Redo Pyeloplasty Research Articles

Pediatric Pyeloplasty: Comparison of Literature Meta-Analysis of Laparoscopic and Open Techniques With Open Surgery at a Single Institution

We performed a meta-analysis of published series of laparoscopic and open pyeloplasty. We compared these data to open pyeloplasty at our institution using diuretic renography as the indicator for obstruction and postoperative success. Laparoscopic studies included 19 series published between 1995 and 2007 comprising 346 kidneys. Open pyeloplasty studies included 9 series published between 1998 and 2007 comprising 486 kidneys. Data from our institution included records for 213 patients (224 kidneys). We defined reoperative intervention as unplanned placement of a nephrostomy tube or ureteral stent, balloon dilation or redo pyeloplasty. In the laparoscopic studies 171 cases (49%) were evaluated by preoperative and 137 (40%) by postoperative diuretic renography. Of patients undergoing postoperative diuretic renography 10 (7%) underwent reoperative intervention, including redo pyeloplasty (6, 4%), nephrostomy (3, 2%) and balloon dilation (1, 1%). In the open pyeloplasty studies performed elsewhere 165 cases (34%) were evaluated by preoperative and 230 (47%) by postoperative diuretic renography. Of patients undergoing postoperative diuretic renography redo pyeloplasty was required in 3 (1%). Of 224 cases managed by open pyeloplasty at our institution 215 (96%) had preoperative and postoperative diuretic renography data available. Of these patients 7 (3%) underwent reoperative intervention, including redo pyeloplasty (4, 2%), ureteral stent (2, 1%) and nephrostomy (1, 0.4%). Most publications do not confirm preoperative obstruction or, following laparoscopic or open pyeloplasty, postoperative success via diuretic renography. While not statistically significant, in the minority of studies with postoperative diuretic renography results the reoperative intervention rate and redo pyeloplasty rate following laparoscopy are approximately double those of open pyeloplasty.

Laparoscopic pyeloplasty in children: Long‐term outcome

To asses the safety and efficacy of laparoscopic pyeloplasty in pediatric patients. Data of pediatric patients under the age of 14 years, who had undergone laparoscopic pyeloplasty from January 2000 to December 2005, were prospectively analyzed. The various parameters recorded were: operative time, blood loss, need for analgesics, intra/postoperative complications, hospital stay and postoperative outcome. Success was defined as either symptomatic improvement and/or better drainage on postoperative isotope renography There were 53 patients with a mean age of 9.12 years (1-14 years) and a male to female ratio of 4.3:1. Dismembered pyeloplasty was done in 41 patients and Foley Y-V plasty in 12 patients via a transperitoneal approach using 3 ports in 50 children or 4 ports in 3 children. Mean operative time was 181 min (78-369); mean blood loss was 118.01 mL (50-250) with a mean hospital stay of 5.05 days (2-11). Conversion to open surgery was required in 4 (7.54%) patients. Follow-up renograms were available in 49 patients, which showed improvement in drainage in 44 patients and an obstructed pattern in five; of these, two patients had significant deterioration in split function. Two patients among the obstructed group underwent redo pyeloplasty by open technique while the other three elected for a conservative approach. Thus at a mean follow up of 24.58 months (4-45) the overall success rate was 89.75%. Laparoscopic pyeloplasty is a safe and effective, minimally invasive procedure in pediatric patients with a good intermediate term success rate and minimal morbidity.

Robot assisted laparoscopic pyeloplasty in patients of ureteropelvic junction obstruction with previously failed open surgical repair

To review our experience of robotic redo pyeloplasty as a salvage procedure in previously failed repair of ureteropelvic junction (UPJ) obstruction. In one year, robot-assisted laparoscopic pyeloplasty was performed in nine patients for previously failed open pyeloplasty. Four of these patients had undergone additional retrograde endopyelotomy following failed repair, prior to being referred to us. The mean age was 16.4 years. All patients presented with persistent flank pain and an obstructive pattern on diuretic renogram. Robotic redo pyeloplasty could be performed successfully in all patients without any technical problems. Intraoperative findings for cause of UPJ obstruction were peri-ureteral fibrosis, narrow ureter, anterior crossing vessels, and redundant pelvis. The mean hospital stay was 3.4 days (2-5 days). All patients had improvement in symptoms and the nuclear scan showed non-obstructive drainage. Robot assisted redo pyeloplasty enables complex repair in patients with previous failed cases of UPJ obstruction repair. Three-dimensional magnified vision, and a dynamic articulated endowrist, allows fine dissection in the fibrosed area and precise suturing in an ergonomic fashion with a success equivalent to open surgery.

