Concomitant Ureteropelvic Junction Obstruction Research Articles

Does preoperative screening VCUG affect the outcomes and complications of pyeloplasty in patients with ureteropelvic junction obstruction?

The role of voiding cystourethrogram (VCUG) in evaluating vesicoureteral reflux (VUR) in patients with known ureteropelvic junction obstruction (UPJO) remains unclear. While VCUG is frequently performed, the incidence of concomitant VUR and UPJO is low, and VUR is often low-grade with high rates of spontaneous regression. To analyze the clinical relevance of VCUG in patients with UPJO by determining its incidence and studying the difference in clinical outcomes between patients with known, unknown, and negative VUR. Retrospective review of patients with UPJO who underwent pyeloplasty from 2012 to 2020 with <18 years-old, unilateral UPJO, postoperative follow-up of ≥2 months and had at least 1 renal ultrasound (US) after pyeloplasty. Results were compared among 3 groups: patients who underwent VCUG before pyeloplasty and were found to have VUR (group 1), patients who underwent VCUG before pyeloplasty without VUR (group 2), and patients who did not have a VCUG before pyeloplasty (group 3). A total of 275 patients met the inclusion criteria, of which 21 patients were classified in group 1, 166 patients in group 2, and 88 patients in group 3 (Table). The age at preoperative VCUG was 14.7±32.9 months in group 1 and 15.17±35.8 months in group 2 (p=0.960). Overall, the incidence of concomitant UPJO and VUR was 11.2%. In group 1 the initial VUR grade was 5 in 2 patients, 4 in 3, 3 in 5, 2 in 7, and 1 in 4 patients. Of these, only 1 patient required ureteral reimplantation after pyeloplasty. Post-pyeloplasty, no significant differences were observed in complications (p=0.7436), length of follow up (p=0.3212), SFU grade 4 hydronephrosis (p=0.2247), postoperative UTIs (p=0.1047) and pyeloplasty success rate (p=0.4206) among the 3 groups. Despite the use of antibiotic prophylaxis being significantly different amongst the three groups (p<0.001), it was not associated with a lower incidence of postoperative UTIs (group 1 p=0.068, group 2 p=0.486, group 3 p=1). In patients with reflux, an increase in age was associated with a decrease in the rates of complications (p=0.019). We found no significant difference in the outcomes in patients who had a preoperative VCUG as compared to those who did not. The preoperative diagnosis of VUR by VCUG changed the management in less than 1% of the study population and thus its role in patients with UPJO should be reevaluated.

A combined approach of robot-assisted laparoscopic pyeloplasty and flexible endoscopy to treat concomitant ureteropelvic junction obstruction and calyceal stones in children: Technical considerations and review of the literature.

The management of children with concomitant ureteropelvic junction (UPJ) obstruction and calyceal stones remains challenging. The various treatment options available for pediatric nephrolithiasis may require multiple sessions, and the techniques by themselves are not designed for simultaneous correction of UPJ obstruction. Recently, success in combining robot-assisted laparoscopic pyeloplasty (RALP) and flexible endoscopy has been reported by multi-institutional studies to treat children with concomitant UPJ obstruction and renal stones. Given the paucity of technical details of this novel approach in the existing literature, we herein report our techniques to treat two girls aged 6 and 10 years who had concomitant UPJ obstruction and multiple stones in mid- and lower poles calyces. Three robotic ports were used without any assistant ports. A flexible endoscope, either a cystoscope or a single-use ureteroscope, was introduced via the undocked epigastric port to perform nephroscopy and stones removal after the renal pelvis was opened. The rest of the RALP was completed in the usual manner. Technical modifications were employed to facilitate the flexible endoscope to examine the entire calyceal system. Both patients underwent successful surgical procedures by the combined approach without any intra- or post-operative complications. Three and 14 stones were removed from each of the patients respectively. Postoperative investigations demonstrated successful correction of UPJ obstruction and complete stone clearance in both patients. A combined approach of RALP and flexible endoscopy is a safe and effective technique to treat concurrent UPJ obstruction and calyceal stones in children.

