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Objective@#Comparison of the efficacy of mini flank incision and laparoscopy in the treatment of infants with ureteropelvic junction obstruction.@*Methods@#We retrospectively analyzed 85 cases of infants with ureteropelvic junction obstruction in our hospital from Jan. 2016 to Jan. 2018, all the patients underwent dismembered pyeloplasty. According to the surgical approach, they were divided into two groups: There were 45 cases in the mini flank incision group, including 39 males and 6 females, aged from 1 month to 3 years, with a median age of 4 months, and 40 patients in the laparoscopy group, including 33 males and 7 females, aged from 2 months to 3 years, with a median age of 9 months. The clinical effects of the two groups were compared.@*Results@#The patients were followed up for 12-24 months. The operation time[(68.0±15.3)min vs.(79.6±18.8)min], fasting time[(5±1)h vs.(14±8)h] and indwelling time of peri-renal drainage tube[(3.1±1.4)d vs.(4.3±2.2)d] in the mini flank incision group were shorter than those in the laparoscopy group (P<0.01), but there was no significant difference in the amount of blood loss[(2.1±0.9)ml vs.(2.2±0.6)ml] during the operation (P>0.05). The recurrence rate[0 vs.5%(2/40)] and the incidence of complications[11.1%(5/45)vs. 17.5%(7/40)] in the mini flank incision group were lower than those in the laparoscopy group, but there was no statistical difference (P>0.05).@*Conclusions@#Pyeloplasty via mini flank incision or laparoscopy are both safe, effective and cosmetic.Mini flank incision surgery has the advantage of short operation time, easy to master and less disturbance of physiological function. Pyeloplasty via mini flank incision it is one of the reasonable options for the treatment of infants with ureteropelvic junction obstruction.
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Objective@#This study was a retrospective analysis of the efficacy of conservative treatment of unilateral renal pelvic ureteral junction obstruction with good renal function at the time of initial diagnosis.@*Methods@#The clinical data of 101 children with unilateral pelvic ureteral junction obstruction from January 2008 to December 2017 was analyzed retrospectively. All the patients underwent non-surgical treatment. There were 67 males and 34 females. The age range is from 10 days to 10 years old, with an average age of 3.4 years. 52 cases got left side obstruction and 49 cases got the right side obstrction. 14 children had abdominal pain symptoms. Among the 37 neonates: 21 male, 16 female. 15 were left, 22 were right. 10 cases were found during prenatal pregnancy, and 27 were dignosed postpartum. The indication for conservative treatment is no hydronephrosis-related symptoms or normal renal function at the initial diagnosis. The hydronephrosis did not affect the child's breathing, growth and development. The B-ultrasound was done every 1 to 6 months which depended on the different grades of hydronephrosis during a conservative observation period. The diuretic radionuclide imaging was done every 6 to 12 months. The end point of follow-up was surgery or disappear of the hydronephrosis in the affected side. Surgical indications are symptoms of hydronephrosis during follow-up which affecting growth and development, renal function reduction >10%, hydronephrosis SFU, UTDP grade progressive increase. Among them, 3 cases were raised from SFU2 to SFU3, 17 cases were raised from SFU3 to SFU4; 4 cases of neonatal UTDP2 progressed to grade 3 hydronephrosis and UTDP3 increased in 5 cases. Regression of hydronephrosis test three consecutive urinary renal ultrasound was defined as no hydronephrosis in.@*Results@#Continuous follow-up ranged from 1 year to 5 years, a median follow-up is 37 months. Of the 101 patients, 41 (40.5%) required surgery, and 60 (59.5%) kept conservative follow up. 2 cases of SFU1 children with hydronephrosis spontaneously disappeared. Of the 26 SFU class 2 children, 15 (69.2%) spontaneously resolved, 7(30.7%) improved, and 4 underwent surgery. Of the 50 children with SFU grade 3 hydronephrosis, 11(22.0%) spontaneously resolved, 19 improved or remained unchanged, and 20 patients eventually underwent surgery. Of the 23 patients with SFU grade 4 hydronephrosis, 6(26.0%) improved (to SFU 2) and 17(73.9%) underwent surgery. 37 of the 101 children were enrolled in the neonatal group for SFU grading while performing UTDP grading. Twenty-seven (70.2%) of the 37 neonates underwent conservative treat ment, including 8(100.0%) UTDP grade 1 hydronephrosis, 8(66.7%) UTDP grade 2 hydronephrosis, and UTDP grade 3 10 cases (58.8%) of hydronephrosis were effective for conservative treatment. There was a statistically significant difference between the level of hydronephrosis at the time of initial diagnosis of hydronephrosis and the efficacy of conservative treatment.@*Conclusion@#Conservative treatment of unilateral ureteral pelvic and ureteral junction obstruction is safe and effective. Severe hydronephrosis is unlikely to spontaneously resolve, often accompanied by early loss of renal function, and should be followed closely by ultrasound.
