Cases Of Ureteropelvic Junction Obstruction Research Articles

Robotic-Assisted Laparoscopic Pyeloplasty in Challenging Cases of Ureteropelvic Junction Obstruction in the Pediatric Population: A Multicenter Review.

Purpose: To report a multi-institutional international experience in performing robotic pyeloplasty for complicated cases of ureteropelvic junction obstruction (UPJO) in the pediatric population and assess feasibility and outcomes. Materials and Methods: Retrospective chart review of all pediatric patients who underwent robotic-assisted laparoscopic pyeloplasty (RALP) for UPJO in challenging cases between 2013 and 2021 was included. Demographics, perioperative surgical data, complications, and results are described. Challenging cases were defined as bilateral UPJO, failure of previous open pyeloplasty (thus re-do cases), correction of UPJO in kidneys with anatomical variations, huge hydronephrosis, and low-weight infants (<6 kg). Results: Over an 8-year period, 36 children (62% males and 38% females) met the inclusion criteria for our study. Fifteen patients underwent RALP for recurrent UPJO; among them, 2 children required simultaneous surgery for renal stones, 3 cases of lower pole UPJO in double collecting system, 3 cases of pelvic and horseshoe kidneys, 10 cases of infants weighing <6 kg, 3 cases of huge hydronephrosis, and 2 cases of bilateral UPJO. The median age and weight were 36 months (interquartile range [IQR] 14-84) and 12 kg (IQR 10-20.5), respectively. All robotic cases were completed successfully with no conversion to an open procedure. The median operative time was 120 minutes (IQR 90-135). The mean length of hospital stay was 2.6 days. Four patients (17%) had postoperative complications-1 ileus (Clavien-Dindo grade [CDG] I) and 3 urinary tract infections (CDG II). No CDG III or higher complication was encountered. At a median follow-up of 36 months, the success rate was 95% with 1 patient requiring another re-do procedure due to recurrent obstruction. Conclusions: Our data suggest that RALP is safe and effective even for challenging cases of UPJO in children.

Expression and clinical implications of PARs in the stenotic tissue of ureteropelvic junction obstruction.

To explore the expression and clinical implications of protease activated receptors (PARs) in the pathogenesis of children with ureteropelvic junction obstruction (UPJO). Immunohistochemistry was employed to investigate the distribution of PARs in both normal human ureteropelvic junction (UPJ) and cases of UPJO. Furthermore, PAR gene expression levels were assessed using real-time PCR (RT-PCR), and the patients in the UPJO group were stratified according to the Onen grading system. Subsequently, the clinical implications of PARs in UPJO were explored through RT-PCR analysis. Immunofluorescence showed robust PAR2 expression in the control group compared with the UPJO group. The results of RT-PCR analysis revealed a significant decrease in the relative mRNA expression of PAR2 in the UPJO group compared to the control group. Notably, the relative RNA expression of PAR1 was significantly lower in the Onen-4 group compared to the control group. Furthermore, the relative mRNA expression of PAR2 exhibited a statistically significant difference among the Onen-3 group, Onen-4 group, and control group. PARs are widely distributed throughout the SIP syncytium of the UPJ and play a role in maintaining smooth muscle cells (SMCs) membrane potential by interacting with interstitial cells of Cajal (ICCs), as well as platelet-derived growth factor receptor alpha-positive cells (PDGFR α+ cells). The decreased expression of PAR1 suggests a higher preoperative Onen grade in UPJO patients. Furthermore, the downregulation of PAR2 effects at the UPJ may be involved in the loss of inhibitory neuromuscular transmission, disrupting the rhythmic peristalsis of the UPJ.

Voiding Cystourethrogram Before Pyeloplasty: To Do or Not To Do?