Retrograde Intrarenal Surgery Following Laser Endopyelotomy; Sequential Procedures for Ureteropelvic Junction Obstruction and Nephrolithiasis.

This study was designed to evaluate the effectiveness and safety of retrograde intrarenal surgery (RIRS)following retrograde laser endopyelotomy (rLEP) in concomitant ureteropelvic junction obstruction (UPJO) andstone disease. Patients with concomitant UPJO and renal stone disease who were first treated in ourclinic by rLEP for obstruction and then RIRS for stone disease were enrolled. Study period went from 2012 to2017. RIRS following rLEP was performed earliest at the sixth week. Patients who underwent rLEP were matchedwith those with normal anatomy at a 1:1 ratio based on the propensity scores. Additionally, clinical results werecompared in order to evaluate the effects of rLEP surgery on RIRS. Subsequently, patients who underwent RIRSfollowing rLEP were independently evaluated and factors affecting the success of sequential procedures wereinvestigated. The sole difference between those that underwent RIRS following rLEP (n=27) and controls with normalanatomy that underwent RIRS was in operative times (p = .011). Evaluation of potential success factors inthe sequential rLEP-RIRS group revealed that primary etiology, obstruction length less than 1cm, smaller stonesize and presence of single stone showed significant effects (p = .047, p = .030, p = .040, p ? .001, respectively).RIRS following rLEP generated an 81.5% stone-free and, after a median follow-up time of 32 months, a 74.1%obstruction-free rate. RIRS following rLEP in patients with UPJO and renal stones is an effective treatment method. It canbe used safely in patients with single stones < 2cm, short obstruction lengths, and presence of primary etiology.

Endoscopic-assisted robotic pyelolithotomy: a viable treatment option for complex pediatric nephrolithiasis

Endourological and percutaneous approaches are the standard of care for treatment of pediatric urolithiasis. However, in certain situations, an endoscopic-assisted robotic pyelolithotomy (EARP) can be an acceptable alternative. Limited data existon pediatric EARP; thus, the authors describe their experience. Patient selection: The authors retrospectively analyzed the records of all robotic procedures performed at five institutions from 7/09-10/17 to identify patients who underwent EARP. The authors collected demographics data, indications, operative time, and postoperative complications. Stone composition was reported as the majority composition (≥50%), unless any uric acid or struvite was noted, and those stones were classified as such. Through a traditional or hidden incision endoscopic surgery (HIdES) robot pyeloplasty approach, the authors are able to easily pass a flexible endoscope through a robotic trocar and into the renal collecting system to perform pyeloscopy or ureteroscopy. Stones were primarily retrieved via the pyelolotomy and, if indicated, treated with laser lithotripsy. The authors identified 26 patients who underwent EARP in 27 renal units. Median patient age was 12.2 years (interquartile range [IQR] 6.1-14.5 years), and body mass index was 17.5kg/m2 (IQR 16.5-25.4kg/m2). The median pre-operative dimension of the largest stone was 9.0mm (IQR 5.8mm-15.0mm). Reasons for EARP: 21 (77.8%) concomitant pyeloplasty, four (14.8%) altered anatomy precluding other techniques, and two (7.4%) multiple large stones. Multiple stones were present in 20 renal units (74.1%). Stones were located in the renal pelvis in nine (33.3%), lower pole in 10 (37.0%), ureter in one (3.7%), and multiple locations in seven (25.9%). Hidden incision endoscopic surgery approach was used in 14 (51.9%), and the median operative time was 237.5min (IQR 189.8-357.8min) with a median length of stay 1.0 day (IQR 1.0-2.0 days). Stone composition included calcium oxalate in 14 (51.9%), calcium phosphate in five (18.5%), cysteine in two (7.4%), struvite in two (7.4%), and unknown in four (14.8%). Overall stone free status was 19 (70.4%); of the eight (29.6%) renal units with residual stones, four underwent ureteroscopy, two extracorporeal shockwave lithotripsy (ESWL), one spontaneously passed, and one underwent percutaneous nephrolithotomy (PCNL). After secondary treatment, final stone free rate was 96.3%. Complications included stent migration and admission for urosepsis. At a median follow-up of 12 months (IQR 6.2-19.2 months), five (18.5%) had stone recurrence. Endoscopic-assisted robotic pyelolithotomy is a reasonable treatment option for select pediatric patients with concomitant ureteropelvic junction obstruction and nephrolithiasis or pediatric patients with stones inaccessible by standard methods.

