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UPJ Obstruction (upj + obstruction)

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Medical Sciences100%

Selected Abstracts

Laparoscopic pyeloplasty for ureteropelvic junction obstruction: Outcome of initial 12 procedures

INTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2004
MASATSUGU IWAMURA
Abstract Background:, Open pyeloplasty has been the gold standard for surgical treatment of ureteropelvic junction (UPJ) obstruction, enjoying a long-term success rate exceeding 90%. Unfortunately, this procedure requires a muscle incision that entails some degree of morbidity. We have, therefore, investigated the feasibility of laparoscopic pyeloplasty for UPJ obstruction and report here the outcomes of our early cases. The median follow up is 25 months (range, 12,42 months). Methods:, Between March 1999 and September 2001 we performed laparoscopic pyeloplasty on 12 ureters in 11 patients presenting with symptomatic hydronephrosis, secondary to a short stenosis of the UPJ or to ventrally crossing vessels; bilateral pyeloplasty was performed as a single procedure in one patient. We performed dismembered Anderson,Hynes pyeloplasty, Fenger plasty and Y-V plasty in eight, two and two ureters, respectively. All procedures were carried out transperitoneally. Results:, The procedure was completed successfully in all cases. Crossing vessels were noted in six of 12 ureters (50.0%). Mean operative time and blood loss in 11 patients (including one bilateral case) were 272.8 min (range, 175,480 min) and 96.4 mL (range, 20,340 mL), respectively. Postoperative complications were noted in two patients (18.2%): one instance of prolonged urine leakage and one anastomotic re-stricture. Eleven of 12 ureters (91.6%) demonstrated a patent UPJ on excretory urography and/or improvement of renal function on diuretic renography at a minimum follow up of 12 months. Conclusion:, Although the procedure requires advanced laparoscopic skills, it can be safely and successfully completed as frequently as the conventional open procedure. Laparoscopic pyeloplasty seems to be a valuable alternative to open pyeloplasty for UPJ obstruction. [source]

Cost-effective laparoscopic pyeloplasty: Single center experience

INTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2003
ASHOK KUMAR HEMAL
Summary Objective:, Laparoscopic pyeloplasty (LPP) is a minimally invasive treatment option for ureteropelvic junction (UPJ) obstruction. We report here our experience of performing cost-effective LPP on 24 patients at a single center. Methods:, Between October 1999 and March 2002, LPP was performed in 24 patients (17 male, seven female; age range 8,51 years) including two patients who had failed previous endourologic treatments. In two patients with concomitant renal stones, laparoscopic pyelolithotomy was also performed. LPP was conducted in a cost-reductive manner by both transperitoneal (n = 12) and retroperitoneal (n = 12) access. To reduce the cost, an indigenous balloon to create the retroperitoneal space, reusable ports, ordinary polyglactin suture and intracorporeal free-hand suturing were employed. To reduce operative time, antegrade stenting was also performed in some cases. Results:, Laparoscopic Anderson,Hynes pyeloplasty was performed in 16, Foley Y,V pyeloplasty in five and Fenger pyeloplasty in three patients. One patient required conversion to open surgery due to tension at the anastomosis site during Anderson,Hynes pyeloplasty. The mean operating time, blood loss, analgesic (pethidine) requirement, duration of drain and hospital stay for the retroperitoneal and transperitoneal groups were 170.3 and 187.6 min, 102.2 and 145.9 mL, 125 and 136.4 mg, 2.1 and 2.5 days, and 3.4 and 4.3 days, respectively. No significant complications were encountered apart from prolonged ileus in three patients in the transperitoneal group. The mean follow-up period was 10.8 months with a range of 2,24 months. Postoperative renal scan was performed at 3 months in 21 patients, and 1 year in 11 patients. There was evidence of equivocal obstruction in one patient, but there were no obstructions in the remaining patients. Conclusion:, Although LPP is technically demanding, it is emerging as a viable, minimally invasive alternative to open pyeloplasty for UPJ obstruction with a success rate similar to that of open pyeloplasty. It allows the duplication of open surgery steps (unlike endoscopic procedures), thereby providing durable and sustained results. LPP can also be performed safely, effectively and efficiently in a cost-efficient manner. [source]