ABSTRACT
Objective Comparison of the efficacy of mini flank incision and laparoscopy in the treatment of infants with ureteropelvic junction obstruction.Methods We retrospectively analyzed 85 cases of infants with ureteropelvic junction obstruction in our hospital from Jan.2016 to Jan.2018,all the patients underwent dismembered pyeloplasty.According to the surgical approach,they were divided into two groups:There were 45 cases in the mini flank incision group,including 39 males and 6 females,aged from 1 month to 3 years,with a median age of 4 months,and 40 patients in the laparoscopy group,including 33 males and 7 females,aged from 2 months to 3 years,with a median age of 9 months.The clinical effects of the two groups were compared.Results The patients were followed up for 12-24 months.The operation time[(68.0 ± 15.3) min vs.(79.6 ± 18.8) min],fasting time [(5 ± 1) h vs.(14 ± 8) h] and indwelling time of peri-renal drainage tube [(3.1 ± 1.4) d vs.(4.3 ± 2.2) d] in the mini flank incision group were shorter than those in the laparoscopy group (P ＜ 0.01),but there was no significant difference in the amount of blood loss[(2.1 ± 0.9) ml vs.(2.2 ± 0.6) ml] during the operation (P ＞ 0.05).The recurrence rate [0 vs.5 ％ (2/40)]and the incidence of complications[11.1％ (5/45) vs.17.5％ (7/40)] in the mini flank incision group were lower than those in the laparoscopy group,but there was no statistical difference (P ＞ 0.05).Conclusions Pyeloplasty via mini flank incision or laparoscopy are both safe,effective and cosmetic.Mini flank incision surgery has the advantage of short operation time,easy to master and less disturbance of physiological function.Pyeloplasty via mini flank incision it is one of the reasonable options for the treatment of infants with ureteropelvic junction obstruction.