To assess the incidence of concomitant vesicoureteral reflux (VUR) in unilateral cases of ureteropelvic junction obstruction(UPJO) and to identify factors that predict VUR. Files of 381 pediatric patients who underwent unilateral pyeloplasty between 2000 and 2017 were retrospectively reviewed.A total of 270 patients with available data and ≥5 years of follow-up were eligible for this study.Demographic parameters,preoperative hydronephrosis grade,renal pelvis anteroposterior diameter(APD),renal parenchymal thickness(PT),split renal functions on MAG-3 scan and VUR status were noted.The patients were divided into two groups:Those with concomitant VUR(Group I, n:24, 8.9%) and those without VUR(Group II,n:246, 91.1%). Among 270 patients(205 boys,75.9%) with a median age of 4 months(2-98),197 (72.9%)had antenatal hydronephrosis.Median follow-up was 11 years(5-22).Among 24 patients with concurrent VUR,6(25%) had Grade II VUR,whereas Grade III-V VUR was detected in 18(75%).Of these,12(50%) had ipsilateral VUR,3(12.5%) had contralateral,and 9(37.5%) had bilateral VUR.In a median 137-month follow-up,spontaneous VUR resolution was observed in 6(25%) patients,whereas 15 (62.5%) patients underwent endoscopic subureteral injection and 3(12.5%) patients ureteroneocystostomy,respectively.Preoperative APD[35.5, IQR(27.6-36.0) vs. 26.5 IQR(25.0-35.0), p=0.004] were significantly higher in Group I,whereas Group I had significantly lower PT[3.7, IQR(3.4-6.4) vs. 5.8 IQR(4.4-6.1), p=0.026].Predictive factors for concomitant VUR were presentation with febrile UTI(OR:2.769,p=0.048), PT<3.95 mm(OR:1.367,p=0.043),and APD>28.8 mm (OR:1.035,p=0.001). Our results indicated that concomitant VUR and UPJO might be detected in 1 out of every 11 patients undergoing pyeloplasty,while some type of surgical intervention for VUR was required in 75% of these patients.Thus,VCUG prior to pyeloplasty may be limited in those presenting with febrile UTI,having higher APD and lower PT on preoperative urinary ultrasonography.

Primary laparoscopic ureterocalicostomy as an option in selected cases of ureteropelvic junction obstruction

Primary laparoscopic ureterocalicostomy as an option in selected cases of ureteropelvic junction obstruction

Association between intraoperative anatomical variation and histopathological parameters in cases of ureteropelvic junction obstruction in children: A cross-sectional study.

The intraoperative anatomical findings (IOAF) of all ureteropelvic junction obstruction (UPJO) cases are not identical. Moreover, there is also controversy in the literature regarding histopathological (HP) findings in cases of UPJO. In the present study, we evaluated different IOAF and assessed their association with specific HP parameters. This was a cross-sectional study set-up, which was carried out in a tertiary care centre. Children with UPJO who underwent surgery between 2017 and 2020 were enrolled. The following IOAF were noted: Type of pelvis (extrarenal or intrarenal), insertion of the ureter (high or normal), presence of lower pole crossing vessel (CV), negotiation of UPJ segment with double J stent (3 Fr) and length of internal narrowing (LIN) at UPJ. The resected segment of UPJ was assessed at three levels (pelvis, UPJ and ureter) for various HP parameters including fibrosis, oedema, inflammation and smooth muscle hypertrophy (SMH). Thirty-nine children were included in the study with a mean age of 31 months. The summary statistics of IOAF were intrarenal pelvis in 5 cases, high insertion of the ureter (HIU) in 9, CV in 6, negotiable UPJ in 23, and 16 cases showed LIN >1 cm. All cases showed SMH at the pelvis region and SMH with fibrosis at the UPJ region. At the pelvis region, there was an association between (1) HIU with oedema and chronic inflammation (CIF), (2) CV with CIF and (3) LIN with CIF and SMH. At the UPJ region, there was an association between (1) CV and negotiable UPJ with less fibrosis and (2) LIN with SMH. At the ureteric end, CV showed an association with less fibrosis and more CIF. All UPJO cases have some common HP findings. Although, some particular IOAF, i.e., presence of CV, negotiable UPJ, HIU and LIN showed association with specific HP parameters.

