Ureteropelvic Junction Stenosis Research Articles

Determining Split Renal Function in Children With Ureteropelvic Junction Stenosis: Technetium-99m Mercaptoacetyltriglycine (Tc-99m MAG-3) or Technetium-99m Dimercaptosuccinic Acid (Tc-99m DMSA)?

Background Ureteropelvic junction stenosis (UPJS) is the most common cause of clinically significant antenatal hydronephrosis. We compared separate renal function results obtained using technetium-99m-mercaptoacetyltriglycine (Tc-99m MAG-3) and technetium-99m-dimercaptosuccinic acid (Tc-99m DMSA) in pediatric patients with UPJS to evaluate the adequacy of Tc-99m MAG-3 scintigraphy and the necessity of additional Tc-99m DMSA scintigraphy during follow-up. Methodology Patients diagnosed with hydronephrosis in the Pediatric Nephrology Department of Pamukkale University Faculty of Medicine over a period of 10 years (2012-2022) were evaluated retrospectively. Patients who had been diagnosed with UPJS and underwent both Tc-99m MAG-3 and Tc-99m DMSA scintigraphy during follow-up were included in the study. Technetium-99m-labeled MAG-3 and DMSA scans were re-evaluated for all patients by the Department of Nuclear Medicine. Results The study included 52 children with unilateral UPJS (12 girls and 40 boys) with a mean age of 6.34 ± 4.81 years (range: 2.97-9.79 years). Thirty-six patients (69.2%) were diagnosed antenatally. Differential renal function in Tc-99m DMSA was 46.94 ± 10.64 and in Tc-99m MAG-3 was 43.08 ± 11.18; the functions were lower in Tc-99m MAG-3, but the values were within normal limits for both groups (p=0.0001, z=-3.893). When differential renal functions were compared between Tc-99m DMSA and Tc-99m MAG-3 results, a statistically significant positive and strong correlation was found in the kidney with ureteropelvic junction obstruction (UPJO) (p=0.0001, r=0.752). When classifying the Tc-99m MAG-3 and Tc-99m DMSA results in the kidney with UPJO (supranormal, normal, low function) for the determination of differential renal functions, there was a consistency of 76%, and it was correlated (p=0.0001, k=0.456). While two patients had supranormal function and 13 patients had low function in Tc-99m MAG-3, five patients had supranormal function, and eight patients had low function in Tc-99m DMSA. Conclusions Some studies in the literature have reported that Tc-99m MAG-3 causes supranormal function measurements in patients with UPJS; our results showed that Tc-99m DMSA resulted in a higher rate of supranormal values for affected kidneys. We believe that Tc-99m DMSA should not be performed in addition to Tc-99m MAG-3 scintigraphy in the follow-up of every patient with UPJS but can be utilized in select cases, such as patients with surgical indications and those suspected before surgery.

BUCCAL MUCOSAL GRAFT ONLAY TECHNIQUE FOR UPPER URETERIC AND UPJ STRICTURES

Objective: In this paper we report our experience in the use of buccal mucosal grafts in the reconstruction of difficult upper ureteric and uretero-pelvic junction strictures. Material & Methods: We retrospectively looked at our hospital inpatient and outpatient records of all patients who underwent surgical treatment for benign upper ureteric strictures and ureteropelvic junction strictures. Results: During the study period a total of 22 patients with a mean age of 326.07 years underwent buccal mucosal graft repair. The mean length of the narrowing/stricture was 6.40 1.44 cm. Conclusion: Buccal mucosal onlay graft ureteroplasty is a suitable treatment option for long, complicated benign upper ureteric and select ureteropelvic junction stric­tures. It is technically simple and capable of providing optimum patency of ureter with good urinary drainage. It is safe and effective. 
 Keywords: Buccal mucosa, ureteric stricture, ureteropelvic junction stricture, graft, ureteroplasty