UP022 - Sequential retrograde laser endopyelotomy and retrograde intrarenal surgery in concomitant ureteropelvic junction obstruction and nephrolithiasis

UP022 - Sequential retrograde laser endopyelotomy and retrograde intrarenal surgery in concomitant ureteropelvic junction obstruction and nephrolithiasis

Сравнительный анализ результатов перкутанной нефролитотрипсии и лапароскопической пиелолитотомии

Percutaneous nephrolithotripsy (PNL) is considered as the main treatment method of patients with large and staghorn kidney stones. In some cases, laparoscopic pyelolithotomy (LP) may be an alternative option to PNL. The aim of our work was to compare the results of these surgical methods for treatment of large pelvis stones. The results of surgical treatment of 60 patients with large pelvis stones were reviewed. In 40 patients (66.7%) PNL were performed, while in 20 cases (33.3%) LP were done. In the PNL group, the average stone size was 2.7 (2.5-3.8) cm and in the LP group it was 3.0 (2.6-4.2) cm. Four patients in the LP group had kidney malrotation, one patient had pelvic dystopia, and in another case a horseshoe kidney was diagnosed. The operative time and stone-free rate, intra- and postoperative complications, the amount of blood loss and the length of hospitalization were compared. There was no conversion in both groups. There were no significant differences in the mean length of hospitalization (4.5+/-1.5 vs 4.4+/-1.4 days) and analgesic use (2.2+/-0.9 vs 2.4+/-1.0 days) and stone-free rate (100 vs 90%) between groups. The mean operative time was significantly higher at the PL (110.0+/-25.0 vs 65.4+/-24.5 min; p less or equal 0.05), but the amount of blood loss was significantly lower (70+/-28 versus 160.0+/-55 ml; p less or equal 0.05) compared to the PNL group. PNL remains the main treatment method for patients with large kidney stones. However, abnormal kidneys, concomitant ureteropelvic junction obstruction or endoscopic treatment failure can be indications to LP.

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

Ultrasound-Guided Percutaneous Nephrolithotomy for Staghorn Stone in Crossed Fused Ectopic Pelvic Kidney

Abstract Introduction and Objectives: Crossed fused ectopia is a rare congenital renal anomaly that can be associated with concomitant ureteropelvic junction obstruction, malrotation, and abnormal ...

Robotic Surgery for Large Renal Stones: Prospective Three Years Single-Institution Experience

This prospective study evaluates the role of robotic surgery in the management of large renal stones. Robotic renal stone surgery is safe and effective, and may be considered among the treatment options for large renal calculi in adults, especially for patients with concomitant ureteropelvic junction obstruction. The benefits brought by robotic systems include improved 3-D visualization, greater dexterity, precision, and increased range of motion. Thus, robotic pyelolithotomy has been recommended for the treatment of renal calculi with concurrent upper tract abnormalities. The efficacy and safety of robotic pyelolithotomy as a treatment of large renal pelvic stones and partial staghorn stones is evident in our study, with a substantially high stone clearance rate. We were able to complete the robotic procedures safely and successfully in all but one of our 38 patients, who was converted to open surgery due to bleeding and severe adhesions. Overall, we found this procedure feasible, safe, efficacious, and high yielding in the management of large renal stones, especially when the procedure is accompanied by renal pelvis reconstructive surgery.&#x0D;

