Pyeloplasty In Adults Research Articles

Minimally invasive pyeloplasty in adults: A systematic review on stent vs. stentless technique

Minimally invasive pyeloplasty in adults: A systematic review on stent vs. stentless technique

The Utility of Radiologic and Symptomatic Surveillance After Minimally-invasive Adult Pyeloplasty

To evaluate different types of failure after minimally-invasive pyeloplasty (MIP) when stratified by initial radiologic study and symptoms after ureteral stent removal. We retrospectively reviewed adults who underwent MIP (1996-2019) at a single academic center. Patients with at least 11 months of follow-up and patients who had a Mag3 scan as their initial postoperative imaging were included. Postprocedure, patients were categorized as having normal, equivocal, or obstructed imaging based on their initial radiologic test. Patients who were obstructed were excluded. Primary outcome was procedural failure, defined as the need for a procedure to treat recurrent obstruction. Secondary outcomes were radiologic failure and symptomatic failure. Groups were compared to assess for statistical significance (P <.05). Overall, 122 patients met inclusion criteria. On initial postoperative imaging, 108 (89%) patients had no obstruction and 14 (11%) had equivocal findings. The procedural failure rate was 6.5% in the unobstructed group and 28.6% in the equivocal group (P=.023). Seven unobstructed patients (6.5%) and 2 equivocal patients (14.3%) eventually experienced radiologic failure (P=.275). Among patients who had no obstruction on initial imaging and remained asymptomatic, only one (0.9%) required a salvage procedure. Recurrent obstruction after pyeloplasty varied based on the outcome of the initial radiologic study. These rates can be used to counsel patients and guide physicians' choice of surveillance schedules. The risk of future failure is very low in asymptomatic patients with normal initial imaging. The utility of routine radiologic surveillance in these patients may be limited.

Impact of drainage technique on surgical treatment of ureteropelvic junction obstruction in adults

Introduction. Urinary drainage is a key part of ureteropelvic junction obstruction treatment. Both external and internal drainage methods have been widely used for many years, but there is now relevant research comparing these methods and their impact on surgical outcomes in adults. The aim of the current research was to assess the efficacy and safety of two different types of urinary drainage on adult pyeloplasty. Material and methods. We conducted a retrospective and prospective clinical controlled study in the Department of Urology at the Republican Clinical Hospital from Chisinau. We reviewed 118 consecutive adult pyeloplasties for ureteropelvic junction obstruction. In 62 (52.54%) patients, we used double-J ureteral stent insertion (DJ); in another 56 (47.46%) patients, we used different types of external drainage (ED): uretero-pyelo-nephrostomy, nephrostomy, or a combination of both. Operative time, hospital stay, use of analgesics, overall complications, type of complications, and success rates were compared between the two groups. Results. The mean operative time in the DJ group was 93.52±18.10 min. vs. 95.77±20.48 min. in the ED group (p = 0.001). The average postoperative hospital stay in the DJ group was 8.45±2.02 days vs. 14.71±3.45 days in the ED group (p=0.000). The DJ group used 7.77±3.48 analgesics on average, while the ED group used 9.86±4.64 (p = 0.006). Overall complication rate was 9.68% in the DJ group and 32.14% in the ED group (p = 0.002). The most frequent complication for all patients was acute pyelonephritis (12.71%): 4.84% in the DJ group vs. 21.43% in the ED group (p = 0.007). The success rate was 96.77% in the DJ group and 92.86% in the ED group. Conclusions. Both urinary drainage methods appear equivalent concerning overall success rates, but double-J ureteral stents are associated with a shorter operating time, fewer postoperative pain medications, a shorter postoperative hospital stay, and a lower number of postoperative complications compared with external urinary drainage methods.

The influence of interstitial cells of Cajal density in the outcomes of pyeloplasty in adults: A prospective analysis.