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Objective This study was a retrospective analysis of the efficacy of conservative treatment of unilateral renal pelvic ureteral junction obstruction with good renal function at the time of initial diagnosis.Methods The clinical data of 101 children with unilateral pelvic ureteral junction obstruction from January 2008 to December 2017 was analyzed retrospectively.All the patients underwent non-surgical treatment.There were 67 males and 34 females.The age range is from 10 days to 10 years old,with an average age of 3.4 years.52 cases got left side obstruction and 49 cases got the right side obstrction.14 children had abdominal pain symptoms.Among the 37 neonates:21 male,16 female.15 were left,22 were right.10 cases were found during prenatal pregnancy,and 27 were dignosed postpartum.The indication for conservative treatment is no hydronephrosis-related symptoms or normal renal function at the initial diagnosis.The hydronephrosis did not affect the child's breathing,growth and development.The B-ultrasound was done every 1 to 6 months which depended on the different grades of hydronephrosis during a conservative observation period.The diuretic radionuclide imaging was done every 6 to 12 months.The end point of follow-up was surgery or disappear of the hydronephrosis in the affected side.Surgical indications are symptoms of hydronephrosis during follow-up which affecting growth and development,renal function reduction ＞ 10％,hydronephrosis SFU,UTDP grade progressive increase.Among them,3 cases were raised from SFU2 to SFU3,17 cases were raised from SFU3 to SFU4;4 cases of neonatal UTDP2 progressed to grade 3 hydronephrosis and UTDP3 increased in 5 cases.Regression of hydronephrosis test three consecutive urinary renal ultrasound was defined as no hydronephrosis in.Results Continuous follow-up ranged from 1 year to 5 years,a median follow-up is 37 months.Of the 101 patients,41 (40.5％) required surgery,and 60 (59.5％) kept conservative follow up.2 cases of SFU1 children with hydronephrosis spontaneously disappeared.Of the 26 SFU class 2 children,15 (69.2％) spontaneously resolved,7 (30.7％) improved,and 4 underwent surgery.Of the 50 children with SFU grade 3 hydronephrosis,11 (22.0％) spontaneously resolved,19 improved or remained unchanged,and 20 patients eventually underwent surgery.Of the 23 patients with SFU grade 4 hydronephrosis,6 (26.0％) improved (to SFU 2) and 17 (73.9％) underwent surgery.37 of the 101 children were enrolled in the neonatal group for SFU grading while performing UTDP grading.Twenty-seven (70.2％) of the 37 neonates underwent conservative treat ment,including 8 (100.0％) UTDP grade 1 hydronephrosis,8(66.7％) UTDP grade 2 hydronephrosis,and UTDP grade 3 10 cases (58.8％) of hydronephrosis were effective for conservative treatment.There was a statistically significant difference between the level of hydronephrosis at the time of initial diagnosis of hydronephrosis and the efficacy of conservative treatment.Conclusion Conservative treatment of unilateral ureteral pelvic and ureteral junction obstruction is safe and effective.Severe hydronephrosis is unlikely to spontaneously resolve,often accompanied by early loss of renal function,and should be followed closely by ultrasound.
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Objective To investigate the timing and scheme of surgical treatment for the concomitant ureteropelvic junction obstruction(UPJO) and congenital abnormalities of the kidney.Methods The clinical data of 155 patients with concomitant UPJO and congenital abnormalities of the kidney from January 2006 to January 2016 was retrospectively analyzed.There were 107 males and 48 females,who aged 6 months to 16 years and 6 months.The average time was 5 years and 9 months old when they received operation.There were 8 cases less than 1 year old.There were 93 cases of UPJO on the left side,54 cases on the right side,and 8 cases on both sides.There were 33 cases with duplication of kidney,19 cases with solitary kidney,and 6 cases with renal dysplasia,6 cases with renal ectopia,12 cases with polycystic kidney disease,and 41 cases with dysplasia;2 cases with renal malrotation.There were 100 cases with symptoms such as fever,abdominal pain,vomiting.5 cases had received Anderson-Hynes pyeloplasty in other hospitals,2 cases received nephrectomy with symptoms did not relieve.4 cases were treated with nephrostomy in other hospital.Children with the repeated clinical symptoms,or renal function decreased significantly,or hydronephrosis progressive to the anteroposterior diameter of more than 30 mm received surgical treatment.Results There were 140 cases received Anderson-Hynes pyeloplasty,and 8 cases received nephrectomy with 5 cases were UPJO side and 3 cases were only abnormalities of the kidney without UPJO.All patients received IVP or ultrasonography postoperative 3-6 months,which showed hydronephrosis improved or no obvious change,and 4 cases were improved obviously.The IVP results showed that 5 patients with renal dysplasia together with UPJO had the renal function improved.There were 128 cases followed up for 12 to 106 months,with an average of 64.5 months.All patients had no clinical symptoms.83 cases were reexamined by IVP or ultrasonography,and hydronephrosis was getting better or no change.Conclusions The patients with concomitant UPJO and congenital abnormalities of the kidney don't need surgery in advance.The best choice for those patients is Anderson-Hynes pyeloplasty.The indication of nephrectomy should be considered carefully.
