Laparoscopic Pyeloplasty - Our Early Experience (original) (raw)
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Outcome of Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction: Experience With 13 Cases
Bangladesh Journal of Urology
Background: Open pyeloplasty has been the gold standard for surgical treatment ofureteropelvic junction (UPJ) obstruction, enjoying a long-term success rate exceeding90%. Unfortunately, this procedure requires a muscle incision that entails some degreeof morbidity. We have, therefore, investigated the feasibility of laparoscopic pyeloplastyfor UPJ obstruction and report here the outcomes of our early cases. The median followupwas 21 months (range, 12–30 months). Objectives; The aim of our study was to explore the safety, feasibility and usefulness oflaparoscopic pyeloplasty and to assess the short- term outcome of patients treated withthis surgical approach. Materials and methods: This study was performed on 13 patients presenting withsymptomatic hydronephrosis, secondary to UPJ obstruction at the Department of Urology,Shahid Sheik Abu Naser Specialized Hospital, Khulna from January 2015 to June 2017.Patients having previous abdominal surgery and sepsis were excluded from this study...
Archivio Italiano Di Urologia Andrologia Organo Ufficiale Di Societa Italiana Di Ecografia Urologica E Nefrologica Associazione Ricerche in Urologia, 2011
OBJECTIVE: This study aimed to evaluate laparoscopic dismembered pyeloplasty compared with open surgery and to determine whether the morbidity and outcome rates are different in each of these techniques. We report our 10-year experience with open and laparoscopic pyeloplasty at one istitution.METHODS: From February 1999 to October 2010, 49 patients with ureteropelvic junction obstruction were assigned into two groups. 25 patients underwent open surgical pyeloplasty (period 1999-2010) and 24 underwent laparoscopic pyeloplasty (period 2004-2010). 25 patients undergoing open pyeloplasty had a retroperitoneal flank approach. Of the 24 laparoscopic cases 18 had a transperitoneal retrocolic access, 1 had a transperitoneal transmesocolic access and 5 had a retroperitoneal access. In all 49 cases an Anderson-Hynes dismembered pyeloplasty was used. We retrospectively compared the operative time, hospital stay, perioperative complications and follow-up of the two groups. Clinical symptoms were assessed before and after surgery, subjectively.RESULTS: Patients dermographic data were similar between the two groups with mean age of 42 years (range 6-78) and with a male/female ratio of 1:1.45. A crossing vessel could be identified in 37.5% (9/24) with laparoscopy vs. 32% (8/25) in open surgery. Compared with open procedures, laparoscopic procedures were associated with a longer mean operating time (274 vs 143 min), a shorter mean hospital stay (9.9 vs 15.8 day) and the perioperative complication rates were 16.7% for laparoscopic pyeloplasties and 20% for open pyeloplasties. The success rates were 90.5% for laparoscopy and 90.9% for open surgery. Average follow-up was 40.9 month for the laparoscopic group and 72.3 month for the open group. Failed procedures showed no improvement in loin pain or obstruction.CONCLUSIONS: The efficacy (in term of success rate and perioperative complications) of laparoscopic pyeloplasty is comparable to that of open pyeloplasty, with shorter mean hospital stay and better cosmetic results. These findings may suggest, that the laparoscopic dismembered pyeloplasty has the potential to replace open surgery and may be considered the first option for the treatment of ureteropelvic junction obstruction in expert hands.
JPMA. The Journal of the Pakistan Medical Association, 2016
To compare laparoscopic with open pyeloplasty. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of patients who underwent surgical correction of ureteropelvic junction obstruction between during January 2008 and December 2012. Patients with laparoscopic pyeloplasty were placed in group 1 and those with open pyeloplasty in group 2.The groups were compared for operative time, hospital stay, perioperative complications, blood loss, duration of surgery, outcome and follow-up. Data was analysed using SPSS 19. Of the 73 patients, 29(40%) were in group 1, and 44(60%) in group 2. A crossing vessel could be identified in 25(86.2%) in group 1 and in 33(75 %) in group 2. Laparoscopic procedures were associated with a longer mean operating time (p=0.04), median estimated blood loss (p<0.001) and a shorter mean hospital stay (p<0.001). Follow-up mercaptoacetyltriglycinescan was done in 21(74.5%) patients in group 1 and 23(52.2%) in group...
