Ureteropelvic Junction Obstruction Research Articles

Blunt renal trauma in ureteropelvic junction obstruction kidney: A case report.

IntroductionKidneys are one of the most commonly affected retroperitoneal organ in trauma cases despite its relatively well-protected location. Renal trauma occurs in 80–95% of urogenital trauma cases and 8–10% of abdominal blunt trauma. Renal trauma in hydronephrotic kidney due to ureteropelvic junction obstruction (UPJO) is a rare entity, despite of high risk of trauma urogenital due to large size and thin parenchyma. In this case we reported blunt renal injury with a congenital abnormality of the kidney.Case presentationWe present a case of abdominal blunt trauma due to motor-vehicle accident in a 23 year old male patient. The patient complaint of visible hematuria since 1 day after falling from motorcycle with right flank hit the road, accompanied with right flank pain. Vital signs were within normal limits. Physical examinations reveal distention of right flank with no sign of peritonitis. Supporting examination with FAST ultrasound revealed grade 4 hydronephrosis with internal echo, suspected blood accumulation inside the kidney. Abdominal CT scan revealed grade IV hydronephrosis of right kidney with thin parenchyma. We performed laparotomy and renal exploration, intraoperatively we found multiple laceration of the kidney into pelvicalyceal system (AAST grade IV) with hematoma inside the right kidney and UPJ stenosis (about 5 cm). We decided to perform right nephrectomy despite of grade IV injury with consideration of poor renal function, long stenosis segment and thin renal parenchyma will cause many complications in the future for the patient.ConclusionRenal injury in UPJO kidney is a rare entity despite of high risk of injury in this population. Management of renal injury in this population might be not consistent with guideline for renal trauma, and clinical judgement from the physician plays an important role to provide the best treatment for this patient.

Comparing the Effects of 2D and 3D Imaging Systems on Laparoscopic Pyeloplasty Outcomes in the Treatment of Adult Ureteropelvic Junction Obstruction.

Background: The aim of this study was to compare the efficacy, safety, and the clinical and perioperative outcomes of two-dimensional (2D) and three-dimensional (3D) laparoscopic imaging systems in adult patients undergoing laparoscopic pyeloplasty in our clinics due to ureteropelvic junction (UPJ) obstruction. Methods: A total of 46 adult patients who had undergone laparoscopic pyeloplasty due to UPJ obstruction were included in the study. Cases that had undergone the operation before January 2019 were retrospectively evaluated with the 2D imaging systems. Cases after that date were evaluated by using the 3D imaging systems, and the operative, perioperative, and postoperative findings of these patients were recorded prospectively. Patients who had undergone laparoscopic pyeloplasty were classified into two groups as the "2D group" and the "3D group." To standardize the preoperative findings, the cases that were operated by a single surgeon experienced in both 2D and 3D imaging systems were included in the study. The demographic characteristics and the clinical findings of the patients were compared between the groups. Results: A total of 41 patients were included in the study. The mean age was 27.7 ± 9.17 years. Among the patients, 23 (56.1%) were in the 2D group and 18 (43.9%) were in the 3D group. No statistically significant difference was observed between groups with regard to the demographic characteristics of the patients. According to the perioperative and postoperative findings of the patients, the duration of the operation was significantly shorter in the 3D group. Conclusion: The duration of the operation was significantly reduced in the 3D image-guided laparoscopic pyeloplasty in the treatment of UPJ obstruction of the adult, compared with 2D image-guided operations. The 3D imaging systems provide a better image quality, an important convenience in intraoperative saturation, and low rates of complication in laparoscopic pyeloplasty, and they may be used safely and effectively.

