Ureteropelvic Junction Obstruction Research Articles

A Case Report of Dorsal Pancreatic Agenesis and Uterus Didelphys in a Young Woman: A Seldom- reported Association

Agenesis of the dorsal pancreas is a rare congenital anomaly that often remains asymptomatic and is frequently discovered incidentally during imaging for other conditions. Its association with Müllerian anomalies, such as uterus didelphys, suggests that both conditions may stem from similar embryological disruptions during early fetal development. This report aims to raise awareness of Agenesis of the Dorsal Pancreas (ADP) and its potential associations with Müllerian anomalies. By presenting a detailed case study, we seek to address the diagnostic challenges faced by healthcare professionals and the implications for patient management, emphasizing the importance of early detection and appropriate intervention. We present a case involving a 24-year-old Iranian female who presented with a 10-day history of abdominal pain and vomiting. Initial ultrasound imaging revealed moderate hydroureteronephrosis in the right kidney, prompting further investigation. A contrast-enhanced CT scan was performed, which not only confirmed ureteropelvic junction obstruction but also unexpectedly revealed dorsal pancreatic agenesis. In addition to these findings, the patient was diagnosed with uterus didelphys, highlighting a significant developmental anomaly. This case underscores the necessity for increased awareness of ADP and its associations with Müllerian anomalies among healthcare providers. Early and accurate diagnosis through advanced imaging modalities significantly improves patient outcomes and facilitates better management strategies for associated complications.

The efficacy and safety of laparoscopic pyeloplasty via abdominal approach for the treatment of ureteropelvic junction obstruction in children.

The efficacy and safety of laparoscopic pyeloplasty via abdominal approach for the treatment of ureteropelvic junction obstruction in children.

Heterozygous variants in the teashirt zinc finger homeobox 3 (TSHZ3) gene in human congenital anomalies of the kidney and urinary tract.

Around 180 genes have been associated with congenital anomalies of the kidney and urinary tract (CAKUT) in mice, and represent promising novel candidate genes for human CAKUT. In whole-exome sequencing data of two siblings with genetically unresolved multicystic dysplastic kidneys (MCDK), prioritizing variants in murine CAKUT-associated genes yielded a rare variant in the teashirt zinc finger homeobox 3 (TSHZ3) gene. Therefore, the role of TSHZ3 in human CAKUT was assessed. Twelve CAKUT patients from 9/301 (3%) families carried five different rare heterozygous TSHZ3 missense variants predicted to be deleterious. CAKUT patients with versus without TSHZ3 variants were more likely to present with hydronephrosis, hydroureter, ureteropelvic junction obstruction, MCDK, and with genital anomalies, developmental delay, overlapping with the previously described phenotypes in Tshz3-mutant mice and patients with heterozygous 19q12-q13.11 deletions encompassing the TSHZ3 locus. Comparable with Tshz3-mutant mice, the smooth muscle layer was disorganized in the renal pelvis and thinner in the proximal ureter of the nephrectomy specimen of a TSHZ3 variant carrier compared to controls. TSHZ3 was expressed in the human fetal kidney, and strongly at embryonic day 11.5-14.5 in mesenchymal compartments of the murine ureter, kidney, and bladder. TSHZ3 variants in a 5' region were more frequent in CAKUT patients than in gnomAD samples (p < 0.001). Mutant TSHZ3 harboring N-terminal variants showed significantly altered SOX9 and/or myocardin binding, possibly adversely affecting smooth muscle differentiation. Our results provide evidence that heterozygous TSHZ3 variants are associated with human CAKUT, particularly MCDK, hydronephrosis, and hydroureter, and, inconsistently, with specific extrarenal features, including genital anomalies.