To evaluate if the density of interstitial cells of Cajal (ICC) in the ureteropelvic junction (UPJ) influences the outcomes of pyeloplasty in adults. Twenty-three patients with the diagnosis of ureteropelvic junction obstruction (UPJO) that underwent laparoscopic dismembered pyeloplasty were included. ICC density was measured using immunohistochemistry reaction for c-KIT expression in the resected UPJ segment. Pyeloplasty outcome was evaluated by patient self-report pain, urinary outflow using DTPA renogram and hydronephrosis assessment using ultrasound (US) at 12 months of follow-up. A logistic regression analysis was performed to assess the association of pyeloplasty outcomes and ICC density. Low, moderate, and high ICC density were present in 17.4%, 30.4%, and 52.2% of the patients, respectively. Complete pain resolution was observed in 100%, 85.7%, and 75% of patients with low, moderate and high ICC density, respectively (p = 0.791). DTPA renogram improved in 75%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively (p = 0.739). Hydronephrosis improved in 25%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively (p = 0.032). Patients with high ICC density have a significant amelioration of hydronephrosis after pyeloplasty. However, ICC density is not associated with functional outcomes.

SC120 - Three-dimensional versus two-dimensional laparoscopic pyeloplasty in adults: a two-center comparative study

SC120 - Three-dimensional versus two-dimensional laparoscopic pyeloplasty in adults: a two-center comparative study

Three-dimensional versus two-dimensional laparoscopic pyeloplasty in adults: a two-center comparative study.

Three-dimensional versus two-dimensional laparoscopic pyeloplasty in adults: a two-center comparative study.

Day-case catheterless and drainless minimal-access pyeloplasty in adults: A single-center experience of 13years.

To analyze our practice of drainless and catheterless day-case minimal-access pyeloplasty with regard to feasibility, safety and long-term outcomes. Patients undergoing minimal-access pyeloplasty (laparoscopic, with or without robotic assistance) in a single center between 2007 and 2020 were included in this retrospective observational study. Patient demographics and the success rate of day-case discharge along with postoperative outcomes were analyzed. A total of 129 patients underwent minimal-access pyeloplasty in this time period, of whom 116 met the inclusion criteria. The mean patient age was 48years. A total of 65% of the patients (n=75) were discharged on the same day and 88% (n=101) were discharged within 23h of surgery. Of the 14 patients with a hospital stay of >24h, pain was the most common reason (60%) for delayed discharge. The overall subjective (pain-free status) and objective (unobstructed drainage) success rates were 91% and 86%, respectively. This study demonstrates that routine drains or urethral catheters are not necessary in minimal-access pyeloplasty, and their omission could facilitate early recovery and day-case discharge without compromising long-term surgical outcomes. Large randomized controlled studies are required to prospectively evaluate outcomes.

Challenging Cases of Laparoscopic Pyeloplasty in Adults: Troubleshooting and Technical Aspects to Optimize the Outcome

Abstract Introduction: Minimally invasive pyeloplasty for redo cases or after recurrent attacks of pyelonephritis is a challenging procedure and requires extensive surgical experience and a prolong...

Functional, morphological and operative outcome after pyeloplasty in adult patients: Laparoscopic versus open

Objective: The aim of this study is determine and compare improvement of hydronephrosis, renal function, and operative outcome between laparoscopıc and open pyeloplasty in adults. Material and methods: Sixty-five adult patients with primary ureteropelvic junction obstruction (UPJO) underwent pyeloplasty between January 2014 and September 2020. Thirty-four patients had laparoscopıc pyeloplasty (LP), 31 patients had open pyeloplasty (OP). In this retrospective study demographics, differential renal function (DRF), hydronephrosis, anteroposterior diameter of pelvis renalis (APD) and operative outcomes: operation time, blood loss, complications, hospital stay, etiology, analgesic requirement, complications, and success rates were compared between two groups. Results: Improvement of APD is higher in OP group ( p: 0.001). Improvement of DRF ( p: 0.713) and hydronephrosis ( p = 1.000), success ( p: 0.407) and complication rate ( p: 0.661) are comparable between two groups. Median hospital stay, postoperative analgesia requirement and blood loss was less in LP group, mean operative time was shorter in OP group ( p: 0.001). Conclusion: Pain complaints are greatly reduced after pyeloplasty in adult patients but the drainage of kidney, DRF and hydronephrosis does not improve as much as desired. Improvement of APD is better and median operative time is less in OP, intraoperative blood loss, hospital stay, and analgesic requirement is less in LP group in our study.

