Junction Obstruction In Children Research Articles

Long-term outcome of retroperitoneoscopic one-trocar-assisted pyeloplasty: a single-center and single-surgeon experience.

The aim of this study was to assess the long-term outcomes of retroperitoneoscopic one-trocar-assisted pyeloplasty (OTAP) for ureteropelvic junction obstruction (UPJO) in children. This retrospective analysis included 70 pediatric cases, all under the age of 5, diagnosed with UPJO and treated with the OTAP technique between May 2011 and June 2013 by a single surgeon. A single 10mm operative scope with a 5mm working channel was utilized to mobilize the ureteropelvic junction (UPJ) and exteriorize it through the trocar insertion site. Subsequently, conventional Anderson-Hynes dismembered pyeloplasty was conducted extracorporeally. Patient's demographics, operative time, hospital stay, complications, and success rate were evaluated. Seventy pediatric patients (65 males and 5 females) underwent OTAP, with ages at the time of operation ranging from 1month to 5years (mean = 22.6 ± 18.6months). The mean operative time was 74.8 ± 15.2min. There was a significant reduction in the mean renal pelvis size from 34.3 ± 8.1mm preoperatively to 13.8 ± 4.7mm postoperatively (p < 0.05). Moreover, the mean differential renal function (DRF) increased from 47.9 ± 9.8% preoperatively to 51.2 ± 5.9% postoperatively (p < 0.05). All patients experienced an uneventful postoperative recovery, with a median hospital stay of 3.4days. The success rate was 95.7%, with a median follow-up time of 75months (range: 6-125months). OTAP is a safe and feasible minimally invasive technique to correct ureteropelvic junction obstruction in children. It could be considered as a treatment of choice for children under the age of 5 as it combines the advantages of open and retroperitoneoscopic pyeloplasty and presents excellent long-term outcomes. NCT06349161 April 4th, 2024, retrospectively registered.

Comparison of robot-assisted single-port-plus-one pyeloplasty vs. laparoscopic single-port pyeloplasty in the treatment of ureteropelvic junction obstruction in children.

To compare the efficacy of robot-assisted single-port-plus-one pyeloplasty (RSPY) and laparoscopic single-port pyeloplasty (LSPY) in the treatment of children with ureteropelvic junction obstruction (UPJO). The clinical data of 47 children who underwent surgery for UPJO at the Department of the Pediatric Surgery of the Fujian Provincial Hospital from October 2020 to September 2022 were analyzed retrospectively. Of these 47 children, 27 received RSPY while 20 underwent LSPY. The baseline data, operation time, intraoperative anastomosis time, intraoperative blood loss, postoperative hospital stay, complications, total cost, preoperative and postoperative renal parenchymal thickness (PT), anteroposterior renal pelvis diameter (APD), and differential renal function (DRF) of the two groups were compared to evaluate the clinical efficacy of the two surgical methods. The results showed that both surgical techniques were successful and no patient transitioned to open surgery. There was no significant difference between the two groups in baseline data, intraoperative blood loss, complications, APD, and PT 6 months after surgery. There was also no significant difference in APD, PT, and DRF 12 months after surgery (all P > 0.05). Compared with the LSPY group, the RSPY group had shorter operation time [(153.04 ± 14.44) vs. (189.90 ± 32.59) min, t = -5.24, P < 0.05], less intraoperative anastomosis time [(68.81 ± 16.80) vs. (97.45 ± 11.99) min, t = -6.49, P < 0.05], shorter postoperative hospital stay [(5.96 ± 1.34) vs. (9.00 ± 1.33) d, t = -7.68, P < 0.05], but higher total cost [(57,390 ± 7,664) vs. (30,183 ± 4,219) yuan, t = 14.32, P < 0.05]. Compared with LSPY, RSPY achieves equivalent efficacy in the treatment of UPJO in children and has certain advantages by shortening the operation time, intraoperative anastomosis time, and postoperative hospital stay. However, its cost burden is heavy, and appropriate cases need to be selected for popularization and application.