The relationship between uropathogens and clinical characteristics of children with urinary tract infection

Urinary tract infections (UTI) are common bacterial infections in children. This study aimed to examine the relationships between different microorganisms and both clinical and laboratory findings in pediatric patients with UTIs. We conducted a retrospective evaluation of children with UTI between 2019 and 2024. Patients were divided into four main groups as normal anatomy, vesicoureteral reflux (VUR), ureteropelvic junction obstruction (UPJO), and neurogenic bladder (NB). Information on clean intermittent catheterization (CIC) and prophylactic antibiotic use was recorded. Laboratory results were compared across these patient groups. The study included 266 patients, with a female predominance (female/male ratio: 7.33). NB was the most common urinary tract condition (43.3%), followed by VUR (10.9%) and UPJO (9%). Prophylactic antibiotics were used by 9% of the patients. Acute phase reactants in patients with CIC were significantly higher (p=0.023 for white blood cell (WBC) and p=0.002 for C-reactive protein (CRP) levels). They were also higher in patients with prophylactic antibiotics compared to those without (p=0.001 for both). The most frequently detected bacteria in urine cultures were E. coli (65%), followed by Klebsiella spp. (18.8%), Pseudomonas spp. (7.5%), and Proteus spp. (4.9%). Klebsiella spp., Enterococcus spp., and Morganella spp. were not isolated from patients receiving prophylaxis (p=0.022). Risk factors for UTIs need to be carefully assessed for every patient, and treatment should be customized according to clinical and laboratory results. Individual patient factors should guide drug selection, and treatment plans should account for potential resistance patterns.

Comparison of the safety and efficacy of laparoscopic single-incision triangulated umbilical surgery pyeloplasty with traditional three-hole surgery in a pediatric tertiary center.

To report the application of laparoscopic single-incision triangulated umbilical surgery (SITUS) pyeloplasty in children with ureteropelvic junction obstruction (UPJO) and compare its feasibility and efficacy with traditional three-hole laparoscopic pyeloplasty. Data from children with UPJO who underwent SITUS between July 2018 and August 2021 were included in this retrospective study and patients who were treated with traditional laparoscopic pyeloplasty were chosen for comparison. Thirty-two patients from SITUS group and 72 patients from traditional group were reviewed. The clinical characteristics, complications, and follow-up results were collected and compared. The preoperative demographic data and imaging parameters, including sex, surgical side, age, BMI, and preoperative anterior-posterior pelvic diameter (APD), showed no significant differences between the two groups. The median surgical time was 135 min (IQR: 119.75-160.5) in SITUS group, while 163.5 min (IQR: 141.25-187.5) in the traditional group (p = 0.0008). Two Clavien-Dindo III complications (6.25%) in SITUS group and 11 (15.3%) in the traditional group were recorded (p = 0.335). The success rate was 100% (32/32) in SITUS group and 94% (68/72) in the traditional group (p = 0.309). SITUS pyeloplasty is a feasible and effective laparo-endoscopic single-site (LESS) technique for pediatric patients with excellent cosmetic results comparable to the conventional laparoscopic pyeloplasty. More cases and longer follow-up periods are needed to determine the exact outcomes of the modified LESS technique.

Potential impact of severe hydronephrosis secondary to ureteropelvic junction obstruction on pediatric blood pressure

Hydronephrosis could affect blood pressure (BP) according to published case reports and animal experiments. The impact on pediatric BP is often overlooked due to children's inherently lower BP, superior vascular elasticity and greater resistance to hypertension than adults. This study aimed to prospectively observe the effects of hydronephrosis, secondary to ureteropelvic junction obstruction (UPJO), on pediatric BP. Children with hydronephrosis secondary to UPJO who required pyeloplasty were categorized into five age groups: neonates, infants, toddlers, preschoolers, and school-aged children. Preoperative and postoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), active renin concentration (ARC), and aldosterone concentration (AC) were compared among these age groups, followed by comparison with a control group of children without nephritis or cardiovascular conditions. The impact of severe hydronephrosis secondary to UPJO on pediatric BP and its association with the renin-angiotensin-aldosterone system (RAAS) were examined. This study enrolled 114 children with severe hydronephrosis secondary to UPJO and 153 without nephritic or cardiovascular conditions between September 2021 and June 2023. As the control group aged, SBP and DBP increased, whereas ARC and AC decreased. Overall, hydronephrosis group had higher SBP, DBP, ARC, and AC than the controls group. These differences differed between the age groups. After pyeloplasty, the postoperative BP of hydronephrosis group approximated that of the control group. Postoperative ARC levels were higher than those in the control group but were much lower than the preoperative levels. AC did not decrease significantly after surgery. The change in DBP in children with hydronephrosis before and after pyeloplasty showed a positive correlation with the change in AC. Pediatric patients with severe hydronephrosis, a condition secondary to UPJO, displayed elevated BP, ARC, and AC. Following pyeloplasty, these patients noted a reduction in BP. The correlation between elevated blood pressure and the RAAS necessitates further comprehensive investigation.