Laparoscopic Versus Open Pyeloplasty for Management of Secondary Ureteropelvic Junction Obstruction
The Egyptian Journal of Hospital Medicine, 2020
Background: Ureteropelvic junction obstruction (UPJO) causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new techniques must be compared. Objective: To evaluate the laparoscopic management of secondary pelvi-ureteric junction obstruction regarding the operative time. Bleeding requiring blood transfusion intraoperative complication, hospital stays short- and long- term complication, and the rate of success in comparison to open repair in literature. Patients and methods: This study was conducted at the Urology Department of Aswan and Sohag University Hospitals. In the period from April 2016 to April 2020, a total of forty-five patients with secondary PUJ obstruction fulfilling the inclusion criteria were admitted for undergoing laparoscopic pyeloplasty. Results: The median follow-up period was 24 months (6-36 months). The mean of operative time (LPP) was 154.9± 25.4 minutes, ranged from 80 to 185 m...
The Laparoscopic Management of the Ureteropelvic Junction Obstruction: Our Initial Experience
Medical Science and Discovery, 2016
Objective: Higher morbidity rates, extensive scar tissue formation and longer hospitalization periods of the standard open surgical methods for ureteropelvic obstruction has led to acceleration of minimal invasive techniques. Success rate and clinical outcomes of laparoscopic pyeloplasty has become comparable with open surgery. Purpose: The aim was to evaluate the clinical results and complications of transperitoneal laparoscopic pyeloplasty in ureteropelvic obstruction. Material and Methods: Thirty-three patients with ureteropelvic obstruction were enrolled into this study. Eighteen patients underwent Anderson-Hynes dismembered Pyeloplasty and 15 underwent Y-V plasty. Patients were followed-up at postoperative 3., 6. months and then yearly. Partial or total relief of symptoms and improvement in diuretic renogram were accepted as success. Results: Median age was 34.5±15.5(13-74) years, number of males were 13 (39.4%) and females were 20 (60.6%). Median Body Mass Index (BMI) was 25.3±15.4(18.5-33.4). Eight were asymptomatic, and 23 had intermittent pain, preoperatively. Fourteen cases had left ureteropelvic obstruction (42.4%) and 19 had in the right kidney. Intraoperatively 19 cases had aberrant vessel. Mean surgery time was 127.9±38.9 (68-245) minutes, median anastomosis time was 20.8±7.3 (8-39) minutes. Median blood loss was 57.1±28.3 (20-150) ml, median postoperative drainage time was 2.6±1.1 (2-7) days. Only one had prolonged ileus and peritoneal irritation findings. Median narcotic and nonnarcotic requirements were 21.5±4.8 (15-30) and 132.6±37.2 (75-200) mg/day, respectively. Median follow-up period was 35.1±13.6 (11-59) months. Conclusions: Laparoscopic pyeloplasty, is minimally invasive and reliable technique replaces open pyeloplasty in many institutions. Shorter hospitalization, lower postoperative morbidity rates, better cosmetic results and higher success rates can be easily achieved..
Transperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction
Central European Journal of Urology, 2013
Introduction. Laparoscopic pyeloplasty was first described by Schuessler. During the last decade, this technique has been developed in order to achieve the same results as open surgery, with lower rates of morbidity and complications. In this study we review our experience using laparoscopic pyeloplasty as the gold standard for the treatment of the ureteropelvic junction obstruction (UPJO). Material and methods. We performed a retrospective review of 62 laparoscopic pyeloplasties carried out at our center. In the last 2 years we used 3 mm and 5 mm ports in order to achieve better cosmetics results. Demographic data is described and the functionality of the affected kidney and surgical data, among others were analyzed statistically. In the case of bilateral statistical tests were considered significant as those with p values <0.05. Results. The most frequent reason for consultation was ureteral pain. Patients mean age was 40 years and 94% of them had preoperative renogram showing a full or partial obstructive pattern. The right side was affected in 61% of cases and the left in the remaining 39%. The presence of stones was observed in 12 patients and crossing vessels in 58% of cases. The average stay was 3.72 days. Post-surgery complications were observed in two patients. The operative time was 178 minutes. Mean follow-up was 45 months and a success was achieved in 91%. Conclusions. The transperitoneal laparoscopic pyeloplasty has become the gold standard for the treatment of ureteropelvic junction stenosis in our center because of high success rate, shorter postoperative stay, and low intra and postoperative complications.