Xi Robotic versus laparoscopic Anderson-Hynes pyeloplasty in adults: a single surgeon experience

Xi Robotic versus laparoscopic Anderson-Hynes pyeloplasty in adults: a single surgeon experience

Mini-Laparoscopic Management of Ureteropelvic Junction Obstruction in Adults and Children: A High-Volume Case Series.

Purpose: We retrospectively reviewed the perioperative outcomes of mini-laparoscopic procedure in the treatment of ureteropelvic junction obstruction (UPJO) in children and adults. Methods: From August 2009 to March 2017, 229 patients referred to our center to repair UPJO by mini-laparoscopic operation. In 203 cases, dismembered pyeloplasty was accomplished, while in other 26 cases, crossing aberrant vein division and crossing artery upward transposition were performed. A follow-up renal ultrasound was done on the cases 3 and 6 months after surgery. During the follow up period, if the patients had persistent hydronephrosis or sustained clinical complaints, diethylenetriamine pentaacetic acid (DPTA) scan was done to rule out the stenosis. Results: Among 229 patients, 140 patients were younger than 18 years (Range: 2 months-18 years old, mean: 3.01 ± 1.2 year) and others were scheduled as Adult (Range: 18-57 years old, mean: 35.12 ± 7.54 year). Total clinical and radiological success rates were 99.5% (228/229) and 86.5% (198/229) respectively. Mean operative times were 127.4 ± 20.3 minutes in dismembered pyeloplasty and 110.6 ± 12.7 minutes in crossing vessel transposition surgery. Mean of hemoglobin decreasing in children and adults was 0.3 ± 0.1 mg/dL; P = .26, and 0.5 ± 1.5 mg/dL; P = .13, respectively. Length of hospital stay was 3.41 ± 0.6 days in dismembered pyeloplasty and 2.1 ± 0.6 days in patients with crossing vessel transposition surgery. We did not suture the skin incision in the entrance site of 3 mm ports and the surgical scar was hardly visible after 6 months. Conclusions: The results of our study suggest that mini-laparoscopic pyeloplasty in adults and particularly in children is feasible, and it seems to be safe and effective in the treatment of UPJO. Furthermore, the patients tolerated the surgery well and they appreciated its outstanding cosmetic outcomes.

Mini-laparoscopic pyeloplasty in adults: Functional and cosmetic results.

The study objective was toevaluate thesafety and efficacyof mini-laparoscopic pyeloplasty (mLP) in an adult population and to demonstrate the functional and cosmetic results. Data for 29 patients (19 men and 10 women) undergoing mLP for ureteropelvic junction obstruction (UPJO) from May 2014 to December 2016 in Turkey were collected in this prospective study. Inclusion criteria were age ? 18 years, body mass index (BMI) ? 30 kg/m2 and primary UPJO, and no previous surgery on the affected kidney or previous abdominal surgery. Postoperative Visual Analogue Scale scores and the Patient Scar Assessment Questionnaire (PSAQ) were used. Demographic data, perioperative parameters, complications, and postoperative functional and cosmetic results were recorded. All statistical analyses were done by SPSS software. P value of <05 was considered statistically significant. Twenty-nine adults with a mean age of 29.4 ± 10.2 years (19-38 years) were included. The patients' mean BMI was 22.4 ± 4.3 kg/m2 (a range of 16-29 kg/m2). The procedures were performed using three ports (one 5 mm port for the camera and two 3 mm ports). Mean operative time was 119 ± 28.5 minutes (85-144 minutes). Major complications were not observed, as per the Clavien-Dindo classification of surgical complications (grades IV-V). The mean VAS score was 1.2 ± 0.2 points. Functional obstruction was reported in one patient on renal scintigraphy at 12 months postoperatively. The success rate of mLP was 97%. The minimum and maximum PSAQ scores at month 3 postoperatively were 24 and 86, respectively. All the patients were satisfied with the intervention and with their cosmetic results. mLP is a safe, effective and feasible treatment method for UPJO in adult patients. This treatment modality offers excellent cosmetic and functional results following treatment for UPJO.