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Objective To investigate the experience of diagnosis and management of coexisting ureteropelvic junction obstruction (UPJO) and nonreflux megaureter (NRM).Methods The retrospective study of UPJO with NRM was based on 10 years information retrieved from January 2005 to December 2015.The data of 13 patients (8 males and 5 females) were available and recorded.Mean age at surgery was 3.7 years old (range 1.8 to 14 years).The diagnosis and mangement were summarized.Coexisting ureterovesical junction obstruction (UVJO) and vesicoureteral reflux,iatrogenic stricture and vesicoureteral reflux were excluded.Intravenous pyelography,voiding cystourethrography,ultrasound and CT reconstruction were performed before operation.Only six patients had an accurate diagnosis as UPJO with UVJO before surgery.Pyeloplasty was the initial surgical management choice for 10 patients,and ureteroneocystostomy in 3 patients.Results UVJO were diagnosed with pyelography techniques in 3 patients after pyeloplasty,while 4 were diagnosed as nonreflux and nonobstruction megaureter.Of the 10 patients who underwent initial pyeloplasty,additional ureteroneocystostomy was required in 3 and the prognosis was good.Additional pyeloplasty was required in 2 of the 3 patients who initially underwent ureteroneoeystostomy.Mean follow-up time from last operation was 23.3 months (6-53 months),the overall prognosis was good.Conclusions It is often difficult to correctly diagnose coexisting UPJO and NRM.In patients with UPJO,it is highly recommended nephrostomy radiography after pyeloplasty to evaluate the distal ureterovesical junction.Initial pyeloplasty is always recommended as first-line therapy.Additional ureteroneocystostomy was required when hydroureteropelvic was aggravated.
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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.
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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.
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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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Objective To study the possibility of establishment of an animal model of hydronephrosis by ureteropelvic junction obstruction,and to evaluate the value of CT perfusion imaging in assessment of the renal function in the animal models. Method Fifty 10-week-old male New Zealand rabbits were randomly assigned to two groups:sham-operated group with separation of the left ureter (20 rabbits),and model group (30 rabbits) with the left ureter embedded at the ureteropelvic junction under the psoas major muscle. The left kidney function in the two groups was confirmed to be normal by SPECT before operation. CT perfusion and SPECT imagings were performed to assess the left kidney function in the two groups at three months after surgery,and the results were compared with that of pathological examination. Statistical analysis was performed on the parameters of SPECT and CT perfusion imaging and glomerular filtration rate (GFR). Results The success rate of model establishment was 70%,showing pathological changes of chronic hydronephrosis. CT perfusion demonstrated that BF,BV,PS of the left renal cortex and medulla were decreased,and had a good positive correlation with the changes of GFR. Conclusions It is feasible to establish a rabbit model of chronic hydronephrosis by embedding the left ureter at ureteropelvic junction under the psoas major muscle,and CT perfusion imaging parameters can be used to evaluate the renal function in the animal models.
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Objective To describe the new technique of transperitoneal laparoscopic dismembered pyeloplasty and to evaluate its clinical effect. Methods Of the 18 cases of ureteropelvic junction (UPJ) obstruction who underwent transperitoneal laparoscopic dismembered pyeloplasty,8 cases had severe hydronephrosis;7,intermediate;3,mild. Results Operations were all successful in 18 cases with the operating time being 100 to 210 min (mean,142 min) and the blood loss,40 to 200 ml.All the pores of puncture healed at phase 1;mean hospitalization was 7.4 d.Only 1 case had postoperative urine leakage.Follow-up of 3 to 12 months showed there was no stricture at UPJ and hydronephrosis was remitted (intermediate hydrops in 4 cases,mild in 7 and resolution in 7).The renal functions were improved. Conclusions Laparoscopic dismembered pyeloplasty is an effective and minimally invasive approach and can be used as an alternative to open surgery for UPJ obstruction.