International braz j urol
To describe and analyze our experience with Anderson-Hynes transperitoneal laparoscopic pyeloplasty (LP) in the treatment of recurrent ureteropelvic junction obstruction (UPJO). Materials and methods: 38 consecutive patients who underwent transperitoneal laparoscopic redo-pyeloplasty between January 2007 and January 2015 at our department were included in the analysis. 36 patients were previously treated with dismembered pyeloplasty and 2 patients underwent a retrograde endopyelotomy. All patients were symptomatic and all patients had a T1/2>20 minutes at pre-operative DTPA (diethylene-triamine-pentaacetate) renal scan. All data were collected in a prospectively maintained database and retrospectively analyzed. Intraoperative and postoperative complications have been reported according to the Satava and the Clavien-Dindo system. Treatment success was evaluated by a 12 month-postoperative renal scan. Total success was defined as T1/2≤10 minutes while relative success was defined as T1/2between 10 to 20 minutes. Post-operative hydronephrosis and flank pain were also evaluated. Results: Mean operating time was 103.16±30 minutes. The mean blood loss was 122.37±73.25mL. The mean postoperative hospital stay was 4.47±0.86 days. No intraoperative complications occurred. 6 out of 38 patients (15.8%) experienced postoperative complications. The success rate was 97.4% for flank pain and 97.4% for hydronephrosis. Post-operative renal scan showed radiological failure in one out of 38 (2.6%) patients, relative success in 2 out of 38 (5.3%) patients and total success in 35 out of 38 (92.1%) of patients. Conclusion: Laparoscopic redo-pyeloplasty is a feasible procedure for the treatment of recurrent ureteropelvic junction obstruction (UPJO), with a low rate of post-operative complications and a high success rate in high laparoscopic volume centers.
Öz Amaç: Laparoskopik transperitoneal pyeloplasti (LTP), üreteropelvik bileşke darlığı (ÜPBD) tedavisinde artan bir sıklıkta tercih edilmektedir. Bu çalışmada, kliniğimizde ÜPBD tedavisinde uyguladığımız LTP yönteminin tedavi etkinliği üzerine sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntem: Kliniğimizde 2004 ve 2017 yılları arasında LTP uygulanan hastaların verileri retrospektif olarak incelendi. Toplam 116 hastanın verileri çalışmaya dahil edildi. Olguların demografik özellikleri, başvuru yakınmaları, klinik, laboratuvar ve radyolojik görüntü bulguları incelendi. Hastalar iki gruba ayırılarak demografik veriler (yaş, yaş grubu, cinsiyet), taraf ve böbrek taşı varlığı ile çaprazlayan damar varlığı arasındaki ilişki araştırıldı. İstatistiksel analizde ki-kare, Student's t-testi, Fisher exact testi kullanıldı. Bulgular: Hastaların ortalama yaşı 29,9 (19-51) idi. Hastaların 8 tanesi ÜPBD tanısıyla açık cerrahi uygulanmış olan sekonder hastalardı. Hastaların 41'inde (%35,3) çaprazlayan damar basısı, 17'sinde (%14,6) böbrek taşı, 5'inde (%4,3) soliter böbrek ve 3'ünde (%2,5) de at nalı böbrek anomalisi saptandı. Operasyon süresi ortalama 124 (80-245) dakikaydı. Çaprazlayan damar varlığı ile yaş, cinsiyet, taraf ve taş varlığı arasında istatistiksel Objective: Laparoscopic transperitoneal pyeloplasty (LTP) is being widely preferred in the treatment of ureteropelvic junction obstruction (UPJO). This study aims to assess the outcomes of treatment efficacy of LTP performed in our clinic for the treatment of UPJO in adult patients. Materials and Methods: Data of patients, who underwent LTP procedure in our clinic between 2004 and 2017, were reviewed retrospectively. Data of 116 patients in total were included in the study. The cases were reviewed in terms of demographic characteristics, complaints at admission, and clinical, laboratory and radiological findings. The patients were divided into two groups and correlation of demographic data (age, age group, and gender), side and presence of kidney stone with the presence of crossing vessel was investigated. Chi-square test, Student's t-test and Fisher's exact test were applied for statistical analysis. Results: The mean age of the patients was 29.9 (19-51) years. Eight patients were the secondary patients