GIANT HYDRONEPHROSIS DUE TO URETEROPELVIC JUNCTION STENOSIS IN PEDIATRICS: A RARE CASE

Objective: This case report presented giant hydronephrosis (GH) due to Ureteropelvic Junction Stenosis in pediatrics. Case(s) Presentation: A three-year-old boy was admitted with abdominal distension and pain for the last three month. CT scan without contrast of the abdomen showed a left kidney size of 141x 97x 63.5 mm, massive dilatation of the pelvicalyceal system, thinning cortex in the left kidney, and left ureter measurement of 16 mm in diameter. An urgent percutaneous nephrostomy tube (10Fr) was placed in the left kidney for this patient, followed by a pyeloplasty procedure in the next three weeks. The patient was discharged on day five, and the six-month follow-up results were good. Discussion: Giant Hydronephrosis is a rare entity, with less than 500 global cases reported in the literature. The diagnostic approach to suspected hydronephrosis in pediatrics is sonography and may be followed by CT or MRI. Management of giant hydronephrosis requires two stages procedure with percutaneous nephrostomy followed by pyeloplasty. This two-stage method ensure the renal function is preserved. Conclusion: Ureteropelvic Junction Stenosis is a common cause of giant hydronephrosis in pediatrics. Appropriate physical examination and other diagnostic approaches are needed to diagnose patients with giant hydronephrosis and determine the best management.
 Keywords: Giant hydronephrosis, ureteropelvic junction stenosis, pyeloplasty.

Efficacy and safety of retrograde laser endopyelotomy in the treatment of strictures of thepyeloureteral segment

Introduction: Retrograde endoscopic laser pyelotomy is a minimally invasive procedure that is increasingly used for the management of ureteropelvic junction (UPJ) strictures. Holmium laser has been recognized as having ideal qualities for cutting tissue, namely, precision and minimal thermal spread. Objective: The objective of our study is to evaluate the efficacy and safety of Holmium laser endopyelotomy in the treatment of ureteropelvic junction strictures. Material and methods: A retrospectively collected database of 14 patients who unederwent laser endopyelotomy for UPJ strictures between January 2017 and January 2020 in the Clinic of Endourology and SWL, Military Medical Academy, Sofia, Bulgaria was reviewed. Confirmation of obstruction and the results of the intervention were obtained by combinations of retrograde ureteropyelography, ultrasonography and CT. The endopyelotomy was performed under direct vision using a semirigid or a flexible ureteroscope. The first postoperative and latest radiographic follow-up studies were compared with the preoperative studies to determine whether the obstruction was resolved, unchanged, or worsened. Success was defined as symptomatic relief and the absence of obstruction from the radiographic studies. Results: Patients’ mean age was 50.2±12.7 years and male-to-female ratio – 57.1%/42.9%. Congenital obstruction of the UPJ was observed in 5 patients(35.7%). Nine of the patients(64.3%) were with secondary strictures of the UPJ – 5 people(35.7%) had a previous open pyeloplastic, 4(28.6%) had an anamnesis of impacted stones in the UPJ in the past. Mean length of the UPJ stricture was 10.3±2.8 mm. Six of the patients (42.9%) were with severe degree of hydronephrosis, 7 (50%) were with moderate hydronephrosis and 1 (7,1%) were with mild degree of hydronephrosis There were no intraoperative complications. Mean hospital stay was 3.6±1.2 days. In all of the patients pyelostent Retromax Plus 7/14 Fr was put postoperatively. The pyelostent was removed 4 to 6 weeks (mean 5 weeks) after the procedure. The success rate after the endopyelotomy was 85,7% (12/14), while 2 cases (14.3%) needed the placement of stent JJ 5 months after the intervention. Conclusions: Ureteroscopic laser endopyelotomy is a minimally invasive, short-stay outpatient procedure associated with a good success rate that is a method of choice mostly for secondary UPJ strictures. It is a minimally invasive procedure with less morbidity for the treatment of UPJ obstruction.