V6-10 ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY FOR STAGHORN STONE IN CROSSED-FUSED ECTOPIC PELVIC KIDNEY

You have accessJournal of UrologyUrolithiasis1 Apr 2015V6-10 ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY FOR STAGHORN STONE IN CROSSED-FUSED ECTOPIC PELVIC KIDNEY Haresh Thummar, Usama Khater, V. Joshi, and Mantu Gupta Haresh ThummarHaresh Thummar More articles by this author , Usama KhaterUsama Khater More articles by this author , V. JoshiV. Joshi More articles by this author , and Mantu GuptaMantu Gupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.475AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Introduction ; Crossed-fused ectopia is a rare congenital renal anomaly that can be associated with concomitant ureteropelvic junction obstruction, malrotation, and abnormal or aberrant renal vasculature predisposing to obstructive changes, infection, calculi and renal damage. Due to anomalous anatomy, surgical intervention, especially minimal invasive approaches, can be more challenging. Here we present our technique of PCNL in a crossed-fused pelvic ectopic kidney. METHODS A 25 year old female presented with right flank pain, fever and pyuria. On evaluation, she had a crossed-fused ectopic pelvic kidney with right pelvic staghorn calculus and moderate hydronephrosis. She underwent our technique of ultrasound-guided modified supine percuataneous renal access with bowel displacement. Purulent urine was drained with a nephrostomy tube and then single stage PCNL was performed 3 days later. RESULTS Stone was cleared completely on follow up imaging and postoperative nephroscopy. She had uneventful recovery and was discharged on postop day 5. She has remained symptom free in 3 years of follow up. CONCLUSIONS With some technical modifications, ultrasound-guided PCNL is a safe, feasible, and effective modality as an alternative to open and laparoscopic surgery in select cases for stones in crossed-fused ectopic pelvic kidneys with minimum morbidity and complete stone clearance. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e580 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Haresh Thummar More articles by this author Usama Khater More articles by this author V. Joshi More articles by this author Mantu Gupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical characteristics and management of children with ureteropelvic junction obstruction and severe vesicoureteral reflux

Objective: The aim of this study was to investigate the physiopathology of isolated or coexisting ureteropelvic junction obstruction (UPJ-O) and high-grade vesicoureteral reflux (VUR), including the clinical characteristics and management. Summary background data : The association between UPJ-O and VUR was reported more frequently in boys with high-grade VUR; however, the physiopathology of concomitant UPJ-O and VUR is still unknown. Primary pyeloplasty, followed by ureteral reimplantation, if needed, has been widely accepted, although VUR should be treated first (most often by endoscopic treatment) in the presence of a functional obstruction. Methods: We reviewed the charts of 78 children with isolated or coexisting high-grade VUR/UPJ-O. Among the children, 14 had isolated UPJ-O, 16 had high-grade VUR/ UPJ-O, and 48 had high-grade VUR. Children with other urological or extrarenal conditions were excluded. Results: Patients with isolated UPJ-O showed significantly different clinical characteristics compared with the other two groups of patients with high-grade VUR. Among the patients of group 2, 3/13 (23%) showed progression from functional to obstructive UPJ-O after endoscopic treatment. All of them underwent secondary pyeloplasty, which was complicated at follow-up by VUR recurrence needing further endoscopic injection. Conclusion: We suggest that UPJ-O in high-grade VUR patients is just a complication of severe VUR that produces structural changes in predisposed children. The treatment of children with associated high-grade VUR/UPJ-O may be complicated by the progression of urinary flow obstruction or VUR recurrence after pyeloplasty. Endoscopic treatment of high-grade VUR is associated with a high rate of VUR recurrence in children requiring subsequent pyeloplasty. Keywords: Children, Endoscopic Treatment, Ureteropelvic Junction Obstruction, Vesicoureteral Reflux

Cryotherapy of the Nephrostomy Tract: A Novel Technique to Decrease the Risk of Hemorrhage After Tubeless Percutaneous Renal Surgery