Predictive Value of Initial Diagnostic Imaging for Congenital Ureteropelvic Junction Obstruction Requiring Pyeloplasty

Predictive Value of Initial Diagnostic Imaging for Congenital Ureteropelvic Junction Obstruction Requiring Pyeloplasty

The role of nuclear medicine techniques; Tc-99m-labeled dimercaptosuccinic acid, diethylenetriaminepentaacetic acid, and mercaptoacetyltriglycine scintigraphies in pediatric surgery

The purpose of this review is to highlight the pivotal role of nuclear medicine in pediatric surgery, specifically in the diagnosis and management of nephro-urological conditions. This review focuses on the applications and advantages of three key nuclear medicine techniques: Tc-99m dimercaptosuccinic acid (DMSA), Tc-99m diethylenetriaminepentaacetic acid (DTPA), and Tc-99m mercaptoacetyltriglycine (MAG3) scintigraphies. These imaging modalities are crucial for providing detailed anatomical and functional information with minimal invasiveness, essential for evaluating congenital anomalies, urinary tract infections, and obstructive uropathies in children. DMSA Scintigraphy is established as the gold standard for detecting renal cortical scarring and assessing functional renal parenchymal damage. It offers superior sensitivity and specificity compared to other imaging techniques, making it indispensable for identifying renal scars from recurrent urinary tract infections or pyelonephritis. DTPA Scintigraphy is critical for measuring glomerular filtration rate (GFR) and analyzing renogram curves, providing quantitative assessments of renal function. It effectively evaluates renal perfusion and identifies perfusion defects and renal ischemia, essential for managing conditions like renal artery stenosis and unilateral kidney disease. MAG3 Scintigraphy excels in dynamic renal scintigraphy, particularly in patients with impaired renal function. It provides high-quality images and superior diagnostic capability, making it invaluable for assessing ureteropelvic junction obstruction and other obstructive uropathies in pediatric patients. The review concludes by emphasizing the integration of these scintigraphy techniques with SPECT/CT, enhancing diagnostic accuracy and providing comprehensive anatomical and functional insights. Despite concerns regarding radiation exposure, measures such as dose optimization and advanced imaging techniques ensure safety and efficacy in pediatric applications.

Robot-assisted laparoscopic Anderson–Hynes pyeloplasty for ureteropelvic junction obstruction

ObjectivesTo explore surgical, functional, and symptomatic outcomes in a series of patients who underwent robot-assisted laparoscopic Anderson–Hynes pyeloplasty (RALP) for ureteropelvic junction obstruction using the DaVinci Si surgical robotic system.MethodsRetrospective study including patients aged 16 years or older who underwent RALP from June 2016 to December2021. The following outcomes were recorded: operative outcome and complications [classified according to the Clavien–Dindo Classification (CD)] within 30 days of the procedure as well as 1 year success rate and restenosis during follow-up.ResultsIn total, 194 patients were available for analyses with a median follow-up of 4.5 (IQR 3.0-6.0) years. The primary indications were loss of kidney function (45%), pain (36%), infection (11%), kidney stone (6%), and others (2%). The median operation time was 134 min (IQR 112-159), the median length of stay was 2 days (IQR 2-2), and the median time with double-j stent postoperatively was 24 days (IQR 22-27). Overall, 65 out of 194 patients (33%) experienced a postoperative complication (12% CD I, 13% CD II, 8% CD IIIa or IIIb). The 1 year success rate was 92% for patients treated because of deteriorating renal function, 78% for patients treated because of symptoms, 82% for patients treated because of infections, and 78% for patients treated because of kidney stones. Seven percent of the patients presented a recurrent ureteropelvic junction stricture during follow-up.ConclusionsIn our experience, robot-assisted laparoscopic Anderson–Hynes pyeloplasty performed with the DaVinci Si system is a safe with a few major complications and acceptable success rate.

Application of different CO2 pneumoperitoneum pressure in laparoscopic pyeloplasty for infants with ureteropelvic junction obstruction.