Пиелостомия при лапароскопической пиелопластике у детей

The selection of surgical options for hydronephrosis correction and urinary diversion methods remains a relevant problem nowadays despite the widespread use of minimally invasive procedures. This paper summarizes our own long-term experience of using various drainage methods during ureteropelvic junction endoscopic surgery in children. Objective. To investigate the safety problems and assess the effiсacy of using pyelostomy during laparoscopic pyeloplasty in children. Patients and methods. Between 2011 and 2021, we performed Anderson–Hynes–Kucera laparoscopic pyeloplasty with partial resection of the renal pelvis and affected ureter area in 109 patients aged 3 months to 18 years. Among those, 15 children had grade 2 hydronephrosis, 59 children had grade 3 hydronephrosis, and 35 patients had grade 4 hydronephrosis. Only patients with primary ureteropelvic junction stricture causing hydronephrosis were included in the study. Children in whom hydronephrosis aroused due to other reasons (aberrant vessel, ureteric calculi, etc.) were not included in the statistics. The follow-up period ranged from 6 months to 2 years after surgery. Results. Pyelostomy as a method of renal pelvis drainage was performed in 77 patients. The mean duration of pyelostomy was 5 minutes. The mean duration of pyeloplasty with the use of pyelostomy was 90 minutes. Retrograde and antegrade double J stent (JJ/DJ stent) insertion took significantly more time. The mean surgery duration with the use of those methods was 115 and 120 minutes, respectively. Pyelostomy was successfully performed in all patients (100%). Retrograde stent insertion was unsuccessful in 3 patients (14%), and antegrade stent insertion – in 2 patients (18%). In the long-term follow-up period, 2 patients (2.6%) after pyelostomy and 1 patient (4.8%) after retrograde stenting developed ureteropelvic junction stricture, which required repeated pyeloplasty. Conclusion. Pyelostomy is an effective, sparing, and relatively easy to perform method of renal pelvis drainage during laparoscopic pyeloplasty. It allows to significantly reduce the time of surgical intervention, as well complication rate. The presence of pyelostoma in patients does not affect the length of hospital stay. Key words: hydronephrosis, children, laparoscopic pyeloplasty, pyelostomy, urinary tract drainage, DJ stent / JJ stent.

Parapelvic cyst causing ureteropelvic junction stricture: a case report

Parapelvic cyst is a special type of cystic lesion of the kidney. Due to the characteristics of its anatomical relationship, parapelvic cyst can compress the collecting system or the blood vessels at the pedicle of the kidney in the early stage of the disease. Compared with other cystic diseases of the kidney, aggressive treatment should be taken earlier. Here, we report a patient with hydronephrosis secondary to renal pelvis and parapelvic cyst compression at the ureteropelvic junction was admitted to our hospital. Laparoscopic left pyeloureteroplasty was performed after condications were ruled out. During the operation, a cystic mass was observed between the two renal pelvis. There was no stenosis or dilatation in the upper part of the left ureter. In conclusion, considering the long-term compression of cysts between the renal pelvis of the two branches of the UPJO system in the patient, laparoscopic parapelvic cysts of the left side were performed.

Predictor Factor for Severity Degree of Pediatric Hydronephrosis in Tertiary Hospital

Pediatric hydronephrosis is often hideous, and its severity highly correlates with a significantly increased incidence of pathological condition and outcome. The management of this disease is based on the severity level by identifying the clinical manifestation, so performing an early detection is crucial to prevent the disease progression. This research aimed to determine the predictor factors for the severity degree of pediatric hydronephrosis to give better treatments for patients. This study retrospectively reported 51 data of hydronephrosis cases that were collected from January 2012 to August 2019. Severity degree was evaluated using SFU (Society of Fetal Urology) scoring system and divided into two groups, mild-moderate (first and second degree) and moderate-severe (third and fourth degree). Data including age, gender, number of kidneys affected, etiology, and antenatal care were collected and statistically analyzed using Pearson's Chi-square and Fischer Exact test. The research result from 51 pediatric patients, 72.55% were categorized as moderate-severe hydronephrosis while the remaining 27.45% were categorized ad mild-moderate hydronephrosis. Ureteropelvic junction (UPJ) stenosis (37.25%) is the most common cause of pediatric hydronephrosis. Significant correlations are noted among severity degree and gender, the number of kidneys affected, etiology, and chosen antenatal care between obstetrician-gynecologist and midwife (p<0.05). In short, gender, number of kidneys affected, etiology, patient's choice on antenatal care can be the predictor factors for pediatric hydronephrosis. Thus, these findings are essential for urologists in pediatric hydronephrosis management.

A Comparative Analysis of Robot-Assisted Laparoscopic Pyeloplasty in Pediatric and Adult Patients: Does Age Matter?

We investigated factors that affect the surgical outcomes of robotic pyeloplasty by comparing the surgical results of pediatric and adult patients with ureteropelvic junction stricture (UPJO). We retrospectively reviewed patients who underwent robotic pyeloplasty for UPJO between January 2013 and February 2022. The patients were categorized into two groups: the pediatric (≤18 years) and adult (>18 years) groups. The perioperative and postoperative outcomes and surgical complications were comparatively analyzed. Prognostic factors for predicting surgical failure were analyzed with multivariable logistic regression analysis. The pediatric group showed longer total operation and console times. The mean pain score was lower in the pediatric group than in the adult group on days 1 and 2 after surgery. The average amount of morphine used in the pediatric group was lower during postoperative days 0–2. No differences in the length of hospital stay, incidence of surgical failure, and incidence of urolithiasis requiring treatment after robotic pyeloplasty were observed between the groups. The only factor that predicted surgical failure was a history of urolithiasis before surgery. The results showed that age did not affect the surgical outcome.