The role of renal parenchyma to hydronephrosis area ratio in the evaluation of ureteropelvic junction obstruction in children

Purpose For the initial assessment and follow-up of patients with ureteropelvic junction obstruction (UPJO), we conducted this prospective study to assess the renal parenchyma to hydronephrosis area ratio (PHAR) in conjunction with the renal scan in patients who will undergo pyeloplasty. Patients and methods Patients who had visited the outpatient clinic for 2 years were diagnosed with UPJO, and fit the requirements for requiring surgical intervention were chosen. Before pyeloplasty and 3 months after surgery, PHAR and a renal isotope scan were conducted concurrently. Results Thirty-six patients were evaluated. After the operation, 31 (86.1%) cases improved and five (13.9%) cases did not improve. There was a significant change in all parameters at 3 months postoperatively as the mean T½ has significantly decreased (25.22±2.49 vs. 17.57±3.84). Also, there was a significant increase in the mean parenchymal thickness (9.42±4.92 vs. 15.12±4.86), glomerular filtration rate of the affected kidney (34.31±3.31 vs. 48.32±6.99) split renal function (37.30±3.80 vs. 44.03 ±4.11) and PHAR (0.86±0.30 vs. 2.45±0.93) at 3 months postoperative. PHAR postoperatively shows a positive correlation with parenchymal thickness, glomerular filtration rate of the affected kidney, and renal split function, while there is a negative correlation with T½. Conclusion PHAR is a potential noninvasive measure that may be evaluated during ultrasonography assessment to aid in predicting future surgical needs for UPJO and for postpyeloplasty follow-up in pediatric patients.

The Role of Renal Parenchyma to Hydronephrosis Area Ratio (PHAR) in Evaluation of Ureteropelvic Junction Obstruction in Children

Background The cortex/ pelvis ratio or parenchymal to pelvicalyceal area ratio can help initial evaluation and follow up of the children with uretropelvic junction obstruction as simple modality using the cut off which is 1.6 (pelvis/ cortex) ratio. There are many studies evaluating the various preoperative parameters which influence the post-operative outcomes after pyeloplasty. Practically there are many ultrasound parameters in the post-operative period which indicate the change in renal function. So, our rationale in this study is to evaluate the role of the parenchyma hydronephrosis area ratio (PHAR) in initial evaluation and follow up of UPJO patients in correlation to renal isotope studies. Objective To evaluate sonographic assessment of Renal Parenchyma to Hydronephrosis Area Ratio (PHAR) in the initial management and follow up of UPJO patients in correlation with the renal scan. Patients and Methods Site of the study: All patients were selected from the children who attended our outpatient department and have proven UPJO and meeting the criteria for the need of surgical intervention at Faculty of Medicine, Ain Shams University. Sample Size: 36 patients. Using PASS II Program for sample size calculation and according to (Rickard et al,2016), the expected AUC for PHAR prediction of future surgical intervention = 0.18, 30% rate of surgical intervention, setting power at 8% and error at 0.05, sample size of 36 patients will be needed. Results We enrolled 36 cases of children ≤ 16 years old (7.93 ± 0.83) with unilateral UPJO. Preoperative ultrasound parameters of the hydronephrotic kidneys [including degree of hydronephrosis, parenchymal thickness and PHAR] and renal isotope are measured &amp; compared with the same parameters after surgical repair of the UPJO (Anderson Hynes pyeloplasty) at 3rd months. After operation, 31 cases (86.1%) improved &amp; 5 cases not improved (13.9%). We find a significant change in all parameters at 3 months postoperatively (p &amp;lt; 0.01) as T ½ (25.22 ± 2.49 &amp; 17.57 ± 3.84) significantly decrease &amp; parenchymal thickness (9.42 ± 4.92 &amp; 15.12 ± 4.86), GFR of the affected kidney (34.31 ± 3.31 &amp; 48.32 ± 6.99) split renal function (37.30 ± 3.80 &amp; 44.03 ±4.11) and PHAR (0.86 ± 0.30 &amp; 2.45 ± 0.93) significantly increase post operatively. PHAR post operatively shows positive correlation with parenchymal thickness &amp; renal isotope while negative correlation with T ½. Conclusion PHAR is a promising parameter that can be estimated on presentation US to help predict the future need for surgery and follow up in children with ureteropelvic junction obstruction. Early identification of children who may require surgical intervention allows for closer surveillance of those patients as well as the opportunity for more selective ordering of invasive testing.