who underwent open surgery upon diagnosis of UPJO. Forty-one (35.3%) patients had the anomaly of crossing vessel compression, 17 (14.6%)-kidney stone, 5 (4.3%)-solitary kidney and 3 (2.5%) had horseshoe kidney. The mean operating time was 124 (80-245) minutes. No statistically significant correlation of the presence of crossing vessel with age, gender, side and presence of stone was found. The mean length of hospital stay was 3.05 (2-11) days and the mean postoperative follow-up time was 44 (12-120) months. Success rate was found to be 93.1%. One (0.8%) patient had perioperative and 10 (8.6%) patients had postoperative complications. Conclusion: LTP is a feasible, effective and reliable option in the treatment of UPJO with low complication rate and high success rate. Abstract What's known on the subject? and What does the study add? There are limited studies related to laparoscopic pyeloplasty in adult patients. The technique may be a gold standart treatment method in this patient group. Our study shows that the technique has low complication rate.
Laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction in children
International Journal of Urology, 2009
Objectives: To present our initial experience with laparoscopic pyeloplasty and to evaluate the safety and short-term outcome of this technique in children. Methods: Thirteen kidney units in twelve children underwent laparoscopic dismembered pyeloplasty for the management of ureteropelvic junction obstruction (UPJO) at our institution between 2005 and 2008. Patient age at surgery was 18-177 months (mean 89.8 months). There were six boys and six girls. Ten had unilateral UPJO with a normal contralateral kidney, one had bilateral UPJO and one had UPJO of a solitary kidney. We used 3-and 5-mm instruments for grasping, blunt dissection, incising and suturing to facilitate safe and precise surgery. The outcome was measured by the operative time and resolution of obstruction and symptoms. Results: Median operative time was 275 min (range 154-420). There was a slight relationship between age and operative time. No major perioperative complications occurred in any cases. Median renal pelvic anterior-posterior diameter at ultrasonography significantly decreased from 8.6 cm (range 3.8-22.0) preoperatively to 3.9 cm (1.0-8.9) postoperatively (P < 0.05). The median pre-and postoperative split renal function on diuretic renography in unilateral cases was 37.3% (range 29.7-46.4) and 39.5% (27.8-48.0), respectively. Overall, successful resolution of UPJO was observed in 12 of 13 kidneys (92.3%). Conclusions: Laparoscopic pyeloplasty represents a safe and effective option in the surgical treatment of children with UPJO.
Laparoscopic pyeloplasty: an analysis of first 100 cases and important lessons learned
International Urology and Nephrology, 2010
Aim Laparoscopic pyeloplasty (LP) is a minimally invasive approach that is becoming a standard treatment of ureteropelvic junction obstruction (UPJO). It is providing similar results when compared with open surgery. We here present our technique and analyses of experience of our first 100 cases. Patients and methods We retrospectively reviewed and analyzed the records of first 100 cases of LP performed for UPJO with dilatation of renal pelvis at our centre. Patients' profile; perioperative, intraoperative and postoperative parameters like time of surgery, blood loss, complications, duration of hospital stay, outcome of procedure were analyzed. Results The mean operative time, need for an extra-port, conversions to open, estimated blood loss, complications and recurrences all significantly decreased after first 50 cases. One patient developed shock due to bleeding from inferior epigastric vessels near port-site, and had to be explored. Overall success rate was 96%. Lesser incidence of fourth-port insertion, conversions to open, and thus decreased operative time was attributed to introduction of additional techniques to reduce the learning curve. Conclusion LP is a technically difficult procedure. Sticking to the basic steps of LP, and trying and thus incorporating additional tactics are useful to reduce the learning curve.