Laparoscopic pyeloplasty is a minimally invasive approach for the therapy of infant ureteropelvic junction obstruction (UPJO), reliant on CO2 pneumoperitoneum insufflation. While the impact of CO2 insufflation on adult and older pediatric populations has been studied, its effects on infants remain less explored. This prospective randomized controlled trial included infants with UPJO undergoing laparoscopic pyeloplasty. Patients were allocated to low pneumoperitoneum pressure (LPP, 5 mmHg) or high pneumoperitoneum pressure (HPP, 8 mmHg) groups. Surgical parameters, postoperative complications, acid-base balance, stress markers, inflammatory cytokines, and oxidative stress markers were evaluated and compared. A total of 116 infants were analyzed. Preoperative characteristics were comparable between LPP and HPP groups. No significant differences in blood loss, operation time, or hospitalization time were observed. Postoperative complications were similar between groups. Acid-base balance analysis revealed a decrease in pH after pneumoperitoneum in both groups, with greater reductions in actual base excess and standard base excess in the HPP group. Stress markers, cytokines, and oxidative stress markers increased postoperatively in both groups, with higher levels in the HPP group. HPP leads to more pronounced physiological responses, including acid-base alterations, stress reactions, and inflammatory cytokine elevations.

Ectopic pelvic kidney associated with uretero-pelvic junction obstruction: a case report

Ectopic pelvic kidney associated with uretero-pelvic junction obstruction: a case report

Role of Interstitial Cells of Cajal in Congenital Ureteropelvic Junction Obstruction.

Although congenital ureteropelvic junction (UPJ) obstruction is the most common cause of neonatal hydronephrosis, aetiopathogenesis is still inconclusive. Recently, the paucity of interstitial cells of Cajal (ICC) at the narrow adynamic part of UPJ has been implicated as a causative factor. This prospective study was conducted between October 2019 and March 2022 to find out the density of ICC by the immunohistochemical method using CD117 (c-kit) antibody, in resected segments of UPJ in obstruction patients and in renal tumour patients as control. ICC/high power field (hpf) was also studied from the margins of the resected segment in the obstruction group. The pre-operative and post-operative sonographic and renal scintigraphic features were compared. The median age of patients in the study group (n = 25) was 36 months and in the control group was 39 months. The mean ICC/hpf at the stenotic part of UPJ in the study group was 3.56 ± 1.26 and in the control group was 12.56 ± 1.89 (P = 0.0001). ICC density from the proximal and distal margins of the resected segment was 11.12 ± 2.12 and 11.68 ± 1.62, respectively (P < 0.001). The post-operative antero-posterior diameter of the renal pelvis and differential renal function showed significant improvement in comparison to the pre-operative value (P = 0.0045 and 0.0005, respectively). The significant decrease in the density of ICC at the stenotic part of UPJ compared to controls suggests a pacemaker role of these cells in ureteral peristalsis and the aetiopathogenesis of UPJ obstruction. Histopathological analysis of ICC should not only be limited to the stenotic part of UPJ but also should focus on the anastomosed ends of the ureter, which reflects post-pyeloplasty outcome.

Initial Experience of Robot Assisted Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction Using the Hinotori Surgical Robot System.

This study aimed to investigate the perioperative outcomes of robot-assisted laparoscopic pyeloplasty (RLP) using the recently launched hinotori surgical robot system. This retrospective study compared the perioperative outcomes of 11 consecutive patients who underwent RLP with the hinotori surgical robot system from October 2022 to March 2024 (hinotori group) and 30 consecutive patients who underwent RLP with the da Vinci system from March 2019 to September 2022 (da Vinci group). The patient characteristics of the groups were similar. The median operative times in the hinotori and da Vinci groups were 236.0 and 231.5min, respectively (p=0.480). The success rates were 100.0% and 96.7%, respectively (p=1.000). Clavien-Dindo grade ≥3 complications occurred in one patient (9.1%) in the hinotori group and one patient (3.3%) in the da Vinci group (p=0.470). The perioperative outcomes in the hinotori group were not inferior to those in the da Vinci group.

Unsupervised Machine Learning to Identify Risk Factors of Pyeloplasty Failure in Ureteropelvic Junction Obstruction.