Long non-coding RNA MEG3 promotes tumor necrosis factor-alpha induced oxidative stress and apoptosis in interstitial cells of cajal via targeting the microRNA-21 /I-kappa-B-kinase beta axis

ABSTRACT Interstitial Cells of Cajal (ICC) plays a critical role in the peristaltic contractions of the gastrointestinal and urinary tract. The dysfunction and loss of ICC contributes to hypokinetic disease, such as gallstoneand ureteropelvic junction obstruction . In the present study, we identified the underlying driving molecular signals of oxidative stress and apoptosis in ICC. ICC was isolated from small intestine of Balb/c mice, and stimulated with tumor necrosis factor-alpha (TNF-α). MTT and flow cytometry were performed to assess cell viability, apoptosis, and the level of reactive oxygen species in ICC, respectively. The level of malondialdehyde, superoxide dismutase, and glutathione peroxidase in cells were measured to assess oxidative stress. The expression of inflammatory factors (interleukin, IL-1 and IL-6) and apoptosis-related proteins were detected by western blot. We observed that TNF-αinduced inflammation, oxidative stress and cell apoptosis in ICC. By using quantitative real-time PCR , we verified that the expression of long non-coding RNAMEG3 was elevated by TNF-α in ICC. Silencing MEG3 reversed inflammation, oxidative stress, and cell apoptosisin TNF-α-treated ICC. Subsequently, we confirmed that MEG3 sponged cytoprotective miR-21 to upregulate the expression of I-kappa-B-kinase beta (IKKB) and activate the nuclear factor kappa-B (NF-κB) pathway. Both miR-21 overexpression and IKKB knockdown reduced TNF-α-induced above symptoms in ICC. Taken together, we can conclude that MEG3 mediates inflammation, oxidative stress and apoptosis in TNF-α-treated ICC via the miR-21/IKKB-NF-κB axis. The study improves our understanding of the molecular mechanism of ICC reduction related diseases.

Comparison of Secondary and Primary Minimally Invasive Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis.

Objective: To compare the outcomes of secondary minimally invasive pyeloplasty (MIP) versus primary MIP for the patients with ureteropelvic junction obstruction (UPJO). Materials and Methods: We searched all the literature of PubMed, Web of Science, EMBASE, and Cochrane Library comparing secondary MIP and primary MIP and performed a systematic review and meta-analysis. Results: We included 15 studies involving 1637 patients with 1371 in the primary MIP group and 266 in the secondary MIP group. There were no significant differences in length of hospital stays, and the risk of hematuria, urinary tract infection, intestinal obstruction, stent complications, and overall complications (P > .05). Comparing with the secondary MIP group, the primary MIP group has shorter operative time (mean difference [MD] = -36.91 minutes, 95% confidence interval [CI]: -50.21 to -23.62, P < .00001), less estimated blood loss (MD = -16.70 mL, 95% CI: -31.60 to -1.80, P = .03), lower risk of urinary leakage and injury of blood vessel (relative risk [RR] = 0.32, 95% CI: 0.11-0.93, P = .04) (RR = 0.10, 95% CI: 0.02-0.61, P = .01), and higher success rate (RR = 1.07, 95% CI: 1.02-1.11, P = .003). The robot-assisted pyeloplasty is superior to the laparoscopic pyeloplasty in controlling the amount of blood loss in the secondary operation. Conclusions: Considering the poorer outcomes of secondary surgery, we believe that special attention should be paid to not missing crossing vessels, and it would be more prudent to perform a more definitive procedure with pyeloplasty instead of endopyelotomy for primary UPJO.

Comparing accuracy of urinary biomarkers in differentiation of ureteropelvic junction obstruction from nonobstructive dilatation in children.

Multiple urinary biomarkers have been reported in differentiation of nonobstructive dilatation (NOD) from ureteropelvic junction obstruction (UPJO). In this meta-analysis, we compared the accuracy of common urinary biomarkers applicable to UPJO. A systematic literature review of electronic databases was conducted for: (UPJO) OR (NOD) AND (urinary biomarkers) AND (children) for articles published in the last decade. PRISMA guidelines were used to exclude duplicate and erroneous articles. Meta-analysis involved risk of bias analysis, heterogeneity assessment, and comparison of sensitivity/specificity by forest plot analysis using MetaXL 5.3. Among the 264 articles analyzed, 19 articles met the inclusion criteria and reported the following: neutrophil gelatinase-associated lipocalin (NGAL), monocyte chemotactic protein-1 (MCP1), carbohydrate antigen 19-9 (CA 19-9), kidney injury molecule (KIM1), epidermal growth factor (EGF), and interferon gamma induced protein-10 (IP10). There was substantial heterogeneity among articles. There was wide variation in applied cut-offs among studies. Overall sensitivity was highest at 87% for CA 19-9 while overall specificity was highest at 76% for NGAL. Overall accuracy was highest at 78% for CA 19-9 followed by 77% for NGAL and 75% for KIM1. In this meta-analysis, the overall accuracy was highest for CA 19-9 followed by NGAL and KIM1. The small number of studies for CA 19-9 and considerable heterogeneity for all should be considered while interpreting these findings. Based on the current meta-analysis, we support a panel of biomarkers combining NGAL, KIM, and CA 19-9 for the best diagnostic accuracy of UPJO in children.

