Outcomes Of Laparoscopic Pyeloplasty Research Articles

Outcomes of laparoscopic pyeloplasty and impact of an enhanced recovery protocol

<b>Purpose:</b> The study aims to analyze the enhanced recovery protocol’s (ERP) effectiveness in a comparative study of elective surgeries for ureteropelvic junction obstruction (UPJO).<br /> <b>Methods:</b> The prospective study included 30 patients with UPJO who underwent laparoscopic pyeloplasty in 2018-2021.<br /> <b>Results:</b> Postoperative complications developed rarely, and their frequency and severity were comparable. Independent predictors of UPJO recurrence were the spine osteochondrosis >II period (HR 13.97; 95% CI 1.26; 154.8; p=0.032), the concretions self-discharge (HR 28.49; 95% CI 1.78; 455.62; p=0.018), surgical operation duration > 110 minutes (HR 44.7; 95% CI 3.95; 505.4; p=0.002) and previous nephrostomy (HR 1.07; 95% CI 1.02; 1.13; p=0.002).<br /> <b>Conclusions:</b> In the surgical treatment of UPJO, it is advisable to use ERPs, as this allows achieving a better treatment quality with comparable results.

Outcomes of infants undergoing laparoscopic pyeloplasty: A single-center experience.

The aim of this study was to evaluate the outcomes of laparoscopic pyeloplasty in children less than 12 months of age. The records of 20 infants, who had pelviureteric junction obstruction and subsequently underwent LP from January 2013 to November 2016 with at least 1 year of follow-up, were retrospectively reviewed. Patients demographics, the results of preoperative and postoperative imaging studies, perioperative details, complications, and results were noted. The mean age of 20 infants was 4.75 months. The gender of cases was 5 females (25%) and 15 males (75%). Of that, 13 (65%) laparoscopic pyeloplasties were in left side and 7 (35%) were in right side. No cases needed open conversation. Aberrant crossing vessel was observed in three patients (15%). The mean operation time was 79.35 min (45-128 min). The mean hospital stay was 2.9 ± 0.308 days (2-3 days). There were complications in three children (15%); two patients developed stent migration and one child had fever over 38°. Three children with complications did not require a second intervention. In one child, the kidney was non-functioning in follow-up and nephrectomy was performed. The anteroposterior diameter significantly reduced. Preoperative mean value was 24.305 ± 5.6157 and postoperative mean value was 15.40 ± 6.030 (p = 0.000, p < 0.05). There was a significant degree of improvement in renal split function for all patients. Preoperative mean values were 45.53 ± 11.512, while postoperative values were 47.850 ± 13.347 (p = 0.029, p < 0.05). Although there are doubts about the reliability and efficacy of results for pyeloplasty in children less 12 months, many studies including this study show that laparoscopic pyeloplasty is an effective and reliable method for infants.

The Laparoscopic Management of the Ureteropelvic Junction Obstruction: Our Initial Experience

Objective: Higher morbidity rates, extensive scar tissue formation and longer hospitalization periods of the standard open surgical methods for ureteropelvic obstruction has led to acceleration of minimal invasive techniques. Success rate and clinical outcomes of laparoscopic pyeloplasty has become comparable with open surgery. Purpose: The aim was to evaluate the clinical results and complications of transperitoneal laparoscopic pyeloplasty in ureteropelvic obstruction. Material and Methods: Thirty-three patients with ureteropelvic obstruction were enrolled into this study. Eighteen patients underwent Anderson-Hynes dismembered Pyeloplasty and 15 underwent Y-V plasty. Patients were followed-up at postoperative 3., 6. months and then yearly. Partial or total relief of symptoms and improvement in diuretic renogram were accepted as success. Results: Median age was 34.5±15.5(13-74) years, number of males were 13 (39.4%) and females were 20 (60.6%). Median Body Mass Index (BMI) was 25.3±15.4(18.5-33.4). Eight were asymptomatic, and 23 had intermittent pain, preoperatively. Fourteen cases had left ureteropelvic obstruction (42.4%) and 19 had in the right kidney . Intraoperatively 19 cases had aberrant vessel. Mean surgery time was 127.9±38.9 (68-245) minutes, median anastomosis time was 20.8±7.3 (8-39) minutes. Median blood loss was 57.1±28.3 (20-150) mL, median postoperative drainage time was 2.6±1.1 (2-7) days. Only one had prolonged ileus and peritoneal irritation findings. Median narcotic and nonnarcotic requirements were 21.5±4.8 (15-30) and 132.6±37.2 (75-200) mg/day, respectively. Median follow-up period was 35.1±13.6 (11-59) months. Conclusions: Laparoscopic pyeloplasty, is minimally invasive and reliable technique replaces open pyeloplasty in many institutions. Shorter hospitalization, lower postoperative morbidity rates, better cosmetic results and higher success rates can be easily achieved..

National Practice and Outcomes of Laparoscopic Pyeloplasty in the United Kingdom

Laparoscopic pyeloplasty is now widely practiced in the United Kingdom and considered the gold standard in the treatment of patients with ureteropelvic junction obstruction. The aim of this audit was to determine the national practice and outcomes for this procedure. The British Association of Urological Surgeons sent out standardized audit proformas in May 2008 to units across the United Kingdom inviting surgeons who were performing laparoscopic pyeloplasties to submit their results over the last 4 years. Data on the presentation, preoperative investigations, intra-perative details, and postoperative follow-up were collected centrally and inserted into a national database for analysis. There were 323 returns from a total of 30 surgeons. At a median follow-up of 4 months (1-24), the overall symptomatic and renographic failure rates were 10.3% and 8.7%, respectively. Mean operative time was 181 minutes (3--425 min); there were 18 (6%) conversions, 33 (10.5%) complications, and one (0.3%) mortality. Surgeons who submitted 10 or more returns had a lower conversion rate than surgeons submitting fewer than 10 (2.9% vs 14.7%). The median hospital stay was 3 days (1-34 d). There was no difference in failure and complication rate for the retroperitoneal and transperitoneal approaches, although the conversion rate was higher with the retroperitoneal approach. The results show that laparoscopic pyeloplasty, although achieving acceptable outcomes at a national level in the United Kingdom, had areas of practice that could be improved. It highlights the importance of a high-volume practice in achieving optimum results and the potential problems associated with the retroperitoneal approach.