Introduction: In adult patients with ureteropelvic junction obstruction (UPJO), little data exist on predicting pyeloplasty outcome, and there is no unified definition of pyeloplasty success. As such, defining pyeloplasty success retrospectively is particularly vulnerable to bias, allowing researchers to choose significant outcomes with the benefit of hindsight. To mitigate these biases, we performed an unsupervised machine learning cluster analysis on a dataset of 216 pyeloplasty patients between 2015 and 2023 from a multihospital system to identify the defining risk factors of patients that experience worse outcomes. Methods: A KPrototypes model was fitted with pre- and perioperative data and blinded to postoperative outcomes. T-test and chi-square tests were performed to look at significant differences of characteristics between clusters. SHapley Additive exPlanation values were calculated from a random forest classifier to determine the most predictive features of cluster membership. A logistic regression model identified which of the most predictive variables remained significant after adjusting for confounding effects. Results: Two distinct clusters were identified. One cluster (denoted as "high-risk") contained 111 (51.4%) patients and was identified by having more comorbidities, such as old age (62.7 vs 35.7), high body mass index (BMI) (26.9 vs 23.8), hypertension (66.7% vs 17.1%), and previous abdominal surgery (72.1% vs 37.1%) and was found to have worse outcomes, such as more frequent severe postoperative complications (7.2% vs 1.0%). After adjusting for confounding effects, the most predictive features of high-risk cluster membership were old age, low preoperative estimated glomerular filtration rate (eGFR), hypertension, greater BMI, previous abdominal surgery, and left-sided UPJO. Conclusions: Adult UPJO patients with older age, lower eGFR, hypertension, greater BMI, previous abdominal surgery, and left-sided UPJO naturally cluster into to a group that more commonly suffers from perioperative complications and worse outcomes. Preoperative counseling and perioperative management for patients with these risk factors may need to be thought of or approached differently.

Predictive Value of the Postural Difference in Antero-Posterior Diameter of Renal Pelvis on Ultrasonography of Unilateral Ureteropelvic Junction Obstruction in Determining the Need For Surgery.

Ureteropelvic junction obstruction (UPJO) is the most common cause of antenatal hydronephrosis. Although majority of them improve with time, none of the existing diagnostic modalities can accurately predict which hydronephrotic kidney is at the risk of progressive renal damage and will benefit from early surgery. Postural variations in the anteroposterior pelvic diameter (APPD) of the hydronephrotic kidney in children during follow-up postnatal ultrasonography (USG) reflect the intrapelvic tension, which might help in predicting the need of surgery amongst these patients. We designed this prospective observational study in all unilateral UPJO patients on postural variation in the APPD of renal pelvis on ultrasonography. The mean age of all patients were 2.15 years (0-5 years) and managed at our institute at All India Institute of Medical Sciences, Bhubaneswar. The study duration was from July 2019 to May 2021. The management of these patients was done as per the standard institutional protocol and there was no deviation due to inclusion in this study. We documented the variations in postural APPD both amongst the conservatively managed group and the surgically managed group of patients. Linear correlation between two continuous variables was explored using Pearson's correlation (if the data were normally distributed) and Spearman's correlation (for non-normally distributed data). We found a higher prone APPD than supine APPD in all these patients indicating the obstruction at ureteropelvic junction. However, in the surgical group, there was less variation in the postural APPD compared to the conservative group, and when there was no variation in the postural APPD, the need of surgery was 100%. The limitation of our study was the small sample size (n = 36). A study involving a larger population or involving multiple institutions may further add significance to our findings. We found less postural variation in APPD on USG to be more likely associated with severe UPJO requiring early surgery. This may indicate a non-compliant renal pelvis. However, it was statistically not significant.

Robot-assisted pyeloplasty for ureteropelvic junction obstruction complicating horseshoe kidney.

Horseshoe kidney is characterized by midline fusion of the lower poles of both kidneys. We report a case where robot-assisted pyeloplasty was performed for hydronephrosis complicating horseshoe kidney. A 31-year-old man repeatedly developed fever since childhood. He visited a local clinic for fever and left back pain, where he was diagnosed and treated for acute pyelonephritis. Abdominal computed tomography led to a diagnosis of horseshoe kidney and associated left ureteropelvic junction obstruction. He was referred to our hospital for pyeloplasty because of persistent left back pain. Robot-assisted left pyeloplasty was performed using the Anderson-Hynes technique with four ports because crossing vessels were discovered intraoperatively. Isthmusectomy was not performed. The postoperative course was favorable. Computed tomography performed approximately 2 years post-surgery showed improvement in hydronephrosis. No left back pain was reported. Our case experience suggests the utility of robot-assisted pyeloplasty for patients with horseshoe kidney.