Combination of plastic surgery of the pyeloureteral junction with kidney transposition and nephropexy in hydronephrosis of a dystopic kidney

Introduction. Obstruction of the pyeloureteral junction is the most common anomaly of the upper urinary tract. Irrespective of the causes, narrowing of the ureteropelvic junction leads to abnormal urine outflux, increased intrarenal pressure, gradual sclerosis of renal parenchyma, loss of kidney function. In some cases, obstruction of the ureteropelvic junction can be accompanied by dystopic kidney, nephroptosis, abnormal location of the main and accessory renal vessels which requires correction of the standard surgical treatment.The study objective is to evaluate the effectiveness of combination of laparoscopic pyeloplasty with kidney transposition and nephropexy in obstruction of the pyeloureteral junction of a dystopic kidney.Materials and methods. Medical records of 8 patients who underwent surgery in the Kracnoyarsk Regional Clinical Hospital between 2017 and 2021 were analyzed. Obstruction of the pyeloureteral junction was confirmed clinically by ultrasound of the kidneys, excretory retrograde pyelography, contrast-enhanced spiral computed tomography.Results. In all of the 8 patients, lumbar dystopia of the affected kidney was diagnosed, in 25 % pathology was accompanied by nephroptosis, in 50 % of cases by abnormal location of the main and accessory renal vessels. All patients underwent laparoscopic plastic surgery of the pyeloureteral junction per Anderson–Hynes with antegrade ureter stenting, kidney transposition, nephropexy. Mean operative time was 190 ± 39 min, no intraoperative blood loss was observed. Ureteral catheter was removed at day (6.3 ± 2.2). Hospital length of stay was 9.3 ± 3.7 days. In 1 patient, postoperative period was complicated by suture breakage in the posterior wall of the pyeloureteral anastomosis which required repeat laparoscopy to correct suture defect. Time of ureteral stent implantation was 34.6 ± 8.5 days. Control examination showed full remission of pain syndrome. Excretory urography showed full outflow of the contrast agent after examination with furosemide in 100 % of cases.Conclusion. Combination of laparoscopic plastic surgery of the pyeloureteral segment with kidney transposition and nephropexy is an effective minimally invasive operation for treatment of ureteropelvic junction stricture of a dystopic kidney.

Effect of Huayu Bushen Fangshi Decoction on Patients with Ureteropelvic Junction Stenosis Complicated with Kidney Calculi after Double-mirror Operation

Effect of Huayu Bushen Fangshi Decoction on Patients with Ureteropelvic Junction Stenosis Complicated with Kidney Calculi after Double-mirror Operation

