACT
A Clinical observation of 34 Patients who had taken pyeloureterolasty due to UPJ stricture during 11 years was made. Operative success rate in followed-up patients was 85% and success rate was dismembered pyeloplasty was 88%. Diminition of caliectasis was observed in 78% in 23 kidneys of 20 patients who had taken postoperative urogaraphy. Improved drainage on ureterogram was thought to be a more appropriate indicator than diminition of calietasis in postoperative radiologic evaluation of pyeloureteroplasty.
Subject(s)
Humans , Constriction, Pathologic , Drainage , KidneyABSTRACT
Two cases with uretero-pelvic stricture of which the one was 15 year-old girl and the other was 10 month-old child, underwent pyelo-ureteroplasty by the technique of Foley YV plasty, was reported.