The Course of Congenital Hydronephrosis in Infancy

Objective: The aim of our study is to examine the spontaneous resolution rates of congenital hydronephrosis from a recent perspective. Material and Methods: Sixty-nine pediatric patients (M/F=46/23) with congenital hydronephrosis were enrolled in this study. Results: The mean age at the first postnatal examination was 10.8±7.6 days, and the mean age at the time of the final examination was 9.5±3.2 months. Forty-eight patients’ renal anteroposterior diameters (APD) (69.5%) improved while 8 (11.6%) patients’ APDs worsened during the follow-up period. However, MAG3 of these 8 patients was normal. The remaining thirteen (18.9%) patients had congenital anomalies of the kidney and the urinary tract (8 vesicoureteral reflux, 5 cases of ureteropelvic junction obstruction). The mean baseline APD was 9.1±2.8 mm in the group with reduced APD, and 9.7±2.8 mm in the one with increased APD (p=0.461). The mean APD at the final visit was significantly lower in the group with reduced APD than that in the group with increased APD (5.1±1.8 mm vs 17.9±12.6 mm; p=0.001). The anteroposterior diameter of 26 (81.25%) patients with left-sided hydronephrosis and 10 (71.4%) patients with right-sided hydronephrosis regressed spontaneously. The rate of spontaneous resolution was relatively low in patients with bilateral hydronephrosis (n=13; 56.5%) compared to unilateral ones. Conclusion: Our study indicates that an initially mild hydronephrosis does not exclude a pathological course in cases of congenital hyronephrosis. Therefore, in such patients, routine ultrasonography should be done regularly.

A rare case of ureteropelvic junction obstruction by an aberrant renal vessels

Ureteropelvic junction obstruction results in functionally significant impairment of urinary transport from the renal pelvis to ureter, that may because of intrinsic or extrinsic causes. Abberent renal vessels is the most common cause of pelviureteric junction obstruction in children. Aberrant renal vessels one of the most important cause of ureteropelvic junction obstruction present in about 20-40% of individuals.

Early outcome of pediatric pyeloplasty in kidneys with split renal function less than 10%: A prospective study of 25 cases

ObjectivesTo detect the outcome of pyeloplasty in kidneys with split renal function (SRF) less than 10% in the pediatric age group. Subjects and methodsWe prospectively analyzed the data from 25 cases of ureteropelvic junction obstruction (UPJO) candidate for pyeloplasty with SRF less than 10%. Abdominopelvic ultrasonography and diuretic renogram using technetium-99m diethylenetriamine Penta acetic acid (DTPA) were done in all cases. We studied the improvement in pelvic anteroposterior diameter (APD) postoperatively. We compared pre and postoperative SRF after six months and one year. ResultsThe median age was 24 months (3 months–11 years), male to female 2:1. The median preoperative SRF was 5% (range: 0%–10%) and the median APD of the renal pelvis was 3cm (range: 2.2–5). There was significant improvement of median APD 0.8cm (range: 0.5–1.9) (P value <0.05). There was a significant postoperative improvement in the median SRF (P-value <0.05) as the median SRF after 6 months and 1year were 21% and 20%, respectively but there was no significant difference between SRF at six months and one year (P value 0.174). ConclusionPyeloplasty provides high rates of functional success even in very poorly functioning kidneys with SRF ≤10% by DTPA renogram in pediatric age group.

The application of pyeloureteroplasty in the treatment of children with affected kidney function less than 10

Objective To determine the efficacy and long-term outcome of pyeloureteroplasty in the ureteropelvic junction obstruction (UPJO)patients with poor kidney function(<10%). Methods The data of UPJO patients with poor kidney function treated from January 2006 to September 2016, was retrospectively analyzed. The renal function <10% undergoing pyeloureteroplasty were included. Ipsilateral vesicoureteric reflux, ureterovesical junction obstruction and renal dysplasia were excluded. 39 patients was enrolled. There were 31 boys and 8 girls. The mean age at surgery was 3.1 years old (range 7 months-14 years). There were 36 primary UPJO and 3 extrinsic vessel cases. Twenty-seven cases of UPJO in left side, 9 cases in right side, and 1 case in bilateral side. The preoperative examination included ultrasound, intravenous pyelography (IVU) and 99 mTc DTPA renography. Mean anteroposterior diameter of pelvis was (5.5±2.4)cm before operation (range 3.4-7.4cm); IVU showed non visualized kidney or rim sign.The ill kidneys’mean renal function was (3.25±2.78)% (range 0-9%). Results Open pyeloureteroplasty were performed in the 38 patients, additional nephrectomy was required in 1 because of repeated urinary infection, while the other patients had good prognosis, nephrostomy was kept until 2-3 days’successful clipping. Laparoscope pyeloplasty were performed in one patient with double-J. The patient had urinary infection post operation and was cured. The postoperative examination included ultrasound, intravenous pyelography and 99mTc DTPA renography were performed after 3-6 months. Mean anteroposterior diameter of pelvis was (3.2±1.9)cm (range 2.1-4.5 cm); Intravenous urography showed visualized kidney; Mean renal function was (18.16±13.17)% (9%-27%). There was significant difference between preoperational and postoperational evaluation of renography and pelvis (P 0.05). The mean follow-up time was 10.2 months (range 6-25 months). Conclusions Pyeloureteroplasty could be safe and feasible for the UPJO patients with renal function less than 10%, and could improve the renal function. Key words: Ureteropelvic junction obstruction; Renal function; Radioisotope scanning; Pyeloureteroplasty