V08-07 ROBOTIC PYELOPLASTY OF LOWER POLE MOIETY IN A 2 MONTH OLD INFANT WITH CUTANEOUS PYELOURETERAL (CPU) STENT

You have accessJournal of UrologyCME1 May 2022V08-07 ROBOTIC PYELOPLASTY OF LOWER POLE MOIETY IN A 2 MONTH OLD INFANT WITH CUTANEOUS PYELOURETERAL (CPU) STENTis corrected byV08-07 Robotic Pyeloplasty of Lower Pole Moiety in a 2 Month Old Infant With Cutaneous Pyeloureteral (CPU) Stent. Erratum Amrita Mohanty, Clark Judge, Anastasia Gliatis, Tony Da Lomba, and Mohan Gundeti Amrita MohantyAmrita Mohanty More articles by this author , Clark JudgeClark Judge More articles by this author , Anastasia GliatisAnastasia Gliatis More articles by this author , Tony Da LombaTony Da Lomba More articles by this author , and Mohan GundetiMohan Gundeti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002606.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted laparoscopic pyeloplasty has been demonstrated to be safe and effective in infants. Here we demonstrate the steps to a left robotic pyeloplasty of a ureteropelvic junction obstruction in the lower pole moiety in a 2 month old with a duplicated left collecting system using a CPU stent. METHODS: Prenatal detection of left hydronephrosis and postnatal imaging confirmed grade 4 left hydronephrosis. Renal scan demonstrated significant obstruction of the left kidney, preserved renal function on the left (45%), and a possible duplex system on the left. Voiding cystourethrogram showed no ureteral reflux. The patient had not had any UTIs and was on antibiotic prophylaxis. After discussion with the patient’s parents, they elected to undergo a robotic left pyeloplasty to protect the patient’s renal function. RESULTS: The patient was found to have a duplicated system on the left with a high grade stenosis of the lower pole ureteropelvic junction and a dilated lower pole renal pelvis. The procedure was able to be completed in the standard fashion after the two ureters were dissected apart. The patient recovered well and was discharged on post op day 1. CPU stent was removed on post op day 12. He did suffer a superficial infection of the umbilical surgical site that resolved with antibiotics. At 6 weeks post-op, the patient was doing well and renal ultrasound showed a decompressed, but still hydronephrotic, left kidney. CONCLUSIONS: This video demonstrates that a robotic-assisted laparoscopic pyeloplasty with the use of a CPU stent can safely and effectively be performed in infants, even with duplicated systems. The CPU stent allows for stent removal in the office, avoiding a second round of anesthesia for the patient. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyMay 4, 2022, 12:00:00 AMV08-07 Robotic Pyeloplasty of Lower Pole Moiety in a 2 Month Old Infant With Cutaneous Pyeloureteral (CPU) Stent. Erratum Volume 207Issue Supplement 5May 2022Page: e715 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amrita Mohanty More articles by this author Clark Judge More articles by this author Anastasia Gliatis More articles by this author Tony Da Lomba More articles by this author Mohan Gundeti More articles by this author Expand All Advertisement PDF DownloadLoading ...

Epidemiological Data of Patients with Ureteropelvic Junction Stenosis Performed Pyeloplasty: A Single Center Experience

Amaç: Antenatal hidronefrozun bebeklerde sık nedeni geçici ve kalıcı üreteropelvik bileşke darlığı (UPD)’dır. Renal hasar oluşturan veya oluşturma potansiyeli olan tüm hastalara piyeloplasti uygulanır. Biz bu çalışmada piyeloplasti yaptığımız hastalarımızın epidemiyolojik verilerini paylaşmak istedik. Materyal ve Metot: Çalışmamızda 2011-2021 yılları arasında UPD nedeni ile opere edilen 131 hastayı değerlendirdik. Hastaların tanı zamanı, operasyon yaşı, takip süresi, cinsiyet, patolojinin tarafı, başvuru şikâyetleri, patolojinin etiyolojisi ve karşı böbrek patolojisi kaydedildi. Bulgular: Çalışmaya 109 hasta dâhil edildi. Hastaların %76,1’i erkek, %23,9’u kızdı. Erkek çocuklarda patoloji daha sıklıkla solda (%65,1) görülürken, kız çocuklarında patoloji daha sıklıkla sağda (%57,7) idi (p=0,036). Ortalama piyeloplasti yaşı 39,27±48,01 aydı. Antenatal tanılı hastaların ortalama piyeloplasti yaşı 15,74±23,48 aydı, geç dönem tanılı çocukların ortalama piyeloplasti yaşı 82,52±51,97 aydı (p=0,003). Aberan damar basılı UPD hastalarının %66,7’si geç dönemde tanı alırken, intrinsik nedenli hastaların %29,8’i geç dönemde tanı almıştı (p=0,005). Sonuç: Üreteropelvik bileşke darlığı sıklıkla antenatal dönemde tanı almakta, erkek çocuklarında ve solda sık görülmektedir. Çalışmamızda kız çocuklarında sağ piyeloplastinin daha sık yapıldığı görülmüştür. Aberan damar basılı hastalar antenatal dönemde de tanı alabilmektedir. Bununla birlikte ilerleyen yaşlarda başvuran hastalarda aberan basılı UPD daha sık görülmektedir.

Robot-assisted pyeloplasty with buccal mucosa graft for the management of an extended recurrent ureteropelvic junction stricture

A clinical case of robot-assisted pyeloplasty with buccal mucosa graft of an extended recurrent stricture of the left ureteropelvic junction is presented. The patient had previously undergone left-sided laparoscopic antevasal pyeloplasty and retrograde endopyelotomies with ureteral stenting. However, after these interventions, the dilatation of the left pelvicalyceal system persisted, the patient complained of lumbar pain and periodic exacerbations of chronic pyelonephritis. Transperitoneal robotic access isolated the ureteral upper third and the ureteropelvic junction from scar tissue, after dissecting the narrowed ureteral section, its length was about 3.0 cm. In this regard, plastic surgery was performed with a buccal mucosa graft, the ureter was drained with a stent. There were no postoperative complications, and on day 3 the patient was discharged. The stent was removed 4 weeks after. During the control ultrasound examination, the renal pelvicalyceal system was relatively reduced, and the patient did not notice any pain.

