Abstract
Objective: To report our experience with open dismembered pyeloplasty for uretero-pelvic junction obstruction. Methods: Retrospective study was conducted in the Department of Urology, Jinnah Postgraduate Medical Centre, Karachi for a period of five and half years from May, 2006 to December, 2011. All patients with uretero-pelvic junction obstruction were entered into a database to record patients clinical features, diagnostic tools, operative and post-operative details and follow-up. Over a five-years period, 13 procedures were performed. After clinical evaluation all patient had extensive haematological and radiological workup for diagnosis of uretero-pelvic junction obstruction. All were subjected to open pyeloplasties, out of these 13 patients; one had an aberrant lower pole vessel compressing uretero-pelvic-junction. All procedures were stented. Repair was done with 3/0 vicryl sutures all patients were catheterized and wound drained. Results: Mean operating time was 60 – 100 minutes with about 100cc blood loss requiring no transfusion. The mean follow up was one year. One patient developed post-operative haematuria and was managed conservatively. Two patients developed fever secondary to urinary tract infection despite adequate treatment of urinary tract infection according to culture and sensitivity pre-operatively. One patient developed surgical emphysema detected post-operatively, which required tube thoracostomy. Neither patient developed recurrent symptoms nor had any evidence of obstruction on the renogram on follow-up. Objectively all patients were followed up by intravenous urogram, stress renogram, Urine C/S. Subjective and objective follow-up revealed success in 100% of patients whereas success is defined as no or minimal holder on DTPA renogram, improving renal function and decreasing dilatation on successive intravenous urogram. All patients had a mean post-operative hospital stay of 02 – 04 days Folley catheter was removed after 10-days, double-j- stents were removed after two to three weeks. Conclusion: Our success rate following open pyeloplasty with limited follow-up was 100%. It is comparable with International data. Recent international trend is toward Uretro-pelvic Junction Obstruction (UPJO) repair with laparoscopic approach, they are claiming success rate of 95%.
Highlights
The surgical management of uretero-pelvic junction obstruction has undergone revolutionary changes over the past few years
Open retroperitoneal dismembered reduction pyeloplasty has been considered as the treatment of choice for uretero-pelvic junction obstruction with high success rates of over 95%
The procedure allows the identification of crossing vessels, excision of the pathological uretero-pelvic junction segment ± a reduction pyeloplasty and a water tight anastomosis over a stent
Summary
The surgical management of uretero-pelvic junction obstruction has undergone revolutionary changes over the past few years. Open retroperitoneal dismembered reduction pyeloplasty has been considered as the treatment of choice for uretero-pelvic junction obstruction with high success rates of over 95%.1. The procedure allows the identification of crossing vessels, excision of the pathological uretero-pelvic junction segment ± a reduction pyeloplasty and a water tight anastomosis over a stent. There is less pain with short hospital stay and a quick recovery period.[1] the procedure requires skill, a long learning curve and involves longer operating times as compared to open and minimally invasive techniques. Equivalent success rates have been quoted in the literature.[5,8,9,10,11] We analysed the data of all open pyeloplasty were performed since 2006 to report our experience and the successful outcome we achieved
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