Anterograde Mini-Percutaneous Retropelvic Extra-Luminal Endopyelotomy: A Novel Approach to Uretero-Pelvic Junction Obstruction

BackgroundUretero-pelvic junction obstruction (UPJO) is a common cause of upper tract urinary obstruction. This condition is generally treated with various surgical options which include endoscopic (retrograde or anterograde), laparoscopic, open or robotic-assisted approaches. Herein, we describe a novel endoscopic retropelvic extra-luminal approach using a mini (14 Fr) nephroscope.MethodsA 30-year-old male presented with symptomatic left UPJO and inferior pole renal stones, which were identified on computed tomography (CT) imaging. Mercaptuacetyltriglycine (MAG3) renogram demonstrated a functioning left kidney. With the patient positioned supine, a mini-perc (Karl-Storz) nephroscope was used to access the renal pelvis via the percutaneous route. The retropelvic space was thereafter accessed. Using a Holmium-YAG laser, the UPJO was splayed using an extra-luminal approach.ResultsClear endoscopic vision, minimal bleeding, and overall satisfactory identification of the UPJO were achieved. At the 12-month follow-up, the patient remained stent and symptom-free. On follow-up CT imaging and MAG3 renogram, the system remained dilated with no obstruction noted.ConclusionPercutaneous anterograde retropelvic extra-luminal endopyelotomy is a novel approach that should be considered in patients with secondary renal calculi. This is the first report of the procedure being successfully performed utilizing the mini-perc access route.

Comparative transcriptome analysis of miRNA in hydronephrosis male children caused by ureteropelvic junction obstruction with or without renal functional injury.

MicroRNAs (miRNAs or miRs) are non-coding RNAs that contribute to pathological processes of various kidney diseases. Renal function injury represents a final common outcome of congenital obstructive nephropathy and has attracted a great deal of attention. However the molecular mechanisms are still not fully established. In this study, we compared transcriptome sequencing data of miRNAs of renal tissues from congenital hydronephrosis children with or without renal functional injury, in order to better understand whether microRNAs could play important roles in renal functional injury after ureteropelvic junction obstruction. A total of 22 microRNAs with significant changes in their expression were identified. Five microRNAs were up-regulated and 17 microRNAs were down-regulated in the renal tissues of the hydronephrosis patients with renal function injury compared with those without renal function injury. MicroRNA target genes were predicted by three major online miRNA target prediction algorithms, and all these mRNAs were used to perform the gene ontology analysis and Kyoto Encyclopedia of Gene and Genomes pathway analysis. Then, twelve candidate human and rat homologous miRNAs were selected for validation using RT-qPCR in vitro and in vivo; only miR-187-3p had a trend identical to that detected by the sequencing results among the human tissues, in vivo and in vitro experimental models. In addition, we found that the change of miR-187-3p in vivo was consistent with results in vitro models and showed a decrease trend in time dependence. These results provided a detailed catalog of candidate miRNAs to investigate their regulatory role in renal injury of congenital hydronephrosis, indicating that they may serve as candidate biomarkers or therapeutic targets in the future.

Evaluation of insertion/deletion (I/D) polymorphisms of ACE gene and circulating levels of angiotensin II in congenital anomalies of the kidney and urinary tract.