Comparative Study of Laparoscopic Vs Open Pyeloplasty

Background: Open pyeloplasty has been the gold standard for surgical treatment of PUJ obstruction. Over the last two decades the treatment approach to PUJ obstruction has evolved from open pyeloplasty to various minimally invasive procedures. Laparoscopic pyeloplasty has developed world wide as the first minimally invasive option to match success rate of open pyeloplasty Method: The study was carried out in our tertiary care centre between 2012 to 2015. 50 adult patients of Primary PUJ Obstruction were included in the study who underwent either Open or Laparoscopic Pyeloplasty. Patient were followed up after 4-6 weeks of surgery and outcome of surgery compared. Results: Laparoscopic pyeloplasty appears to be a safe and effective alternative to open pyeloplasty in adults. Laparoscopic Pyeloplasty has almost similar short term outcome if renal parameters are compared. A trend toward longer operating time but shorter hospital stay with the laparoscopic approach was noted, although at this point the evidence does not indicate either technique is better than the other. Conclusions: Laparoscopic Pyeloplasty is a technically sound operation which uses well established principles familiar to urologist. This procedure has a minimal level of morbidity, short hospital stay, better cosmesis compared to open approach. Laparoscopic pyeloplasty has emerged as the standard of care and is here to stay.

Predictors of Recoverability of Renal Function after Pyeloplasty in Adults with Ureteropelvic Junction Obstruction

Background: This study aimed to identify factors predicting the recoverability of renal function after pyeloplasty in adult patients with ureteropelvic junction obstruction. Methods: We retrospectively reviewed 138 adults with unilateral renal obstruction-induced hydronephrosis and who underwent Anderson-Hynes dismembered pyeloplasty from January 2013 to January 2016. Hydronephrosis was classified preoperatively according to the Society for Fetal Urology (SFU) grading system. All patients underwent Doppler ultrasonography, excretory urography, computed tomography, and technetium-99m-diethylenetriamine pentaacetic acid radioisotope (99mTc DTPA) renography before and after surgery. Renal resistive index (RRI) and 99mTc DTPA renography were repeated at 1, 3, 6, and 12 months. Results: Multivariate analysis identified age, renal pelvic type, SFU grade, preoperative RRI, decline of RRI, and renal parenchyma to hydronephrosis area ratio (PHAR) as independent predictors of renal function recoverability after pyeloplasty. However, preoperative RRI and RRI decline were not significantly associated with recoverability of renal function in patients aged >35 years. Lower preoperative RRI, greater decline in RRI, higher PHAR, lower SFU grade, and extrarenal pelvis were associated with greater improvements in postoperative renal function. Conclusions: Preoperative differential renal function cannot independently predict the recoverability of postoperative renal function in adult patients with unilateral renal obstruction-induced hydronephrosis. SFU grade, renal pelvic type, PHAR, preoperative RRI, and decline in RRI were significantly associated with the recoverability of renal function in adult patients aged <35 years, while only SFU grade, renal pelvic type, and PHAR were significantly associated with renal function recoverability in patients aged ≥35 years. Renal function recovery was better in patients younger than 35 years when compared with older patients.