Delayed hemorrhage and significant postoperative pain are associated with complex percutaneous renal surgery. Cryoablation of the percutaneous nephrostomy tract after endoscopic procedures is a potential means of preventing delayed renal hemorrhage. In this study, we investigated the efficacy of this technique by comparing a group of patients who underwent this approach with another group who had nephrostomy tube insertion after percutaneous renal surgery. Sixty patients with complex renal calculi or ureteropelvic junction (UPJ) obstruction underwent percutaneous endoscopic management of their disease. At the conclusion of the procedure, 30 consecutive patients underwent a single 10-minute freeze-thaw cycle, in which a cryoprobe traversed the nephrostomy tract. These 30 patients were compared with the preceding 30 patients who had a nephrostomy tube inserted after complex percutaneous renal surgery. The two groups were well matched in terms of age, body mass index, total stone burden, number of patients with full staghorn calculi, and number of patients with concomitant UPJ obstruction. The cryotherapy group had a significantly shorter hospital stay (2.1 v 3.6 days, P < 0.001); decreased rates of delayed bleeding episodes (3% v 13%, P < 0.001), and urinary leak (0% v 10%, P < 0.001). Cryotherapy of the nephrostomy is a novel means of decreasing the risk of delayed postoperative hemorrhage after complex percutaneous renal surgery. It is associated with significantly decreased length of hospitalization postoperatively, as well as decreased risk of urine leakage compared with nephrostomy tubes in these groups of patients.

LAPAROSCOPIC MOBILIZATION OF LOWER POLE CROSSING VESSELS CAUSING EXTRINSIC URETERO-PELVIC JUNCTION OBSTRUCTION IN CHILDREN

You have accessJournal of Urology1 Apr 2008LAPAROSCOPIC MOBILIZATION OF LOWER POLE CROSSING VESSELS CAUSING EXTRINSIC URETERO-PELVIC JUNCTION OBSTRUCTION IN CHILDREN Juan C Prieto, Linda A Baker, and Duncan T Wilcox Juan C PrietoJuan C Prieto More articles by this author , Linda A BakerLinda A Baker More articles by this author , and Duncan T WilcoxDuncan T Wilcox More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60887-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "LAPAROSCOPIC MOBILIZATION OF LOWER POLE CROSSING VESSELS CAUSING EXTRINSIC URETERO-PELVIC JUNCTION OBSTRUCTION IN CHILDREN." The Journal of Urology, 179(4S), p. 304 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 304 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Juan C Prieto More articles by this author Linda A Baker More articles by this author Duncan T Wilcox More articles by this author Expand All Advertisement PDF downloadLoading ...

Primary Transitional Cell Carcinoma Arising at the Site of Previous Dismembered Pyeloplasty

No AccessJournal of UrologyClinical Urology: Case Report1 Nov 1995Primary Transitional Cell Carcinoma Arising at the Site of Previous Dismembered Pyeloplasty Junghwan Choi and John C. Hulbert Junghwan ChoiJunghwan Choi More articles by this author and John C. HulbertJohn C. Hulbert More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)66800-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Primary Transitional Cell Carcinoma Arising at the Site of Previous Dismembered Pyeloplasty." The Journal of Urology, 154(5), pp. 1856–1857 References 1 : Congenital ureteropelvic junction obstruction with calcified renal pelvis and superimposed spindle cell urothelial carcinoma. Urol. Rad.1990; 12: 15. Google Scholar 2 : Massive haematuria from a renal haemangioma with concomitant ureteropelvic junction obstruction. Int. Urol. Nephrol.1993; 25: 121. Google Scholar 3 : Squamous cell carcinoma arising from suprapubic cystotomy site without bladder involvement. Urology1993; 41: 568. Google Scholar Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota.© 1995 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 154Issue 5November 1995Page: 1856-1857 Advertisement Copyright & Permissions© 1995 by American Urological Association, Inc.MetricsAuthor Information Junghwan Choi More articles by this author John C. Hulbert More articles by this author Expand All Advertisement PDF downloadLoading ...