Congenital Anomalies of the Kidney and the Urinary Tract (CAKUT) are defined as a heterogeneous group of anomalies that resulted from defects in kidney and urinary tract embryogenesis. CAKUT have a complex etiology. Genetic, epigenetic and environmental factors have been investigated in this context. Angiotensin II is a potent vasoconstrictor and exerts an important role in kidney embryogenesis. The angiotensin-converting enzyme (ACE) converts Angiotensin I into Angiotensin II (Ang II) and ACE gene has insertion/deletion (I/D) polymorphisms that have been evaluated in several nephropathies. This study aimed to evaluate whether the I/D polymorphisms of ACE gene and the circulating levels of Ang II are associated with any CAKUT phenotype or CAKUT in general. Our study was performed with 225 pediatric patients diagnosed with CAKUT and 210 age-and-sex matched healthy controls. ACE I/D alleles were analysed by real-time polymerase chain reaction (RT-PCR). The distribution of ACE I/D polymorphisms were compared between CAKUT patients and healthy controls, as well between ureteropelvic junction obstruction (UPJO), vesicoureteral reflux (VUR), multicystic dysplastic kidney (MCDK) phenotypes and control group. No statistical association was detected between ACE I/D polymorphism and CAKUT and UPJO, VUR, and MCDK phenotypes. In a subset of 80 CAKUT patients and 80 controls, plasma levels of Ang II were measured. No significant differences were found between CAKUT patients and controls, even in regard to comparisons of UPJO, VUR and MCDK with control group. Although CAKUT is a complex disease and the ACE gene may exert a role in kidney embryogenesis, CAKUT was not associated with any ACE I/D polymorphisms nor with differences in plasma levels of Ang II in this Brazilian pediatric population.

Transurethral Retrograde Fishing the Double J Urethral Stent: A Tertiary Children Hospital's Experience With a New Technical Strategy.

PurposeThe purpose of this study is to provide a new strategy for non-cystoscopic double J urethral stent (JJS) removal, the transurethral retrograde fishing the double J urethral stent (TURFJJS), that avoids general anesthesia in pediatric populations.MethodsWe retrospectively reviewed the JJS removal records of patients having ureteropelvic junction obstruction (UPJO). We analyzed differences in the removal success rates, operation-related severe complications, total cost, duration, and parental satisfaction between TURFJJS and traditional cystoscopic double J urethral stent removal (CJJSR) procedures.ResultsA total of 324 patients with UPJO were included in this study. CJJSR yielded a success rate of 100%. TURFJJS achieved a success rate of 94.3%. The TURFJJS was just an outpatient procedure, and its total cost was about 800 Chinese yuan (US$ 124). There were no severe JJS removal-related complications using TURFJJS. Parental satisfaction was 98.2 and 92.5% for the CJJSR and TURFJJS protocols, respectively.ConclusionTURFJJS is safe, effective, cost-effective, and well-tolerated in pediatric patients, minimizing or eliminating the need for general anesthesia, additional hospitalization, and waste of time. TURFJJS should be widely used in pediatric urology.

Robot-Assisted Laparoscopic Ureterocalicostomy in the Setting of Ureteropelvic Junction Obstruction: A Multi-Institutional Cohort.

Recurrent ureteropelvic junction obstruction (UPJO) after failed pyeloplasty is a complex surgical dilemma. The robot-assisted laparoscopic ureterocalicostomy (RALUC) is a potential surgical approach, but widespread adoption is limited due to the perceived technical challenge of the procedure. We present a multi-institutional pediatric cohort undergoing RALUC for recurrent or complex UPJO, and hypothesize that the procedure is reproducible, safe and efficacious. A 3-center multi-institutional collaboration was initiated and medical records of children undergoing RALUC between 2012 and 2020 were retrospectively reviewed. The details on baseline demographics, perioperative characteristics and postoperative outcomes were aggregated. During the study period 24 patients, 7 (29%) females and 17 (71%) males, were identified. Of the patients 21 (86%) had a history of previous pyeloplasty prior to RALUC, of whom 5 (24%) had 2 prior failed ipsilateral pyeloplasties. The reason for performing RALUC was short ureter in 3 (13%), intrarenal pelvis in 5 (21%) and extensive scarring at the ureteropelvic junction locus in 16 (67%) patients. The median age of patients at time of surgery was 5.1 years (IQR: 1.9, 14.7). Of the patients 9 (38%) had percutaneous nephrostomy prior to surgery; if percutaneous nephrostomy tubes were placed for relief of obstruction, an antegrade contrast study was done postoperatively to confirm resolution of obstruction. No 30-day Clavien-Dindo Grade III-V complications were noted. During the median followup of 16.1 months (IQR: 6, 47.5), 22 (92%) had improved symptoms and hydronephrosis with no further intervention; 2 (8%) patients underwent endoscopic interventions after RALUC and both ultimately underwent nephrectomy. This multi-institutional cohort demonstrates that RALUC is a safe and efficacious salvage option for failed pyeloplasty or complex anatomy with an acceptable success profile, especially in cases of extensive scarring at the UPJO or an intrarenal pelvis.