Retrograde ureteroscopic endopyelotomy using the holmium:YAG laser

INTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2002
Hatsuki Hibi
Abstract Background: We report our experience of retrograde ureteroscopic endopyelotomy using the holmium laser for ureteropelvic junction (UPJ) obstruction not associated with upper tract stones. Methods: We carried out this procedure on five patients through an 8-Fr semirigid ureteroscope. The ureter was not stented before the procedure and balloon dilation was not necessary before retrograde insertion of the ureteroscope. The obstruction was incised with the holmium laser using a 200 µm fiber in a linear fashion. After completion of the incision, a 12-Fr double-J ureteral stent was left for 6 weeks. Thereafter, patients were monitored with renal scan and/or ultrasound and excretory urography at 3,6 month intervals. Results: Hydronephrosis was obviously improved in four cases (80%) at an average follow up of 12.8 months (4,23 months). Although the number of treated patients was small, retrograde ureteroscopic endopyelotomy for UPJ obstruction using the holmium laser achieved good results. Conclusions: We recommend that this procedure be used initially because it is less invasive and has a favorable outcome. [source]

Robot Assisted Laparoscopic Pyeloplasty: a review of the current status

THE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 1 2007
Ketul K. Shah
Abstract Background Over the last decade minimally invasive endourologic and laparoscopic techniques have become the first line therapies for primary UPJ obstruction. Robotic assisted laparoscopic pyeloplasty for the correction of ureteropelvic junction has achieved outcomes comparable to those of open and laparoscopic techniques. We present a comprehensive review of the current literature of robotic assisted pyeloplasty. Methods We performed a systemic review of all the current literature examining demographic data, intra operative parameters and post-operative outcomes. Results In most published series in the literature, the operative time ranges from 122 to 300 minutes and the operative time ranges from 27 to 77 ml. Most series considers subjective improvement in the symptoms and improved drainage on post-operative diuretic renal scan as the measures of success. The reported success rates vary from 89 to 100%. Conclusion Robotic pyeloplasty is a feasible alternative to laparoscopic pyeloplasty. Short-term results indicate equivalent outcomes with the laparoscopic procedure. Long-term studies are still needed to compare robotic and open pyeloplasty outcomes, and to define the role of robotic pyeloplasty in a cost prohibitive health care system. Copyright © 2007 John Wiley & Sons, Ltd. [source]

52 Laparoscopic pyeloplasty , evolution of a new gold standard

BJU INTERNATIONAL, Issue 2006
D. MOON
Objectives:, We report the largest series of laparoscopic dismembered pyeloplasty for treatment of primary and secondary uretero-pelvic junction (UPJ) obstruction, reviewing the current status of this procedure. Methods:, A total of 170 consecutive cases of laparoscopic pyeloplasty (156 for primary and 14 for secondary UPJ obstruction) were performed or supervised by a single surgeon (C.G.E). A four port extraperitoneal approach was used in all but three cases, which were performed transperitoneally. Results:, Median operative time was 140 min. The complication rate was 7.1% and conversion rate was 0.6% with no conversion in the last 161 cases. The median postoperative hospitalisation was 3 nights. Crossing vessels were encountered in 42% of cases and in 11 patients coexisting renal calculi were successfully removed. At a median follow-up of 12 months, the success rate was 96.2%. Conclusions:, Laparoscopic dismembered pyeloplasty produces functional results comparable to that of open surgery with the advantages of a minimally invasive procedure. Our results are consistent with previous series and support the view that laparoscopic pyeloplasty is moving rapidly towards replacing open surgery as the gold standard in treatment of UPJ obstruction. [source]