Микролапароскопическая пластика гидронефроза. опыт 120 операций

The aim of the study was to evaluate functional results of microlaparoscopy compared with standard laparoscopy in pyeloplasty in adults. Patients and methods. The study included 120 patients who underwent microlaparoscopic pyeloplasty (MLP) - and 101 standard laparoscopic pyeloplasty (SLP). MLP was performed with two or three 2.5-3 mm trocars (Storz) and one 5 mm trocar for the Hd-laparoscope installed through the navel. In all cases Hynes- Anderson procedure was performed with antegrade insertion of stent. Two continuous 5-0 biosyn sutures were used for anastomosis. Stent was removed after 6 weeks and evaluation of renal function was performed in 3-6 months. Results. All options of laparoscopic pyeloplasty provide good postoperative results: 100% - MLP and 98% - SLP (defined as absense of pain and/or T1/2 improvement). There was no conversion. There were no statistically significant differences in complications, duration of hospital stay. After 3-4 months postoperative scars were almost invisible in the navel, and the sites from 3 mm trocars were like little moles, at the same time SLP postoperative scars were more noticeable. Conclusion. In our study MLP showed the same functional outcome and safety in comparison with the SLP. MLP with Hd-vision allows the use of thin filaments № 5-0 for anastomosis to provide greater operative precision that made it a standard method of pyeloplasty in our clinic with regard to a better cosmetic result achieved.

Laparoscopic management of pelvi-ureteric junction obstruction after failed open surgery or Laparoscopic pyeloplasty in adults

Objectives: a prospective study of our experience and midterm results of laparoscopic pyeloplasty (LP) for patients who have failed open or Laparoscopic pyeloplasty in adults. Patients and methods: Thirty two patients with failed open pyeloplasty were reviewed; all of them had transperitoneal dismembered LP. All procedures were performed by experienced laparoscopist during a period of two years. Results: The study group consisted of 14 men and 18 women with the mean age of 29± 6 years. Mean operative time was 123± 22 minutes. Mean hospital stay was 4.7 ± 2.3 days. Mean follow-up was 5.6 ± 2.15 months (range 3-9 months). The overall success rate for secondary LP was 90.6%. There was no conversion to open surgery. Intraoperative and postoperative complications were 9.4 and 12.5% respectively. Conclusions:LP is a safe and viable treatment option for secondary pelviureteric junction obstruction with high success rate but with long operative time. A good experience in laparoscopic reconstructive procedures is a prerequisite for optimal results.

Performance of Adult Pyeloplasty Relative to Endourological Management in the Era of Robotic Surgery: Data from the Nationwide Inpatient Sample

IntroductionReports of robot-assisted pyeloplasty have increased. However, it is unclear if this change is due to increased diagnosis of adult ureteropelvic junction obstruction, a shift in management based on presumed efficacy, a desire to maximize robot use or some combination thereof. Therefore, we acquired and analyzed data on a national scale to determine the incidence of interventions to correct ureteropelvic junction obstruction in adults and to characterize trends in procedure selection. MethodsPatients older than 18 years with ICD-9 procedure codes 55.87 (pyeloplasty) and 55.11 (endopyelotomy) were included in the study, with attention to those designated laparoscopic robotic assistance (17.42). Data were collected for the period from January 2000 through December 2012, and weighted to a national average using Nationwide Inpatient Sample guidelines. ResultsA total of 47,992 pyeloplasties were identified. Pyeloplasty rates exhibited a significant increase during this period [F(1,11)=41.38, p <0.01] and endopyelotomy rates exhibited a significant decrease [F(1,11)=64.7, p <0.01]. A higher percentage of pyeloplasties were performed robotically in 2012 vs 2009 (54% vs 44%, p <0.010). ConclusionsRates of pyeloplasty appear to be increasing at the expense of endopyelotomy. The percentage of pyeloplasty cases performed robotically is increasing but it is unclear if this is due to superior results or a need for increased robot use.

PD40-05 EVALUATION OF LAPAROSCOPIC PYELOPLASTY AS AN ALTERNATIVE TO NEPHRECTOMY IN ADULTS WITH POORLY FUNCTIONING KIDNEYS DUE TO URETEROPELVIC OBSTRUCTION