Laparoscopic pyeloplasty as treatment modality for congenital pelvi-ureteric junction obstruction in children with pelvic kidney: case series

Laparoscopic pyeloplasty as treatment modality for congenital pelvi-ureteric junction obstruction in children with pelvic kidney: case series

Robot-assisted surgery versus laparoscopic surgery of ureteropelvic junction obstruction in children: a systematic review and meta-analysis.

The clinical effectiveness and safety of robot-assisted laparoscopic pyeloplasty (RP) compared with laparoscopic pyeloplasty (LP) have not been clearly established in ureteropelvic junction obstruction (UPJO) children and require review. We searched in the Cochrane, MEDLINE, EMBASE, Web of Science, and CNKI database on 30 June 2022. This systematic review and meta-analysis were performed in RevMan 5.4 based on studies comparing RP versus LP in children with UPJO and subgroup analysis in children < 2years of age has been performed. The Newcastle-Ottawa Scale was used to evaluate the studies. We included one RCT, and eighteen cohort studies, a total involving 3370 children. Compared with LP, RP showed higher surgical success rates (OR 2.57, 95%CI (1.24, 5.32), P < 0.05), lower postoperative complication rates (OR 0.61, 95%CI (0.38, 0.99), P < 0.05), shorter hospital stay (MD - 1.04, 95% CI (- 1.6, - 0.47), P < 0.05) as well as operative time (MD - 22.11, 95%CI (- 35.91, - 8.31), P < 0.05). No significant differences were detected for intraoperative complication rates or conversion to open surgery rates. RP is an alternative to UPJO with higher success rates, and less postoperative complications. Evidence on the effectiveness and safety of RP compared with LP for UPJO children is of low certainty. More quality evidence in the form of randomized controlled trials is needed to obtain more reliable analysis results.

Ureteropelvic junction obstruction in children by polar vessels: histological examination result.

In children, ureteropelvic junction obstruction (UPJO) is mostly caused by intrinsic factors (IUPJO) such as abnormal amounts of muscle and collagen deposition; extrinsic UPJO are rare and often due to crossing vessels (CVs). What is not clear is whether there is also intrinsic UPJ pathology in patients with CV. The aim of our study was to compare the histology of the two types of obstruction and to determine whether these histologic features are distinguishable enough to enable to identify the cause of obstruction based on histologic appearance alone. We retrospectively reviewed pathology reports of 38 children with UPJO that underwent surgery in our hospital from 2008 to 2022. The intrinsic and extrinsic groups consisted of 18 and 20 patients, respectively. After ematoxylin-eosin and Gomori's trichrome staining the specimens were scored for fibrosis and muscular hypertrophy in histhopatology, and CD117 antibody were used to detect interstitial Cajal-like cells. In our study, histological analyses revealed no differences between the CV and IUPJO specimens in terms of presence and degree of fibrosis and muscular hypertrophy; likewise, for presence of interstitial Cajal-like cells.