Efficacy of Open Anderson-Hynes Pyleloplasty in Congenital Unilateral Uretero-Pelvic Junction Obstruction in Terms of GFR in Children

Background: Ureteropelvic junction obstruction” is defined as an anatomical abnormality that results in a functionally significant impairment of urinary transport from the renal pelvis to the ureter. Congenital UPJ obstruction results due to the presence of an aperistaltic segment of the ureter. Objective: To determine the efficacy of Open Anderson-Hynes pyeloplasty in unilateral congenital UPJO in terms of GFR Materials and Methods: This descriptive study of 139 patients of paediatric age group was conducted in the department of urology, Institute of Kidney Diseases, Peshawar from 24 July, 2019 to 24 July 2020. Patients with UPJO were operated. Efficacy of the procedure noted in term of GFR. Follow up ultrasound followed by nuclear scan was done after 2 months. Results: Out of 139 patients, 60(43.16%) were of age 5-10yrs and 79(56.83%) i.e. the majority were 11-15 yrs with mean and SDs of 11±2.37. The overall complication rate was 36.69%. The efficacy in terms of GFR improvement OR at least prevention of deterioration of renal function was recorded in 115 (82.73%) patients while 24 (17.26%) showed no efficacy Conclusion: Anderson-Hynes pyeloplasty is an effective procedure in terms of renal function improvement or to prevent GFR deterioration at the preoperative level in comparison to those not operated with gradual reduction in GFR.

The use of biomarkers in the diagnosis and treatment of obstruction of the upper urinary tract in children.

Antenatal hydronephrosis, dilatation of the upper urinary tract (UUTD), is a common finding on prenatal ultrasound. One of the most common causes is ureteropelvic junction (UPJ) obstruction. Although such prenatally diagnosed UUTD resolves spontaneously in most newborns, further examination of these children is advocated to prevent possible irreversible kidney damage, and ultrasound is mainly used for this. If the dilatation persists or becomes symptomatic, it is necessary to proceed to other relatively demanding and invasive diagnostic examinations for these small patients, where the question of the right timing of indications for possible surgical solutions is still unclear. For this reason, various biomarkers have been investigated in a number of clinical trials as potential mini-invasive diagnostic tools for determining when upper urinary tract dilatation in such children poses a threat to the developing kidneys and they should be operated on, and vice versa, when to proceed conservatively. The aim of this article is to review the findings on and current issues with the use of biomarkers in the diagnosis and treatment of UPJ obstruction in children.