Subadventitial dismembered pyeloureteroplasty – new surgical technique for correction of uretero-pelvic junction stenosis

Objective: Open or laparoscopic dismembered pyeloplasty has been the gold standard for the correction of ureteropelvic junction obstruction (UPJO) with a success rate of about 90%. Main insufficient feature of dismembered pyeloureteroplasty is interfering ureteral blood supply, which creates the prerequisites for the deterioration of the regeneration of the ureter and the possibility of developing restenosis. Methods: We offered and applied the new method – subadventitial resection of ureteropelvic junction (UPJ) to prevent damage to vessels of the distal part of pelvis and proximal part of the ureter. The protection of blood supply in this area should improve anastomosis regeneration and prevent fibrotic changes for long time, simultaneously providing better condition for the kinetic ability of the ureter. Results: Retrospective analysis of 106 patients with hydronephrosis, whom performed 108 open dismembered pyeloplasty (two patients were operated bilaterally) with subadventitial resection of UPJ from 1998-2020 years with a mean follow-up of 36 month shows that this technique has advantages over analogues. Conclusion: Our 22 years of experience shows that the technique of subadventitial resection of the ureter, allows us to save the ureteral blood circulation and thus creates conditions for better regeneration of the anastomosis and prevent later complications of dismembered pyelouretereroplasty.

Uretero-Pelvic Junction Stenosis: Considerations on the Appropriate Timing of Correction Based on an Infant Population Treated with a Minimally-Invasive Technique.

There is no univocal consensus about timing of intervention and best surgical approach for infants with asymptomatic uretero-pelvic junction obstruction (UPJO). We conducted a retrospective analysis of patients undergoing one-trocar-assisted pyeloplasty (OTAP) in a 13 year range period by creating two homogenous groups (indications for surgery were the same for all patients): patients operated on in the first 90 days of life (34 patients; Group 1) and patients operated on between 3 and 12 months of life (34 patients; Group 2). We observed no statistically significant differences between groups in regard to mean operative time, conversion rate to open surgery, mean hospital stay, early complications (urinary leakage) rate and mean antero-posterior diameter (APD) reduction rate. Moreover, no statistical improvement was seen between groups in regard to separate renal function (SRF) at 1-year-follow-up renogram. Thanks to the HSS calculated before and 1 year after surgery, we registered an important improvement in Group I patients (p = 0.023). In our study, there was no significant evidence, in terms of intraoperative data and early postoperative outcomes, between patients who underwent an early pyeloplasty and those who underwent a delayed correction. Nevertheless, we registered a significant improvement in those patients with an impaired SRF that underwent an early surgical correction, especially in terms of urinary flow. Even though this study cannot definitely establish the superiority of early timing of correction, it is evident that further research is needed to clarify this aspect.

Percutaneous thermoablation of small renal masses (T1a) in surgical candidate patients: oncologic outcomes.

To evaluate the local tumour progression-free survival (LTPFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS) of healthy surgical candidates who underwent percutaneous thermoablation (TA) as a first-line therapy for small renal masses (T1a). The institutional review board approved this bi-institutional retrospective study of 85 consecutive surgical candidates with 97 biopsy-proven malignant renal masses (T1a) treated with percutaneous TA from 2008 to 2016. The LTPFS, MFS, CSS and OS rates were calculated using the Kaplan-Meier method. Descriptive analysis was also performed. The median tumour size was 2.3 cm (range, 0.7-3.9 cm). The minimal and mean follow-up periods were 24 and 56 months, respectively. Local recurrence was detected in four patients (4.7%) at 8.5, 13.8, 58.0 and 64.0 months of follow-up and retreated successfully with percutaneous TA. No patient developed metastatic renal cell carcinoma, and none died due to renal oncologic complications. One patient died of heart attack. The 5-year LTPFS, OS, MFS and CSS rates were 93.0%, 98.4%, 100% and 100%, respectively. Only two patients (2.3%) had major complications (Clavien-Dindo grade > II), including ureteropelvic junction stenosis and urinary obstruction due to ureteral blood clots. Our study demonstrates that percutaneous TA is a feasible and effective first-line therapy for healthy surgical candidates with small renal masses (T1a). The 5-year LTPFS, OS, CSS and MFS rates were 93.0%, 98.4%, 100% and 100%, respectively, with a major complication rate of only 2.3%. • Image-guided percutaneous thermoablation of small renal malignancies was effective in 95.3% of the healthy surgical candidates. • Major complications were detected in 2.3% of the patients. • The local tumour progression-free survival rate was 97.6% and 93.0% at 3 and 5 years, respectively.