Surgical decision of concomitant ureteropelvic junction obstruction with congenital abnormalities of the kidney

Objective To investigate the timing and scheme of surgical treatment for the concomitant ureteropelvic junction obstruction(UPJO) and congenital abnormalities of the kidney. Methods The clinical data of 155 patients with concomitant UPJO and congenital abnormalities of the kidney from January 2006 to January 2016 was retrospectively analyzed. There were 107 males and 48 females, who aged 6 months to 16 years and 6 months. The average time was 5 years and 9 months old when they received operation. There were 8 cases less than 1 year old. There were 93 cases of UPJO on the left side, 54 cases on the right side, and 8 cases on both sides. There were 33 cases with duplication of kidney, 19 cases with solitary kidney, and 6 cases with renal dysplasia, 6 cases with renal ectopia, 12 cases with polycystic kidney disease, and 41 cases with dysplasia; 2 cases with renal malrotation. There were 100 cases with symptoms such as fever, abdominal pain, vomiting. 5 cases had received Anderson-Hynes pyeloplasty in other hospitals, 2 cases received nephrectomy with symptoms did not relieve. 4 cases were treated with nephrostomy in other hospital. Children with the repeated clinical symptoms, or renal function decreased significantly, or hydronephrosis progressive to the anteroposterior diameter of more than 30 mm received surgical treatment. Results There were 140 cases received Anderson-Hynes pyeloplasty, and 8 cases received nephrectomy with 5 cases were UPJO side and 3 cases were only abnormalities of the kidney without UPJO. All patients received IVP or ultrasonography postoperative 3-6 months, which showed hydronephrosis improved or no obvious change, and 4 cases were improved obviously. The IVP results showed that 5 patients with renal dysplasia together with UPJO had the renal function improved. There were 128 cases followed up for 12 to 106 months, with an average of 64.5 months. All patients had no clinical symptoms. 83 cases were re-examined by IVP or ultrasonography, and hydronephrosis was getting better or no change. Conclusions The patients with concomitant UPJO and congenital abnormalities of the kidney don′t need surgery in advance. The best choice for those patients is Anderson-Hynes pyeloplasty. The indication of nephrectomy should be considered carefully. Key words: Abnormalities of the kidney; Ureteropelvic junction obstruction(UPJO); Anderson-Hynes pyeloplasty; Nephrectomy

Hydronephrosis in the course of ureteropelvic junction obstruction: An underestimated problem? Current opinions on the pathogenesis, diagnosis and treatment.

Ureteropelvic junction obstruction (UPJO) causes a reduction in the urine flow from the renal pelvis into the ureter. Untreated UPJO may cause hydronephrosis, chronic infection or urolithiasis and will often result in progressive deterioration of renal function. Most cases of UPJO are congenital; however, the disease can be clinically silent until adulthood. Other causes, both intrinsic and extrinsic, are acquired and include urolithiasis, post-operative/inflammatory/ischemic stricture, fibroepithelial polyps, adhesions and malignancy. In the past, the most frequent symptom of UPJO in neonates and infants was a palpable flank mass. Nowadays, thanks to the widespread use of maternal and prenatal ultrasound examinations, asymptomatic hydronephrosis is diagnosed very early. In adults and older children symptoms may include intermittent abdominal or flank pain, nausea, vomiting and hematuria. In addition to high specificity and sensitivity in detecting UPJO, modern technologically advanced equipment such as ultrasound, magnetic resonance imaging and computed tomography provides a lot of information about the function of the affected kidney and the anatomy of the surrounding tissues. Treatment options for UPJO include a wide spectrum of approaches, from active surveillance or minimally invasive endourologic techniques to open, laparoscopic or robotic pyeloplasty. The main goal of therapy is to relieve symptoms and maintain or improve renal function, but it is difficult to define treatment success after UPJO therapy.