Uretero-pelvic junction obstruction in children: Is vascular hitch an effective and safe solutions in very long term outcome? Report of 25 years follow-up

Vascular (VH) according to Hellstrom-Chapman technique is considered a safe and effective alternative approach to pure extrinsic Ureteropelvic Junction Obstruction (UPJO) with good results in short and medium term, but few data are available on long and verylong term outcomes. Our aim is to evaluate VH long and very-long term outcomes in patients treated in pediatric age focusing on relapse, development of hypertension and/or inferior polar kidney hypotrophy during puberty and adulthood. From 1990 to 2015 in our Department 76 children were treated by open or laparoscopic VH for pure extrinsic-UPJO. We were able to contact 54 of 76. 41 patients (25 males, 16 females) accepted to be studied. Mean follow- up time was 12.7 years (range 6-27 years); mean age at the assessment was 22.2 years. We excluded patients who were younger than 13 (if females) or 14 (if males) at the assessment (upper limits of physiological puberty onset). Patients were followed with US, MAG-3-scan and arterial blood pressure measurement. Collected data were compared with the preoperative ones by Student t-test. 95% of US images and MAG-3-scan reports were compatible with complete resolution of obstruction with good renal functionality. 87% of patients were completely healthy. We recorded 3 cases of hypertension (7%) not secondary to renovascular origin; 2 cases with recurrent flank pain (5%) with slightly dilated pelvis at the US and sub-obstructive pattern at MAG-3-scan with preserved renal function. Our experience confirms that VH, (open/laparoscopic) is a safe and effective procedure with good outcomes at very longterm follow-up. No patients at puberty and in adulthood required reoperation or presented polar hypotrophy and related vascular hypertension. VH is an alternative approach to pure extrinsic-UPJO. There were few data about long and very-long term outcomes in patients after this kind of surgery. We followed-up 41 patients confirming that VH (open/laparoscopic) is safe and effective with good long-term outcomes.

Retroperitoneoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Children: Value of Robotic Assistance

AimRetroperitoneal pyeloplasty (RP) for pediatric ureteropelvic junction obstruction (UPJO) performed using retroperitoneoscopy (retro-RP) or robotic assistance (robo-RP) were compared. MethodsAll subjects were Japanese, matched for age, weight, and RP diameters. All RP were performed in the lateral decubitus position at a single institute by the same team using identical protocols. Five independent surgeons were asked to score intraoperative video recordings for perceived difficulty of suturing (DOS; 5 = impossible; 4 = difficult; 3 = tedious; 2 = slow; 1 = easy) and rank RP as +1 if robo-RP appeared to be superior, 0 if they appeared to be the same, and −1 if robo-RP appeared to be inferior. ResultsRobo-RP performed 2018-2022 (n = 22) were matched with retro-RP performed 2011-2019 (n = 34). Mean overall operative times were similar (robo-RP: 305.2 ± 57.8 min versus retro-RP: 340.0 ± 117.9 min; p = 0.19), but securing the larger retroperitoneal space required for robo-RP took significantly longer; 50.8 ± 13.9 min versus 24.3 ± 9.6 min; p < 0.0001. Total anastomotic time (TAT) and TAT per suture were both significantly shorter for robo-RP (p < 0.0001). The coefficient of variation for time taken to place one suture was smaller for robo-RP than for retro-RP. DOS was lower for robo-RP with less variance (p < 0.01). Robo-RP had shorter drainage tube insertion, ambulated quicker postoperatively, and shorter hospitalization. Retro-RP had anastomotic complications; leaks (n = 2) and strictures (n = 2, requiring conventional open re-pyeloplasty). Robo-RP had no anastomotic complications and was ranked +1 unanimously. ConclusionsThe RP anastomosis was quicker with less complications and more precise with robotic assistance in matched patients under similar circumstances. Should RP be indicated, robo-RP is recommended. Level of evidenceIII.

A Cost-effectiveness Model Comparing Urinary Biomarkers with Diuretic Renogram in Diagnosing Ureteropelvic Junction Obstruction in Children.