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion III1 Apr 2016PD40-05 EVALUATION OF LAPAROSCOPIC PYELOPLASTY AS AN ALTERNATIVE TO NEPHRECTOMY IN ADULTS WITH POORLY FUNCTIONING KIDNEYS DUE TO URETEROPELVIC OBSTRUCTION Bruno Nascimento, Eduardo Miranda, Victor Srougi, Marco Arap, Hiury Andrade, Anuar Mitre, Rodolfo Bandeira, Miguel Srougi, and Ricardo Duarte Bruno NascimentoBruno Nascimento More articles by this author , Eduardo MirandaEduardo Miranda More articles by this author , Victor SrougiVictor Srougi More articles by this author , Marco ArapMarco Arap More articles by this author , Hiury AndradeHiury Andrade More articles by this author , Anuar MitreAnuar Mitre More articles by this author , Rodolfo BandeiraRodolfo Bandeira More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and Ricardo DuarteRicardo Duarte More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1537AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic pyeloplasty has been considered the gold-standard treatment for adults with ureteropelvic junction obstruction (UPJO). Likewise, it is well established in adults that a symptomatic non-functioning renal unit should be removed. This study aimed to evaluate safety, kidney function recovery and symptoms improvement after laparoscopic pyeloplasty in adults with poorly functioning kidneys due to UPJO. METHODS Retrospective data analysis from August 2008 to November 2015, from a prospectively maintained database, was performed. Patients with poorly functioning kidney who underwent Anderson-Hynes dismembered laparoscopic pyeloplasty were included. In one patient, the retroperitoneal approach was preferred due to multiple previous abdominal surgeries. Poor function was defined as a split renal function of ≤ 15% in renal scintigraphy with Tc-99m DMSA. Pre and postoperative data were compared regarding differential renal function (DRF) and symptoms. Success was defined as split renal function stabilization (absolute variation of less than 5% in renal scintigraphy) and symptoms improvement. Outcome (renal function stabilization, intra and pos-op complications and symptoms) was further compared to a similar group of patients who underwent Anderson-Hynes dismembered laparoscopic pyeloplasty in normal functioning renal units. RESULTS We identified 167 patients who underwent laparoscopic pyeloplasty in our service. From those, 14 patients had poor renal function, with a mean age of 37 years (23 - 60 years). No major intra or post-operative complications were seen. At a mean follow up of 21.2 months (4-53 m) all patients reported symptoms improvement, no cases of recurrent pyelonephritis or stone formation was seen. Until this date, no patient needed further surgical treatment as re-pyeloplasty, endoscopic treatment or nephrectomy. Complete symptom resolution was seen in 10 patients (71%). One patient, despite showing complete symptom resolution, had decreased postoperative DRF in renal scintigraphy. Overall success rate was 92.8% (13/14). Split renal function remained stable in 11 patients (78,6%), considerably decreased in 1 (7.1%) and considerably increased in 2 (14.3%) patients. Renal function stabilization, intra and post-operative complications were statically similar (p>0.05) when compared to patients with normal functioning renal units who underwent the same procedure. No patient with normal functions renal units showed improvement in DRF measured with Tc-99m DMSA. CONCLUSIONS Laparoscopic pyeloplasty is an alternative to nephrectomy in adults with poorly functioning kidneys due to UPJO, enabling good symptom control with possible considerable improvement in renal function. In this study, laparoscopic pyeloplasty in this of patients showed similar outcomes and success rates to those presented by patients with normal functioning renal units. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e937 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Bruno Nascimento More articles by this author Eduardo Miranda More articles by this author Victor Srougi More articles by this author Marco Arap More articles by this author Hiury Andrade More articles by this author Anuar Mitre More articles by this author Rodolfo Bandeira More articles by this author Miguel Srougi More articles by this author Ricardo Duarte More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Transperitoneal versus retroperitoneal laparoscopic pyeloplasty in children: Randomized clinical trial