Comparative, Prospective, Case-Control Study of Open versus Laparoscopic Pyeloplasty in Children with Ureteropelvic Junction Obstruction: Long-term Results.

We compare open pyeloplasty (OP) versus laparoscopic pyeloplasty (LP) in children in a multicenter, prospective, case-control study. From May 2007 to March 2009, a program was established at Hospital Garrahan, the reference center, to perform LP with a mentoring surgeon that would attend the institution once a month. Every new case of ureteropelvic junction obstruction (UPJO) diagnosed in the reference institution was offered to participate in the study. If the patient was enrolled, it was scheduled for LP. The following patient diagnosed with UPJO was operated on with open technique and served as a case-control. In three other facilities, patients were only offered LP and had a matched control open case at the reference institution. The first end point of the study was patient recovery: analgesia requirement and length of hospitalization (LOH). The second end point of the study was resolution of UPJO in long-term follow-up for the two techniques. Demographic data, surgical time, perioperative complications, analgesia requirement, analgesia score during hospitalization, LOH, and outcome were recorded. Both groups received the same postoperative indications for pain control. Parents were asked to assess pain in their children every 4 h postoperatively and to complete a pain scale chart to which the nurses were blinded. Fifteen OP and 15 LP were compared. Groups were similar with regard to sex, age, weight, and laterality. Mean surgical time was longer in LP than in OP group (mean 188 versus 65 min) (p < 0.01). Hospitalization was shorter for LP group with a mean of 1.9 versus 2.5 days for OP group (p < 0.05). Postoperative analgesia requirement was significantly higher in the OP group with a mean use of morphine of 1.7 versus 0.06 mg/kg in the LP group (p < 0.05). Pain scores were similar in both the groups. At a mean follow-up of 58 months there were no failures. In this prospective comparative cohort, LP was a longer procedure than OP. Both procedures had the same efficacy and complication rates, but patients undergoing LP needed fewer narcotics for pain control and had a shorter hospitalization.

Ureteropelvic junction obstruction and renal cell carcinoma in a patient with solitary functioning kidney.

We present a case of ureteropelvic junction obstruction (UPJO) and renal cell carcinoma (RCC) in a solitary functioning kidney (SFK), managed by robot-assisted dismembered pyeloplasty with partial nephrectomy in a single stage. To our best knowledge, we report the first case of UPJO with RCC in a congenital SFK.

Changes in Cajal cell density in ureteropelvic junction obstruction in children

Congenital ureteropelvic junction obstruction is one the most common causes of neonatal hydronephrosis. The etiology of the ureteropelvic junction (UPJ) obstruction has not been clearly established. The presence of a hypoplastic, adynamic ureteral segment is thought to be the major cause of an UPJ obstruction. We evaluated the distribution of Cajal cells using immunohistologic methods coupled with light microscopy of the UPJ tissues in obstructed and normal UPJs. The study group consisted of 19 patients who underwent pyeloplasty for UPJ obstruction. Twelve patients who had been operated on for oncological indications constituted the control group. The sections were stained immunohistochemically using CD117 (c-kit) antibody; the numbers of CD117 (+) interstitial cells of Cajal were counted in 10 consecutive high-power fields under the light microscope and the cell density was determined for each case. The mean age of the cases who underwent dismembered pyeloplasty and the control group were 116 ± 116 months (14 male, 5 female; 6-420 months) and 279 ± 312 months (9 male, 3 female; 24-948 months) (p = 0.1), respectively. The mean interstitial Cajal cell number in the UPJ obstruction and the control groups were 2.37 ± 2.19 and 24.5 ± 9.73, respectively (p < 0.0001). Thirteen (68.4%) patients had very few, five (26.3%) patients had few, and one (5.3%) patient had many Cajal cells in the UPJ obstruction group. In the control group, all patients had more than seven cells per high-power field. We found that in cases of UPJ, obstruction the numbers of interstitial Cajal cells were decreased, being either absent or significantly reduced. Although data about the motility are currently not sufficient, the decrease in the number of Cajal cells in patients with UPJ highlights that they might be responsible for the initiation, coordination, and conduction of peristaltic activity along the pelvicalyceal system. Improvement and enhancement of contraction waves arising from the upper urinary system depend on interstitial cells of Cajal, which are the pacemaker cells in smooth muscles. We think that a decreased number of interstitial cells of Cajal have a close relationship with changing ureteral motility when we compare our UPJ obstruction cases with the limited data in the literature. Further investigations on these cells will probably give detailed information about the neurophysiology of the urinary system and the diseases that cause congenital hydronephrosis.