In this cost-effectiveness model, we compared the cost-effectiveness of commonly used urinary biomarkers with conventional diuretic renogram (DR) in diagnosing ureteropelvic junction obstruction (UPJO). We hypothesized that urinary biomarkers are as effective as DR. We used incremental cost-effectiveness ratio (ICER) as a tool for our cost-effectiveness analysis model. The cost of biomarker assay and renogram were sourced from the same center while the accuracy data of DR and urinary biomarkers from the relevant pubications. As the accuracy of individual biomarker increased, the ICER also got better. As a panel of biomarker was introduced, the ICER went to the negative range suggesting cost saving as well. ICER of most urine biomarkers is currently less expensive and less effective. When a biomarker panel was applied ICER became more expensive and effective. With higher samples, test running cost is likely to go down in future and thus biomarkers are likely become less expensive and more effective. Individual urine biomarkers are currently less expensive and less effective compared to DR in predicting UPJO. In future, biomarker panel is likely to be more cost-effective and reduce the need for invasive renogram thus reducing the radiation exposure.

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.

Comparison of laparoscopic pyeloplasty vs. robot-assisted pyeloplasty for the management of ureteropelvic junction obstruction in children.

Ureteropelvic junction obstruction (UPJO) is a commonly observed abnormality in pediatric urology. Minimally invasive approaches have gained popularity in recent years. Studies have demonstrated excellent results with both laparoscopic pyeloplasty (LAP) and robot-assisted pyeloplasty (RAP). Few studies have compared the experience of both procedures performed in a single institution. Our objective is to compare laparoscopic pyeloplasty and robot-assisted pyeloplasty in the Puerto Rican pediatric population. We conducted a retrospective cohort study using our clinic's database on patients with UPJO that were operated by the same surgeon (MPB) from 2008 to 2019. Statistical analysis was conducted of demographics, preoperative studies, perioperative data and complications of both procedures. This study was approved by our local IRB committee. A total of 86 patients that underwent pyeloplasty with at least 3 years of follow up were recorded for this study. Laparoscopic pyeloplasty and robot-assisted pyeloplasty were performed in 44 (51.1%) and 42 (48.8%) patients, respectively. Patient age ranged between 4 months and 17 years (LAP group - mean age of 6.19 years/RAP group - mean age of 7.07 years). Success rates was high in this series (LAP - 100% and RAP -95%). Using Wilcoxon signed rank test and Mann whitney sum test, significant differences between preoperative and postoperative hydronephrosis grading were observed in both LAP and RAP groups. However, no significant difference was seen regarding reduction of hydronephrosis grading when comparing both groups. No intraoperative complications were seen on either group. Both LAP and RAP are safe and effective procedures that can properly manage UPJO. Our study shows that, under experienced hands, pure laparoscopic pyeloplasty achieves comparable results to robotic assisted laparoscopic pyeloplasty. Pediatric urologists should be comfortable offering either of these approaches as they demonstrate high success rates in our pediatric population. Selection of LAP vs. RAP approach depends on the Surgeon's preference or experience, and on institutional availability. Minimally invasive therapies will continue to gain popularity with future advances in laparoscopic and robotic technology.

Latitudes and attitudes: A multinational study of laparoscopic pyeloplasty in children

The Anderson-Hynes technique has been the treatment of choice for primary ureteropelvic junction obstruction in children. Laparoscopic approach has shown similar outcomes to open, with advantages of shorter hospital stay and less pain. We reviewed the experience of 11 geographically diverse, tertiary pediatric urology institutions focusing on the outcomes and complications of laparoscopic pyeloplasty. A descriptive, retrospective study was conducted evaluating patients undergoing Anderson-Hynes dismembered laparoscopic pyeloplasty. Centers from four different continents participated. Demographic data, perioperative management, results, and complications are described. Over a 9-year period, 744 laparoscopic pyeloplasties were performed in 743 patients. Mean follow-up was 31 months (6-120m). Mean age at surgery was 82 months (1 w-19y). Median operative time was 177min. An internal stent was placed in 648 patients (87%). A catheter was placed for bladder drainage in 702 patients (94%). Conversion to open pyeloplasty was necessary in seven patients. Average length of hospital stay was 2.8 days. Mean time of analgesic requirement was 3.2 days. Complications, according to Clavien-Dindo classification, were observed in 56 patients (7.5%); 10 (1%) were Clavien-Dindo IIIb. Treatment failure occurred in 35 cases with 30 requiring redo pyeloplasty (4%) and 5 cases requiring nephrectomy (0.6%). We have described the laparoscopic pyeloplasty experience of institutions with diverse cultural and economic backgrounds. They had very similar outcomes, in agreement with previously published data. Based on these findings, we conclude that laparoscopic pyeloplasty is safe and successful in diverse geographics areas of the world.