The fight between PCNL, laparoscopic and robotic pyelolithotomy: do we have a winner? A systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to provide an updated comparison between the currently available minimally invasive approaches (PCNL, laparoscopic [LP] and robotic pyelolithotomy [RP]) for the management of large renal stones. An electronic search of the current literature was conducted through the Medline and NCBI PubMed, Embase, Scopus and Cochrane Collaboration Central Register of Controlled Clinical Trials databases in March 2021. Studies about minimally-invasive treatment for kidney stones were considered. Inclusion criteria were: studies evaluating patients with large renal calculi (≥2 cm); the comparison of at least two of the three approaches (PCNL, LP, RP), and reporting data suitable for meta-analysis evaluation. Patients with concomitant management for ureteropelvic junction obstruction (UPJ-O) were excluded. Overall, 17 reports were considered for qualitative and quantitative synthesis, for a total cohort of 1079 patients, of which 534 with PCNL, 525 treated with LP, and 20 with RP. Of those, 16 compared PCNL with LP, while only 1 study compared LP with RP. PCNL mean operative time was statistically significantly shorter than LP and RP while mean estimated blood loss was statistically significantly higher for PNCL. No statistically significant differences were recorded among the three surgical approaches. Finally, PCNL demonstrated slightly, albeit statistically significant lower stone free rate when compared with LP. PCNL, LP and RP may be safely and efficiently used to manage large renal stones. All three procedures showed reasonably low rate of complications with a satisfactory stone clearance rate.

EDITORIAL COMMENT

New techniques for the treatment of ureteropelvic junction obstruction (UPJO) and proximal ureteral strictures continue to evolve, including buccal ureteroplasty,1 appendiceal interposition,2 and even gonadal vein grafts.3 However, the Anderson-Hynes dismembered pyeloplasty remains the gold standard for repair of UPJO since it was first described in 1949 because of its durable outcomes and relative technical simplicity. While advances in minimally invasive surgical technique have improved procedural morbidity, the true technical principles of the pyeloplasty have remained the same for almost 80 years.

Robotic Pyeloplasty in Patients with Duplex Collecting System with Lower Pole Ureteropelvic Junction Obstruction and with Multiple Crossing Vessels: Tips and Tricks

Robotic Pyeloplasty in Patients with Duplex Collecting System with Lower Pole Ureteropelvic Junction Obstruction and with Multiple Crossing Vessels: Tips and Tricks

Urinary HSP70 can predict the indication of surgery in unilateral ureteropelvic junction obstruction.

Distinguishing hydronephrosis that requires surgical intervention is a clinical challenge. The aim of this study is to determine the level of urinary heat shock protein 70 (HSP70) in children who required surgery for ureteropelvic junction obstruction and its potential use as a biomarker for prediction of surgery in children with isolated unilateral hydronephrosis. The data of 43 children with ureteropelvic junction obstruction who underwent pyeloplasty, 25 patients with non-obstructive dilation (NOD) and 30 healthy children (control group) were collected prospectively for this study. Preoperative and postoperative urinary HSP70/Cr levels were also analyzed in 30 children in the pyeloplasty group who had available follow-up information. HSP70 levels were assessed using ELISA. The median age of the pyeloplasty group was 13months (IQR 7-36months), NOD group was 42.5months (IQR 16-73) and it was36months (IQR 24-47.5) in the control group. The mean preoperative urinary HSP70/Cr was significantly higher in the pyeloplasty group when compared to controls as well as the NOD group (150.6pg/mgCr vs. 65.0pg/mgCr and vs. 64.7pg/mgCr, p < 0.001 and p < 0.001, respectively). The urinary HSP70 levels significantly decreased in the postoperative period (151.5 vs 79.5, p < 0.001). Using the cutoff value of 94.7pg/mgCr, the sensitivity and specificity of urinary HSP70 for predicting the risk of surgical intervention were 69.7% and 68%, respectively (AUC = 0.689). Urinary HSP70 may be used as an adjunct tool to clinical parameters to identify patients that would require surgery due to ureteropelvic junction obstruction.

Laparoscopic and robotic pyeloplasty as minimally invasive alternatives to the open approach for the treatment of uretero-pelvic junction obstruction in infants: a multi-institutionalcomparisonofoutcomes and learning curves.