Delayed Presentation of Ureteropelvic Junction Obstruction and Loss of Renal Function After Initially Mild (SFU Grade 1-2) Hydronephrosis

We report 4 pediatric cases of ureteropelvic junction obstruction involving delayed progression of initially mild postnatal hydronephrosis. All 4 children became symptomatic; however, 3 already had a substantial decrement of ipsilateral kidney function by the time of diagnosis. Two of these 3 patients had previous renal scintigraphy demonstrating normal differential function. We caution that counseling regarding hydronephrosis should emphasize the importance of prompt re-evaluation for any symptoms potentially referable to delayed presentation of ureteropelvic junction obstruction, irrespective of initial hydronephrosis grade. Future studies are needed to determine the optimal follow-up regimen for conservative management of hydronephrosis.

A Curable and Probably Often-Overlooked Cause of Cyclic Vomiting Syndrome

Cyclic vomiting syndrome is a disorder of many causes. The major challenge is to label the disorder as idiopathic or primary only when all possible etiologies, particularly those that can be specifically treated, have been ruled out. In retrospect, our patient had subtle prenatal and early postnatal radiological findings supportive of a urological cause for his symptoms, the importance of which was initially missed. It would probably be wise to include an abdominal ultrasound examination (looking for hydronephrosis) in the "must-do" battery of tests for the investigation of all cases of recurrent cyclic vomiting without apparent cause. Otherwise, it seems likely that many cases of ureteropelvic junction obstruction will be missed, cases in which surgical intervention can be curative.

Rapid and Sustained Recovery of Renal Function with Transient Placement of an Intrauretral Nephrostomy Catheter in an Infant with Ureteropelvic Junction Obstruction and Acute Renal Failure

Ureteropelvic junction obstruction (UPJO) is a common, congenital urinary malformation in the pediatric age group. In most cases the diagnosis is made antenataly and resolves spontaneously. Postnatal diagnosis is made when symptoms of urinary tract infection or abdominal pain occur. We report a six-month-old girl with single kidney and known vesicoureteral reflux grade IV presenting with severe acute renal failure (ARF), requiring acute peritoneal dialysis (PD).After diagnosis of decompensated UPJO, a nephrostomy was performed, and renal function restored within seven days. UPJO was subsequently treated by open pyeloplasty. To our knowledge, this is the first case of UPJO requiring PD due to severe renal failure in a child. Children with UPJO and major morbidity of the contralateral kidney are at risk of renal failure and should therefore be followed carefully to prevent serious complications.

Laparoscopic Anderson-Hynes procedure as a treatment of ureteropelvic junction obstruction caused by fibroepithelial polyp.

Fibroepithelial polyps (FEPs) are rare benign ureteral neoplasms of mesodermal origin. As an intrinsic cause of ureteropelvic junction obstruction (UPJO) they are very uncommon. Excretory urography and diuretic renography used by many urologists to diagnose a UPJO may not detect the ureteral polyp. We present a case of ureteropelvic junction obstruction caused by a fibroepithelial polyp, which was not diagnosed preoperatively. The patient underwent successful laparoscopic excision of the polyp with Anderson-Hynes pyeloplasty. We believe that laparoscopy is a useful, minimally invasive operative technique in the treatment of FEPs and may be considered a procedure of choice in large polyps, in which cases the endoscopic procedure is difficult or impossible to perform.