Laparoscopic and robot-assisted ureterocalicostomy for treatment of primary and recurrent pelvi-ureteric junction obstruction in children: a multicenter comparative study with laparoscopic and robot-assisted Anderson-Hynes pyeloplasty

PurposeThis multi-institutional study aimed to assess the outcomes of laparoscopic ureterocalicostomy (LUC) and robot-assisted laparoscopic ureterocalicostomy (RALUC) and compare them with laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) in children with pelvi-ureteric junction obstruction (PUJO).MethodsThe data of 130 patients (80 boys), with median age 7.6 years and median weight 33.8 kg, receiving minimally invasive treatment of PUJO over a 6-year period, were retrospectively analyzed. Patients were grouped according to the operative approach: G1 included 15 patients, receiving LUC (n = 9) and RALUC (n = 6), and G2 included 115 patients, receiving LP (n = 30) and RALP (n = 85). Patient characteristics and operative outcomes were compared in both groups.ResultsThe median patient age and weight were significantly higher in G1 than in G2 [p = 0.001]. The median operative time was similar in both groups (157.6 vs 150.1 min) [p = 0.66] whereas the median anastomotic time was shorter in G1 than in G2 (59.5 vs 83.1 min) [p = 0.03]. The surgical success rate was similar in both groups (100% vs 97.4%) [p = 0.33]. Post-operative complications rate was higher in G1 than in G2 (20% vs 6.1%) but all G1 complications were Clavien 2 and did not require re-intervention.ConclusionLUC/RALUC can be considered safe and effective alternative approaches to LP/RALP for PUJO repair and reported excellent outcomes as primary and salvage procedures. Robot-assisted technique was the preferred option to treat most patients with recurrent PUJO in both groups.

Perioperative management of surgical correction of ureteropelvic junction obstruction in children: A comparison of robotic-assisted versus conventional minimally invasive techniques.

Perioperative management of surgical correction of ureteropelvic junction obstruction in children: A comparison of robotic-assisted versus conventional minimally invasive techniques.

Pyeloplasty effectiveness in cases of ureteropelvic junction obstruction in children: methodology and assessment parameters

The article presents the analysis of published data (Scopus, Web of Science, PubMed/MedLine, The Cochrane Library, and eLIBRARY databases) devoted to the study of existing criteria for assessment of pyeloplasty effectiveness. Published sources most often refer to the dynamics of reduction of the renal collecting system (RCS) and postoperative renal functional status as the assessment criteria. However, there are no consistent values, which could be employed as assessment criteria indicating success as soon as they are registered. The tools used to estimate RCS reduction are not standardized in terms of research techniques, projection of RCS dilatation measurement, and the locations between which renal and pelvic anatomic structures are measured. A variety of approaches to measuring the anteroposterior renal pelvis dimension in children with hydronephrosis tends to blur the analysis of actual pyeloplasty results. This review of published sources demonstrates the lack of agreement as regards the criteria for assessment of pyeloplasty effectiveness. There is a pressing need for appropriate steps to harmonize ultrasonography methods, to standardize the anatomic landmarks for measurement, and to define the criteria to be used to assess the effectiveness of pyeloplasty.

Retrospective Analysis of the Efficacy of Da Vinci Robot-Assisted Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction in Children.