Laparoscopic pyeloplasty achieves good cosmetic and functional outcomes. Both transperitoneal and retroperitoneal approaches are used. No single study to date has compared the two approaches in a prospective randomized design. We present a prospective randomized comparison between both approaches in children in a trial to define which technique is better with regard to multiple factors including operative time, hospital stay, recovery of bowel movement, analgesic requirement and complication rate. In the period from June 2010 to September 2012, 38 children (25 boys and 13 girls) were operated laparoscopically. Children were randomized into Group I (19 children) operated by the transperitoneal approach, and Group II (19 children) operated by the retroperitoneal approach. Both groups were compared as regards to the operative time, anesthetic changes, and postoperative recovery. A minimum sample size required was calculated to be 19 for each arm based on previous studies of laparoscopic pyeloplasty, using a mean difference in operative time = 40 min, effect size = 0.95, an alpha of 0.05 and power 80% and an online sample size calculator. Statistical analysis was performed using SPSS software using the Fischer exact test, chi square test and Mann-Whitney U test. The operative time was the primary endpoint for comparison between both approaches. Our series is the first in the literature that compares in a prospective randomized design the transperitoneal and retroperitoneal laparoscopic pyeloplasty in children. Shouma et al. is the only prospective randomized study to compare both techniques in adult pyeloplasty. They had a significantly shorter operative time in the transperitoneal group however, the author in the discussion mentioned that he was at the start of the learning curve for retroperitonoscopic pyeloplasty when he conducted his study, which affected the result of the operative time. Hence, as mentioned above, we stressed the importance of a single surgeon with adequate equal experience in both techniques. The recovery of the intestinal motility and start of oral feeding were significantly faster in the retroperitoneal group compared to the transperitoneal group. In our opinion this can be explained by the absence of intraperitoneal manipulations and urine leakage in the peritoneal space. In their series of retroperitoneal pyeloplasty, El Ghoneimi et al. reported feeding after a mean of 1.4 days, however, in our series there was even earlier oral feeding. Shouma et al. reported no significant difference in the start of oral feeding in their adult series. The limitations of our study are: the choice of the 40 min difference created a statistically significant difference in operative time between the groups which might not be considered a truly clinically important difference. In addition, the single author operating for both approaches, which might create a bias, however the author has sufficient experience in both approaches. Moreover, although there were significant differences in hospital stay and intestinal movement between the two groups, it is not clear if these were of clinical significance. Both transperitoneal and retroperitoneal approaches have high success rate. The shorter operative time, shorter hospital stay, rapid recovery of intestinal movement and early resumption of oral feeding are in favor with the retroperitoneal approach.

Erişkinlerde Açık Yardımlı Laparoskopik Dismembered Piyeloplasti: Ekstrakorporeal Anastomoz İçin Kas Ayırma Tekniği

1949 yılında tanımlanmış olan Anderson-Hynes açık dismembered piyeloplasti; primer üreteropelvik bileşke darlığının tedavisinde %90'lık başarı oranı ile hala altın standarttır. Üreteropelvik bileşke darlığının tedavisinde son iki dekatta minimal invaziv teknikler geliştirilmiştir. Popüler hâle gelen laparoskopik piyeloplasti ve robot yardımlı laparoskopik piyeloplastinin başarı oranları açık cerrahinin sonuçlarına yaklaşmaktadır. Transperitoneal veya retroperitoneal yaklaşımla gerçekleştirilebilmektedir. Laparoskopik piyeloplasti rekonstrüktif bir cerrahi olduğundan dolayı, anatomik yapıların dikkatli bir şekilde diseksiyonunda belirli bir eğitim ve laparoskopik vücut içi sütür ve bağlama tekniklerinde ciddi bir tecrübe gerektirmektedir. Bu çalışmada, üreteropelvik bileşkenin laparoskopik diseksiyonun takiben küçük bir flank insizyon sonrası yapılan kas ayırma tekniği ile ekstrakorporeal anastomoz yaptığımız üç Anderson-Hynes dismembered pyeloplasti olgusu sunulmuştur. Ortalama izlem süresi 36 ay idi. Cerrahi sonrası semptomlar düzeldi ve DTPA renal sintigrafi bütün olgularda üreteropelvik bileşke darlığı olmadığını doğruladı. İzlem süresinde herhangi bir komplikasyon veya nüks görülmedi. Ekstrakorporeal üreteropelvik anastomoz için laparoskopik yaklaşım ile kombine edilen kas ayırma tekniği üreteropelvik bileşke darlığı olan erişkin hastalarda güvenli, etkili ve minimal invaziv bir metottur.