Failed Pyeloplasty in Children: Comparative Analysis of Retrograde Endopyelotomy Versus Redo Pyeloplasty

We compared retrograde endopyelotomy to redo pyeloplasty for the treatment of failed pyeloplasty in children. Of 32 patients with recurrent ureteropelvic junction obstruction retrograde endopyelotomy was performed in 18 and redo pyeloplasty was performed in 14. Patient age, gender, side, stent placement at initial pyeloplasty, presentation of secondary ureteropelvic junction obstruction, hospital stay, complications and success rates were compared. Success was defined as radiographic relief of obstruction as determined by ultrasound or diuretic renography at latest followup. Median patient age was 6 years (range 2 to 14) at retrograde endopyelotomy and 7.2 years (1 to 17) at redo pyeloplasty. Retrograde endopyelotomy technique consisted of holmium laser in 10 patients and cautery/balloon dilation in 8. Redo pyeloplasty was performed through a flank incision in 12 patients and by laparoscopy in 2. Retrograde endopyelotomy was successful in 39% of the patients, while redo pyeloplasty had a 100% success rate (p = 0.002). Of the patients with failed retrograde endopyelotomy 5 had a stricture greater than 1 cm and 7 were younger than 4 years. Mean length of the narrowed ureteral segment was 10.1 mm in the failed retrograde endopyelotomy group vs 5.8 mm in the successful group (p <0.01). Only 1 of 8 children (13%) had a successful retrograde endopyelotomy using cautery followed by balloon dilation. Hospital stay was 1.3 days for the retrograde endopyelotomy group and 2.9 days for the redo pyeloplasty group (p <0.01). Mean followup was 47 months (range 15 to 132) after retrograde endopyelotomy and 33.1 months (12 to 78) after redo pyeloplasty. Retrograde endopyelotomy had a significantly lower success rate than redo pyeloplasty for correction of recurrent ureteropelvic junction obstruction after failed pyeloplasty in children. Patient age less than 4 years and narrowed ureteral segment greater than 10 mm were associated with a poor outcome after retrograde endopyelotomy.

1207: Failed Pyeloplasty in Children: Comparative Analysis of Retrograde Endopyelotomy VS. Re-do Pyeloplasty

1207: Failed Pyeloplasty in Children: Comparative Analysis of Retrograde Endopyelotomy VS. Re-do Pyeloplasty

Failed pyeloplasty in children: comparative analysis of retrograde endopyelotomy vs. re-do pyeloplasty.

Purpose To compare endourologic and open surgical management of a failed pyeloplasty in children. Material and methods A total of 478 pts underwent pyeloplasty between January 1997 and December 2005. Of these, 30 (6.3%) had a secondary UPJO which was managed by retrograde endopyelotomy (RE) in 18 and re-do pyeloplasty (RP) in 12. Age, stent placement/type at initial pyeloplasty, symptoms at presentation for secondary UPJO, hospital stay, complications and success rate (SR) were compared between the 2 groups. Success was defined as radiographic relief of obstruction, as determined by ultrasound or diuretic renography at the latest follow-up (F/U). An indwelling ureteral stent was placed in all pts and removed 8-12 weeks postoperatively. Results Tabled 1 Variables RE n=18 (%) RP n=12 (%) p Age < 3 yrs 4 (22.2) 4 (33.3) NS Internal/ext stent 3 (16.6) 3 (25) No stent 5 (27.7) 2 (16.6) Double J 10 (55.5) 7 (58.3) Pyelonephritis 4 (22.2) 3 (25) Obstruction 18 (100) 12 (100) Abdominal pain 9 (50) 5 (41.6) Admission (days) 1.3 2.9 NS Complications 0 1 leakage Success rate 8 (44.4) 12 (100) 0.005 Open table in a new tab Conclusions Single RE had a significantly lower success rate than RP after a failed pyeloplasty in children. We speculate that CWB RE, long strictures and age less than 3 yrs are bad prognostic factors for success in treatment of a secondary UPJO. To compare endourologic and open surgical management of a failed pyeloplasty in children. A total of 478 pts underwent pyeloplasty between January 1997 and December 2005. Of these, 30 (6.3%) had a secondary UPJO which was managed by retrograde endopyelotomy (RE) in 18 and re-do pyeloplasty (RP) in 12. Age, stent placement/type at initial pyeloplasty, symptoms at presentation for secondary UPJO, hospital stay, complications and success rate (SR) were compared between the 2 groups. Success was defined as radiographic relief of obstruction, as determined by ultrasound or diuretic renography at the latest follow-up (F/U). An indwelling ureteral stent was placed in all pts and removed 8-12 weeks postoperatively. Single RE had a significantly lower success rate than RP after a failed pyeloplasty in children. We speculate that CWB RE, long strictures and age less than 3 yrs are bad prognostic factors for success in treatment of a secondary UPJO.