Ureteropelvic junction obstruction (UPJO) is one of the common causes of hydronephrosis in children, and the purpose of this study was to observe the application effect of da Vinci robot-assisted laparoscopic treatment of UPJO and to investigate the safety, feasibility, and advantages of da Vinci robot-assisted laparoscopic surgery. 13 patients who underwent robot-assisted pyeloplasty (RAP) for UPJO admitted from May 2020 to March 2021 were retrospectively analyzed in our study. The clinical data among them revealed the intraoperative and postoperative indicators and complications as follows. UPJO was found on the left side in 9 patients and on the right side in 4 patients. The average operative time, blood loss, and hospital stay were 227.3 (175–310) min, 9.2 (5–30) mL, and 9.2 (6–14) days, respectively. Two cases of gross hematuria and two cases of minor urinary tract infection occurred after surgery, and the rest had no perioperative complications. The clinical treatment efficiency at postoperative follow-up was 100%. Our initial analysis showed that da Vinci robot-assisted laparoscopic surgery is a highly effective and safe option for the treatment of UPJO in children.

MP44-15 HIGH PRESSURE ENDOSCOPIC BALLOON DILATATION FOR TREATMENT OF URETEROVESICAL JUNCTION OBSTRUCTION IN CHILDREN

You have accessJournal of UrologyPediatric Urology II (MP44)1 Sep 2021MP44-15 HIGH PRESSURE ENDOSCOPIC BALLOON DILATATION FOR TREATMENT OF URETEROVESICAL JUNCTION OBSTRUCTION IN CHILDREN Sergei Zorkin, and Dmitry Shakhnovskiy Sergei ZorkinSergei Zorkin More articles by this author , and Dmitry ShakhnovskiyDmitry Shakhnovskiy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002065.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Currently open ureteral reimplantation is considered to be the gold standard treatment for ureterovesical junction (UVJ) obstruction. The aim of this study was to assess long term effectiveness of high pressure endoscopic balloon dilatation for treatment of UVJ obstruction in children. METHODS: From 2015 to 2018 a total of 32 children with a median age of 10 months were treated with high-pressure balloon dilatation. Initial results were evaluated using ultrasonography (US), voiding cystourethrogram and MAG-3 renogram 6 months following the procedure. Then all patients were followed up with US examination annually for 3 years. Positive outcome we considered to be a decrease in pelvic and distal ureteral diameter and an improvement of drainage according to renogram. RESULTS: We observed no intraoperative complications. US pelvic diameter was decreased after balloon dilatation (delta, mm: -10,4±7,1. p<0.0001). MAG-3 renogram showed nonobstructive curve in all patients at 6 months follow up. Washout percentage showed an increase (delta, %: 25,3±13,5. p<0.0001). We observed also an increase in differential renal function after balloon dilatation (delta, %.: 4,3±1,5. p<0.0001). During a follow up period we found results of balloon dilatation to be stable according ultrasound pelvic and distal ureter diameter. CONCLUSIONS: Results of this study confirm that balloon dilatation proved its effectiveness for cases of UVJ obstruction, but further studies with bigger patient sample are needed to confirm long term positive results. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e798-e798 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sergei Zorkin More articles by this author Dmitry Shakhnovskiy More articles by this author Expand All Advertisement Loading ...

Ureteropelvic Junction Obstruction in Children: Is Antibiotic Prophylaxis Really Necessary?