The distribution of interstitial cells of Cajal in congenital ureteropelvic junction obstruction

PurposeThe authors analysed the distribution of c-kit-positive interstitial cells of Cajal (ICCs) in obstructed ureteropelvic junction (UPJ) and its age-related changes.MethodsTwenty specimens were obtained from children with intrinsic ureteropelvic junction obstruction (UPJO), at the average age of 8.1 years (8 months–16.8 years), fixed in formalin and embedded in paraffin. Five control samples were taken from children at the average age of 2.3 years (2.4 months–7.4 years). All specimens were analysed by the immunohistochemistry test with light microscopy with respect to c-kit expression. The distribution of c-kit-positive ICCs in the two groups was compared and the correlation between the distribution of c-kit-positive ICCs and the patients’ age in UPJO cases was analysed. The results were examined by Yates’ χ2 test, Mann–Whitney U test, and t test for Pearson’s correlation coefficient. A P value < 0.05 was considered as statistically significant.ResultsNo statistically significant differences were found in the distribution of c-kit-positive ICCs between UPJO and the control group. No correlation was established between the age of patients with UPJO and the distribution of c-kit-positive ICCs.ConclusionNo distributional difference found in obstructed and unobstructed UPJ seems to indicate that UPJO is not associated with anomalous distribution of c-kit-positive ICCs. Age-related changes in the expression of c-kit-positive ICCs are equally distributed in obstructed UPJ.

V577 PEDIATRIC ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY IN HORSESHOE KIDNEY

You have accessJournal of UrologyPediatrics1 Apr 2013V577 PEDIATRIC ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY IN HORSESHOE KIDNEY Candace F. Granberg, Daniel DaJusta, and Patricio Gargollo Candace F. GranbergCandace F. Granberg Rochester, MN More articles by this author , Daniel DaJustaDaniel DaJusta Louisville, KY More articles by this author , and Patricio GargolloPatricio Gargollo Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1973AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The surgical approach to ureteropelvic junction obstruction (UPJO) in horseshoe kidneys is challenging secondary to the inherent aberrant anatomy. Historically, some have recommended division of the isthmus, while others have advocated transection of crossing vessels, both of which carry risk of nephron damage or loss. With the advent of minimally-invasive surgery, robotic-assisted laparoscopic pyeloplasty (RALP) has become routine in otherwise anatomically normal kidneys; however, there is limited data on the robotic approach to UPJO in children with horseshoe kidneys. Thus, the objective of this video is to detail the surgical approach to RALP in the horseshoe kidney. METHODS Hidden incision endoscopic surgery (HIdES) was developed at our institution, and is applied in all RALP cases. One robotic port is placed infraumbilically, while all remaining ports are hidden below the level of a Pfannensteil incision, thus rendering them nonvisibile when wearing a bathing suit. A 5mm assist port is optional. Using a transmesenteric approach, the UPJ is localized. In this case, a mesenteric vessel overlying the UPJ was divided to maximize exposure of the UPJ and proximal ureter. High insertion was identified as the cause of UPJO in this case. No renal crossing vessels were found, and the isthmus was not a factor, thus was left intact. A hitch stitch is placed in the renal pelvis to elevate the UPJ. After transescting above the UPJ, the ureter is relocated to lie above the mesentery. The UPJ is excised and the ureter spatulated. 5-0 Vicryl is used for the anastomosis over a stent. RESULTS We have performed RALP for UPJO in 4 children with horseshoe kidneys, all of whom were male, with a mean age of 4.7 years. All cases of UPJO in this cohort occurred within the left renal moiety. Mean operative time in these four cases was 120 minutes. The isthmus and renal vasculature were maintained in all cases, and there were no intra- or post-op complications. All patients were dismissed within 24 hours. At mean follow-up of 9 months, all patients were radiologically and clinically improved. CONCLUSIONS In conclusion, RALP in children with horseshoe kidneys is safe and efficacious. Meticulous intraoperative examination of the anatomy is germane to ensure aberrant crossing vessels are not overlooked. Moreover, adequate drainage can be achieved without dividing the isthmus or renal vasculature, which not only maintains blood supply to all nephrons but also avoids inherent risks associated with these maneuvers. Thus, RALP is an excellent minimally-invasive approach for UPJO in children with horseshoe kidneys. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e236-e237 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Candace F. Granberg Rochester, MN More articles by this author Daniel DaJusta Louisville, KY More articles by this author Patricio Gargollo Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...