A comparative study on the Efficacy of Retroperitoneoscopic Pyeloplasty and Open Surgery for Ureteropelvic Junction Obstruction in Children.

Objectives:To compare the therapeutic effect of retroperitoneoscopic dismembered pyeloplasty and open ureteropelvic junction plasty on the ureteropelvic junction obstruction (UPJO) in children.Methods:After the retrospective analysis of clinical data, 78 children with ureteropelvic junction stenosis treated from January, 2012 to June, 2018 were divided into two groups: OP (open pyeloplasty) group (38 cases) and LP (laparoscopic dismembered pyeloplasty) group (40 cases) according to the surgical methods. The operation time, intraoperative bleeding volume, postoperative length of stay (LOS), postoperative complication rate, postoperative hydronephrosis improvement and other indicators were compared between the two groups.Results:All patients underwent surgery successfully, without conversion to open surgery in LP group. The incidence of postoperative urine leakage and the recovery of hydronephrosis between LP group and OP group 12 months after operation showed no statistically significant difference (P>0.05). The intraoperative bleeding volume, the incidence of postoperative retroperitoneal hematoma, and the postoperative LOS in LP group were lower than those in OP group, while the operation time was longer than that in the OP group, with statistically significant difference (P<0.05).Conclusion:Retroperitoneoscopic dismembered pyeloplasty had similar effect with open dismembered pyeloplasty, but faster recovery and fewer complications, so it has become the preferred treatment method for UPJO in children.

Трансуретральная эндопиелотомия с помощью тулиевого волоконного лазера

Transurethral endopyelotomy is an alternative treatment method for short stricture of ureteropelvic junction (UPJ). to evaluate the efficiency of transurethral thulium laser endopyelotomy. A total of 94 patients with UPJ obstruction during the period from December 2016 to December 2018 were prospectively enrolled in the study. Pelvic size did not exceed 3 cm in 31 patients, and it was in the range from 3 to 4 cm and more than 4 cm in 35 and 28 cases, respectively. Depending on the treatment, all patients were divided into 2 groups. The main group included 48 patients who underwent retrograde thulium fiber laser endopyelotomy. In the control group (n = 46), patients underwent Anderson-Hynes laparoscopic pyeloplasty. In the main group, there were significantly more patients with more preserved ipsilateral kidney function, with short (less than 1 cm) and recurrent UPJ strictures and less severe hydronephrosis compared to the control group. In addition, there were no patients with crossing vessel in the main group. Postoperatively, an internal stent of 6-8 Fr was put in all patients for a period of 6-8 weeks. After stent removal, all patients underwent a follow-up examination, including an ultrasound examination and, if pelvic size was more than 3 cm, contrast-enhanced CT-urography was performed. In all patients, after stent removal, a decrease in the pelvic size was noted. The operation time in the main and control group was 24+/-14 minutes and 82+/-26 minutes, respectively. In all cases, ureteropyeloscopy was performed prior to laparoscopy to determine the exact length of stricture and to exclude narrowing of other parts of the ureter. After follow-up of 24 months, an examination in 36 patients of the main group and 29 patients of the control group was performed. There was 1 recurrence after laparoscopic pyeloplasty and 1 recurrence after endopyelotomy. In other patients of both groups, there were neither stricture, nor impaired renal function. The first experience of using a thulium fiber laser for transurethral endoscopic treatment of UPJ obstruction is presented in the article. Indications for the transurethral thulium endopyelotomy are the presence of primary or secondary UPJ obstruction (with a decrease in kidney function by no more than 40%), length of up to 1 cm, absence of an additional vessel and pelvic dilatation of no more than 4 cm.