To assess the risks of developing of urinary tract infection in children with ureteropelvic junction obstruction, depending on the grade of hydronephrosis. The present retrospective study, which was conducted from 2013 to 2018 years, includes data of 131 children with antenatally diagnosed grade III and IV hydronephrosis (SFU). All patients underwent surgical treatment at the age from 3 months to 3 years and did not receive antibiotic prophylaxis. Urinary tract infection was diagnosed in the presence of WBC in urine sample (&gt; 10 WBC/field of view), positive bacterial growth (≥105 CFU/ml) and fever (≥38.5 ° C). Children with duplex system, obstructive megaureter, vesicoureteral reflux, posterior urethral valve, and neurogenic bladder were excluded from this study. Grade III hydronephrosis was detected in 113 children and grade IV in 18 patients. The total incidence of urinary tract infection was 9.2% (12 patients), while in the group of children with grade IV hydronephrosis it was higher (in 3 of 18 - 16.7%) than in children with grade III (in 9 out of 113 - 7.9%) (P &lt;0.05). The incidence of urinary tract infections did not differ significantly depending on the sex or age of the patients. In 7 (58.3%) patients, urinary tract infection was noted before the age of 6 months, with an average age of 2.7 months. A bacteriological study revealed that in eight (66.7%) patients, E. Coli was the causative agent of urinary tract infection. Children with antenatal diagnosed and postnatal confirmed ureteropelvic junction obstruction do not need antibiotic prophylaxis because of the low incidence of urinary tract infection. However, patients with grade IV hydronephrosis under the age of 6 months should be closely follow-up by physicians for the early diagnosis and treatment of urinary tract infection.

Urinary extracellular matrix proteins as predictors of the severity of ureteropelvic junction obstruction in children

Ureteropelvic junction obstruction (UPJO) particularly represents a challenge in regard to management, as not all hydronephrosis (HN) represent a kidney-damaging state. Urinary biomarkers have been proposed as noninvasive tools. Extracellular matrix (ECM) proteins are associated with tissue fibrosis in the setting of UPJO and is poorly explored. To investigate whether urinary ECM proteins are useful to discriminate the severity of urinary obstruction on unilateral UPJO. Children with unilateral UPJO were prospective enrolled. Urinary (u) matrix metalloproteinases (MMP-1,-2,-9 and TIMP-1,-2) as well as clinical characteristics were measured in the following groups: 26 children with obstructive HN at initial diagnosis and after six months of dismembered pyeloplasty; 22 children with non-obstructive HN at diagnosis and after six months of observation; 26 children without any urinary tract condition, as the control group. Results were assessed statistically using for homogenous groups, a one-way analysis of variances (ANOVA) and for nonparametric groups, Mann-Whitney test or Kruskal-Wallis test was performed. ROC curves were performed. Baseline samples demonstrated a higher concentration of uMMP-1/Cr, uMMP-2/Cr, u-TIMP-1/Cr and u-TIMP-2/Cr in obstructive HN group; uMMP-9/Cr levels were higher in non-obstructive HN group and all studied biomarkers had lower concentrations for the control group. On follow-up, for the obstructive HN group, urinary concentration of uTIMP-1/Cr and uTIMP-2/Cr decreased, and uMMP-1/Cr, uMMP-2/Cr and uMMP-9/Cr increased when comparing preoperative to postoperative values. In the non-obstructive HN group, all proteins analyzed were stable after six months of observation. ROC curves analysis showed a promising diagnostic profile for the detection of obstructive HN for uTIMP-1/Cr (area under the curve -AUC-; of 0.692), uTIMP-2/Cr (AUC of 0.678) and for uMMP-2/Cr (AUC of 0.655). The severity of kidney obstruction could correlate with the urinary ECM proteins concentration in this study. This is concordant with prior studies demonstrating that a disruption of the balance of accumulation/degradation of the ECM proteins occur on obstructive uropathy. Limitations of our study include the older age of our patients and that these markers had no influence at all on the surgical decision. We demonstrate that obstructive HN have significantly higher uMMP-2, uTIMP-1 and uTIMP-2 concentrations. Particularly, uTIMP-2 levels were correlated to severity of obstruction and therefore, it might be a useful urinary biomarker to correctly allocate children with HN between surgical management vs follow-up. After pyeloplasty, uTIMP-1 and uTIMP-2 presented a progressive decrease postoperatively, which is also highly desirable for urinary markers.