Laparoscopic Dismembered Pyeloplasty in Children Younger Than 2 Years

Since the first laparoscopic pyeloplasty was described in a child in 1995, there have been several reports of pyeloplasty in older children. However, to date there have been few reports of laparoscopic pyeloplasty in infants and toddlers. The aim of this study was to evaluate the results of laparoscopic pyeloplasty in children younger than 2 years. All laparoscopic Anderson-Hynes pyeloplasties performed in children younger than 2 years were retrospectively reviewed. The diagnosis of ureteropelvic junction obstruction was confirmed on renal sonography and diuretic renogram. Laparoscopic pyeloplasties were performed via a transperitoneal route as originally described, with key modifications. All children were investigated with postoperative diuretic renogram and renal ultrasonography. A total of 38 children with ureteropelvic junction obstruction underwent laparoscopic Anderson-Hynes pyeloplasty between January 2001 and December 2005. Of these patients 11 (7 males and 4 females) were younger than 2 years at surgery (median 1.4, range 2 to 22 months) and 1 had bilateral ureteropelvic junction obstruction, for a total of 12 primary repairs. However, 2 patients (17%) required redo laparoscopic pyeloplasty, for a total of 14 laparoscopic dismembered pyeloplasties in this age group. Operative time ranged from 70 to 140 minutes (mean 100) and median hospital stay was 2 days. Followup studies showed normal drainage in all patients except 1, who after redo pyeloplasty exhibited significantly improved but still prolonged drainage. This study suggests that laparoscopic pyeloplasty can now be performed in young children with good results.

Laparoscopic Transabdominal Pyeloplasty in Children is Feasible Irrespective of Age

We assessed the feasibility of laparoscopic transabdominal dismembered pyeloplasty in 46 infants and children with regard to patient age. A total of 46 consecutive infants and children (31 male and 15 female) underwent laparoscopic transabdominal dismembered pyeloplasty using a 3 to 4-trocar technique. All patients had confirmed unilateral deterioration of renal function on isotope renography. The 46 patients were divided into 3 age groups--1 to 12 months (group 1, 14 patients), 1 to 7 years (group 2, 15 patients) and 7 to 18 years (group 3, 17 patients). Followup included clinical and ultrasound assessment, and isotope renography at 3 months. Laparoscopic pyeloplasty was feasible in 44 of 46 patients (96%). Mean operative time was 175 minutes (range 120 to 270). The operation was converted due to impracticality of stenting the PUJ in 1 patient, and due to bleeding in 1. Mean operative time in 44 successful laparoscopic procedures was not significantly different among the 3 age groups (171 minutes in group 1, 169 minutes in group 2 and 173 minutes in group 3). Two patients required operative intervention for PUJ leakage, and 1 underwent percutaneous nephrostomy with a further uneventful course. Mean followup was 29 months (range 3 to 86). A total of 44 patients (96%) were asymptomatic and had improved PUJ drainage on isotope renography. Two patients underwent redo pyeloplasty due to recurrent hydronephrosis at 1 month and 2 years. Laparoscopic transabdominal dismembered pyeloplasty is effective and safe in infants and children. The feasibility is also excellent in patients younger than 1 year. The transabdominal approach revealed good exposition without a disadvantage for the patient.