Primary pyeloplasty for uretero-pelvic obstruction in the USA adult population with or without double-J indwelling ureteral stents. Insurance claims data on contemporary time to removal trends, perioperative complications, health care costs, and re-intervention rates.

Using a large population-based dataset, we primarily sought to compare postoperative complications, health-care expenditures, and re-intervention rates between patients diagnosed with ureteropelvic junction obstruction (UPJO) undergoing stented vs. non-stented pyeloplasty. The secondary objective was to investigate factors that influence the timing of DJ stent removal. Patients ≥18 years old with UPJO treated with primary open or minimally-invasive pyeloplasty were identified using the Merative™ Marketscan® Databases between 2007-2021. Multivariable modeling was implemented to investigate the association between Double-J (DJ) stent placement and post-pyeloplasty complications, hospital costs, and re-intervention rates and the role of the perioperative predictors on time to DJ stent removal. Subgroup analyses stratified by ureteral stenting duration were additionally performed. Out of 4872 patients who underwent primary pyeloplasty, 4154 (85.3%) had DJ placement. Postoperative complications were rare (N.=218, 4.47%) and not associated with ureteral stenting (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.55-1.12). The median cost for in-hospital charges was $21,775, with DJ stent placement independently increasing the median aggregate amount (OR: 1.29, 95% CI: 1.09-1.53). Overall, re-interventions were performed in 21.18% of patients, with DJ stenting found to be protective (OR: 0.79, 95% CI: 0.66-0.96). Higher Charlson Comorbidity Index, longer hospital stay, and open surgical approach were independent predictors for prolonged DJ stenting time to removal. Our study suggests that patients undergoing stent-less pyeloplasty did have a higher rate of secondary procedures, but not higher complications when compared to those undergoing stented procedures. Concurrently, the non-stented approach is associated with decreased health-care expenditures, despite the increased rates of secondary procedures.

The Optimal Suture Bite Depth in Laparoscopic Pyeloplasty: A Comparative Study in Children.

Background: Modified Anderson-Hynes pyeloplasty is currently preferred for ureteropelvic junction obstruction (UPJO). Extravasation of urine and anastomotic stenosis are the most common complications after Anderson-Hynes pyeloplasty, which are closely linked with the technique for anastomosis. However, there are currently no clear guidelines for the suture bite depth in suturing the anastomosis during pyeloplasty. Objective: To analyze the optimal suture bite depth in laparoscopic Anderson-Hynes pyeloplasty. Study Design: A total of 90 children aged 4-14 years with UPJO-induced hydronephrosis who were surgically treated in the First People's Hospital of Lianyungang from July 2019 to July 2022 were prospectively recruited. All received laparoscopic Anderson-Hynes pyeloplasty using 5-0 Vicryl continuous sutures. According to the suture bite depth, the patients were divided into group A (depth 1 mm, n = 46) and group B (depth 0.5 mm, n = 44). Operation time, postoperative drainage volume, time of ureteral stent removal, incidence of postoperative complications, and time to hydronephrosis resolution were compared between groups. Results: Group A showed significantly less postoperative drainage volume, and shorter time of ureteral stent removal and hydronephrosis resolution (all P < .05). Four cases in group B received replacement of a double-J stent. Except for 1 patient receiving reoperation for anastomotic stenosis caused by massive extravasation of urine, the replaced double-J stent was successfully removed from the remaining 3 patients at 3 months, and the symptoms of anastomotic stenosis disappeared. No significant difference was detected in the operation time between groups (P > .05). Conclusion: An appropriate deeper suture bite depth for anastomosis may reduce postoperative urine extravasation and related complications in children who received laparoscopic pyeloplasty for UPJO-induced hydronephrosis.

PE007 Robotic-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction: A retrospective, high volume UK multi-centre review

PE007 Robotic-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction: A retrospective, high volume UK multi-centre review

Comparison of outcomes of open, laparoscopic and robot-assisted laparoscopic pyeloplasty in children with ureteropelvic junction obstruction: protocol for a systematic review and meta-analysis

IntroductionThe treatment of children with pelviureteric junction obstruction (PUJO) has naturally progressed from open, to minimally invasive approaches, including laparoscopic pyeloplasty and robot-assisted laparoscopic pyeloplasty (RALP). The RALP is now...