Since the development of minimally invasive surgery (MIS), laparoscopic and robotic approaches have been widely adopted. However, little has been published detailing the learning curve of MIS, especially in infants. To quantify the learning curve of laparoscopic (LP) and robot-assisted laparoscopicpyeloplasty (RAL-P) for treatment of uretero-pelvic junction obstruction (UPJO) in infants evidenced by number of cases, operative time, success and complications. Between 2009 and 2017, we retrospectively reviewed pyeloplasty cases for treatment of UPJO in infants at three academic institutions. The primary outcome was success. Secondary outcomes were UPJO recurrence, complications, and operative time as a surrogate of skill acquisition. Continuous variables were analyzed by t test, Welch-test, and one-way ANOVA. Non-continuous variables were analyzed by Chi-squared test or Fisher's exact test. Learning curves (LC) were studied by r-to-z transformation and CUSUM. Thirty-nine OP, 26 LP, and 39 RAL-P had mean operative times (OT) of 106, 121, and 151min, respectively. LCs showed plateau in OT after 18 and 13 cases for LP and RAL-P, respectively. RAL-P showed a second phase of further improvements after 37 cases. At 16months follow-up, there were similar rates of success and complications between the three groups. Despite different duration of learning phases, proficiency was achieved in both LP and RAL-P as evidenced by stabilization of operative time and similar success rates and complications to OP. Before and after achievement of proficiency, LP and RAL-P can be safely learned and implemented for treatment of UPJO in infants.

Robotic-Assisted Laparoscopic Ureterocalicostomy for Persistent Uretero-Pelvic Junction (UPJ) Obstruction after Failed Renal Pyeloplasty

Robotic-Assisted Laparoscopic Ureterocalicostomy for Persistent Uretero-Pelvic Junction (UPJ) Obstruction after Failed Renal Pyeloplasty

A Comparison Between Laparoscopic and Robot-Assisted Laparoscopic Pyeloplasty in Patients with Ureteropelvic Junction Obstruction.

The aim of this study is to compare the results of laparoscopic pyeloplasty and robot-assisted laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. Between March 2008 and May 2019, the patients who underwent retroperitoneal laparoscopic or robotic-assisted laparoscopic pyeloplasty in our institution were retrospectively reviewed. Thirteen patients underwent laparoscopically, and 12 patients underwent robotic surgery. The significant difference was found in median operative time between laparoscopic group (296 minutes) and robotic group (199 minutes) (P = 0.001). The median time for drain removal in laparoscopic group was longer than robotic group (3 vs. 2 days, respectively, P = 0.029). Laparoscopic and robot-assisted laparoscopic pyeloplasty is safe and excellent success rates in patients with ureteropelvic junction obstruction. However, our experience study suggested that robotic surgery improves a total operative time, decreases drain removal time and less intraoperative blood loss than laparoscopic approach.

Erişkin Üreteropelvik Bileşke Darlığı Hastalarında Piyeloplastinin Başarısı: Retrospektif Klinik Çalışma

Objective: Ureteropelvic junction obstruction (UPJO) is a disease often diagnosed in childhood, but it can rarely be detected in adults. Dismembered pyeloplasty is the gold standard treatment method. In this study, we evaluated the success of pyeloplasty in adult patients with UPJO. Material and Methods: We retrospectively reviewed the data of the adult patients who underwent pyeloplasty between January 2012 and July 2021. Preoperative and postoperative differential renal function (DRF), the time required for the clearance of half of the radioisotope from the renal pelvis (T1/2), presence of symptoms, degree of hydronephrosis, anteroposterior (AP) diameter of the renal pelvis, and parenchymal thickness were compared. Results: A total of 30 patients with a mean age of 32.43±7.18 were included in the study. No statistically significant difference was detected between preoperative and postoperative mean DRF (37.6±12.08 and 38±11.35, respectively) (p=0.775). In 19 (63.33%) patients DRF remained unchanged. In 7 (23.33%) patients DRF was improved, and in 4 (13.34%) patients DRF deteriorated. The mean AP diameter and grade of hydronephrosis were significantly improved after pyeloplasty. The ratio of patients with a T1/2>20 minutes significantly decreased from 83.33% to 26.67% (p=0.001). Before the operation 26 (86.67%) patients were symptomatic. After the operation only 8 (26.67%) patients were symptomatic. This change was statistically significant (p=0.001). Conclusion: There were significant improvements in T1/2, AP diameter of the renal pelvis, and the degree of hydronephrosis. Renal function was preserved after the surgery. Also, pyeloplasty was effective in pain relief and should be recommended to adults with UPJO.