Multicenter comparative study of open, laparoscopic, and robotic pyeloplasty in the pediatric population for the treatment of ureteropelvic junction obstruction (UPJO)

ABSTRACT Introduction: Dismembered open pyeloplasty described by Anderson and Hynes is the "gold standard" for the treatment of ureteropelvic junction obstruction. The aim of our study was to compare the results of open (OP) vs laparoscopic (LP) vs robotic (RALP) pyeloplasty. Material and Methods: A multicenter prospective review was conducted of pyeloplasty surgeries performed at five high-volume centers between 2014 and 2018. Demographic data, history of prenatal hydronephrosis, access type, MAG3 renogram and differential renal function, surgery time, length of hospital stay, and complication rate (Clavien-Dindo) were recorded. Access type was compared using the Kruskal-Wallis, Chi-square, or Fisher's exact tests. Results: A total of 322 patients were included: 62 OP, 86 LP, and 174 RALP. The mean age was 8.13 (r: 1-16) years, with a statistically significant lower age (mean 5 years) in OP (p < 0.001). There were no significant differences in the distribution of the side affected. Operative time was 110.5 min for OP, 140 min for LP, and 179 min for RALP (p < 0.0001). Hospital stay was significantly shorter in the RALP group than in the other groups (p < 0.0001). There were no differences in postoperative complications and reoperations between the three groups. Conclusions: Minimally invasive surgery for the management of UPJO in children is gaining more acceptance, even in patients younger than 1-year-old. Operative time continues to be significantly shorter in OP than in LP and RALP. Hospital stay was shorter in RALP compared to the other techniques. No differences were found in complication rates, type of complications, and reoperation rate.

Multicenter comparative study of open, laparoscopic, and robotic pyeloplasty in the pediatric population for the treatment of ureteropelvic junction obstruction (UPJO).

INTRODUCTION: Dismembered open pyeloplasty described by Anderson and Hynes is the "gold standard" for the treatment of ureteropelvic junction obstruction. The aim of our study was to compare the results of open (OP) vs laparoscopic (LP) vs robotic (RALP) pyeloplasty. MATERIAL AND METHODS: A multicenter prospective review was conducted of pyeloplasty surgeries performed at five high-volume centers between 2014 and 2018. Demographic data, history of prenatal hydronephrosis, access type, MAG3 renogram and differential renal function, surgery time, length of hospital stay, and complication rate (Clavien-Dindo) were recorded. Access type was compared using the Kruskal-Wallis, Chi-square, or Fisher's exact tests. RESULTS: A total of 322 patients were included: 62 OP, 86 LP, and 174 RALP. The mean age was 8.13 (r: 1-16) years, with a statistically significant lower age (mean 5 years) in OP (p < 0.001). There were no significant differences in the distribution of the side affected. Operative time was 110.5 min for OP, 140 min for LP, and 179 min for RALP (p < 0.0001). Hospital stay was significantly shorter in the RALP group than in the other groups (p < 0.0001). There were no differences in postoperative complications and reoperations between the three groups. CONCLUSIONS: Minimally invasive surgery for the management of UPJO in children is gaining more acceptance, even in patients younger than 1-year-old. Operative time continues to be significantly shorter in OP than in LP and RALP. Hospital stay was shorter in RALP compared to the other techniques. No differences were found in complication rates, type of complications, and reoperation rate.

Macedo procedure: A continent catheterizable ileum-based reservoir. Step-by-step video.

This video provides a case report of a 16-year-old male patient who underwent bladder enlargement with a catheterized conduit under Macedo's technique. This technique involves the use of a segment of the distal ileum with a flap that is used for confection of the conduit. Key points include: 1) skin incision planning; 2) bladder release to allow a tension-free anastomosis; 3) reservoir and a conduit creation with a distal ileum; and 4) creation of a continence mechanism.

Child non-ischemic priapism, a conservative approach: case report and updated review.

Non-ischemic priapism in children is an uncommon entity usually related to blunt trauma in the perineal region and subsequent fistula formation into the corpus cavernosum. In this report we present the case of a 7-year-old boy who had undergone perineal trauma and developed non-ischemic priapism confirmed radiologically. He was treated by conservative measures along with ultrasonographic monitoring. We discuss the diagnostic approach, the radiologic findings and the mainly conservative management of this infrequent pathology.

Macroscopic and histological evaluation of tunica vaginalis dorsal grafting in the first stage of Bracka's urethroplasty: an experimental study in rabbits.

OBJECTIVE: To evaluate the use of tunica vaginalis as a dorsal free graft in the first stage of Bracka's urethroplasty in a rabbit animal model using macroscopic and histological analysis. MATERIAL AND METHODS: Surgery was performed on 16 rabbits, divided into four groups of four according to the number of weeks after surgery at which they were killed (2, 4, 8 and 12 weeks). The penile urethra was removed and only the ventral aspect of the urethra was reconstructed using a tunica vaginalis free graft dorsally fixed in the corpora cavernosa. Epithelial, inflammatory and fibrotic changes in the graft were evaluated macroscopically then histologically at the point when each rabbit group was killed. RESULTS: Macroscopic evaluation showed good graft uptake with minimal retraction (P > 0.05). Histological evaluation showed a reduction in the inflammatory process during the first 4 weeks, after which inflammation stabilized. The mesothelium was partially healed at 2 and 8 weeks with a metaplasia defined by a stratified squamous, non-keratinized lining. The grafted area was thinner than the surrounding penile skin and similar to urothelial native epithelium. CONCLUSION: Tunica vaginalis used as a free graft placed dorsally on the corpora cavernosa in the first stage of Bracka's urethroplasty shows good tissue integration and develops into a stratified non- keratinized epithelium (metaplasia) without significant retraction, despite exposure to the external environment.

Fibrose retroperitoneal: relato de dois casos e revisäo da literatura / Retroperitoneal fibrosis: relate of two cases and literature review

A fibrose retroperitoneal é uma doença rara, geralmente vista em pacientes com idade entre os 40 e 70 anose é secundária a um processo inflamatório crônico do retroperitôneo quepode comprimir os ureteres. A etiologia é desconhecida na maioria dos casos, ainda que vários fatores, como medicaçöes, doenças malignas einflamatórias, possamestar envolvidos. O diagnóstico de fibrose retroperitoneal deve ser considerado em pacientes com dor abdominal ou lombar e lesäo no retroperitôneo. Os sinais e sintomas säorelacionados com comprometimento de estruturas retroperitoneais como veia cava, aorta e ureteres. Quando ambos ureteres säo comprometidos, a insuficiência renal do tipo obstrutivo pode se desenvolver. Várias opçöes medicamentosas têm sido utilizadas nessas situaçöes. Apresentam-se neste trabalho dois casos de fibrose retroperitoneal: um deles idiopático e o outro, provavelmente, secundário a processo inflamatório crönico. Ambos foram submetidos a procedimentos cirúrgicos convencionais com a liberaçäo cirúrgica dos ureteres ou nefrostomia"au"