Safety and Efficacy of Retrograde Pyeloperfusion for Ureteral Protection during Renal Tumor Cryoablation

PurposeTo determine safety and efficacy of retrograde pyeloperfusion for ureteral protection during cryoablation of adjacent renal tumors. Materials and MethodsRetrospective review of 155 patients treated with renal cryoablation, including adjunctive retrograde pyeloperfusion, from 2005 to 2019 was performed. Ice contacted the ureter in 67 of the 155 patients who represented the study cohort. Median patient age was 68 years old (interquartile range [61, 74]), 52 patients (78%) were male, and 37 tumors (55%) were clear cell histology. Mean tumor size was 3.4 ± 1.3 cm, and 42 tumors (63%) were located at the lower pole. Treatment-related complication and oncologic outcomes were recorded based on a review of post-procedural images and chart review. ResultsTechnical success of cryoablation was attained in 67 cases (100%), and technical success of pyeloperfusion was attained in 66 cases (99%). A total of 13 patients (19.4%) experienced SIR major C or D complications related to the procedure, including hemorrhage (n = 4), urine leak (n = 3), transient urinary obstruction (n = 2), pulmonary embolism (n = 1), hypertensive urgency (n = 1), acute respiratory failure (n = 1), and ureteropelvic junction (UPJ) stricture (n = 1). No complications were attributable to pyeloperfusion. Three of 45 patients with biopsy-proven renal cell carcinoma experienced local recurrence resulting in local recurrence-free survival of 92% (95% confidence interval, 81.5%–100%) 3 years after ablation. ConclusionsRetrograde pyeloperfusion of the renal collecting system is a relatively safe and efficacious option for ureteral protection during renal tumor cryoablation. This adjunctive procedure should be considered for patients in whom cryoablation of a renal mass could potentially involve the ureter.

V05-03 ROBOTIC URETEROCALICOSTOMY: TIPS AND TRICKS

You have accessJournal of UrologyUpper-Tract Reconstruction (V05)1 Apr 2020V05-03 ROBOTIC URETEROCALICOSTOMY: TIPS AND TRICKS Jonathan Schmidt*, James Steward, Jay Sulek, Kevin Heinsimer, and Chandru Sundaram Jonathan Schmidt*Jonathan Schmidt* More articles by this author , James StewardJames Steward More articles by this author , Jay SulekJay Sulek More articles by this author , Kevin HeinsimerKevin Heinsimer More articles by this author , and Chandru SundaramChandru Sundaram More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000874.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureterocalicostomy is a well-described but rarely-performed operation for the treatment of complicated ureteropelvic junction (UPJ) strictures, particularly in the settings of a completely intrarenal pelvis, horseshoe kidney, or failed pyeloplasty. In this video, we demonstrate a robotic-assisted laparoscopic approach to this procedure, while highlighting key steps and offering recommendations on surgical technique. METHODS: A robotic-assisted laparoscopic ureterocalicostomy was performed in a 43 year old female for a complicated, symptomatic UPJ obstruction at our academic institution. Informed consent was obtained for the procedure and for the use of images and video. Preoperative workup included a retrograde pyelogram and CT urogram demonstrating a UPJ stricture, completely intrarenal pelvis, dilated lower pole calyx, and thinning lower pole parenchyma. A radionucleotide renal scan demonstrated a right split function of 42.3% and left split function of 57.7%. T1/2 max on the right was 27.1 minutes and 10.8 on the left. The da Vinci surgical system was used to perform the procedure. Each critical step of the procedure was demonstrated and narrated with a focus on surgical technique. Patient follow up was 6 months. RESULTS: We demonstrate the successful creation of the ureterocalicostomy highlighting critical steps of the operation. These include retrograde pyelogram and ureteral stent placement, kidney parenchyma and hilum exposure, ureteral exposure and transection, closure of the UPJ, clamping, excision of the lower pole of the kidney, and the uretero-calyceal anastomosis. The stent was removed at 1 month. At 3 months a renal ultrasound demonstrated lower pole calcyceal enlargement but overall resolved hydronephrosis. The patient reported resolution of pain at 6 months. CONCLUSIONS: This video demonstrates the utility and feasibility of a minimally-invasive ureterocalicostomy for the adult patient and provides detailed recommendations on surgical technique. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e470-e470 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Schmidt* More articles by this author James Steward More articles by this author Jay Sulek More articles by this author Kevin Heinsimer More articles by this author Chandru Sundaram More articles by this author Expand All Advertisement PDF downloadLoading ...