A New Modification of Dismembered Pyeloplasty for Primary Ureteropelvic Junction Obstruction

Abstract

Aim: To present the results of a new modification of dismembered pyeloplasty performed to prevent the occurrence of secondary obstruction. Methods: Modified dismembered pyeloplasty was performed in 35 children (age range 3 months to 16 years) who had unilateral ureteropelvic junction obstruction. In postoperative follow-up, presence of hydronephrosis on ultrasonography, differential renal function (DRF) and renal drainage half-time on technetium-99m diethylenetriaminepentaacetic acid (DTPA) renography were recorded and compared with preoperative data. Results: Mean anteroposterior renal pelvic diameter, mean preoperative DRF and radioisotope clearance half-time on DTPA renography of the affected kidneys were 61.4 mm, 38.6% and 34.3 min in children with prenatal hydronephrosis, and 67.5 mm, 37.6% and 39.4 min in children that presented with symptoms, respectively. After surgery, mean anteroposterior renal pelvic diameter, mean DRF and radioisotope clearance half-time on DTPA renography of the affected kidneys were 10.9 mm, 45.9% and 11.9 min in children with prenatal hydronephrosis, and 20 mm, 41.9% and 15.2 min in children that presented with symptoms, respectively. No failure was observed in any patient at an average follow-up of 26 months (range 1–5 years). Conclusions: Open dismembered pyeloplasty is the treatment of choice for intrinsic ureteropelvic junction obstruction. The modification of dismembered pyeloplasty that we performed is an alternative for the prevention of secondary obstruction.

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“…Ip PS et al recently suggested that complementary and alternative medicines could be potential sources of new drugs for the prevention of neurodegenerative diseases [53]. Earlier reports revealed that dietary intake of rich polyphenolic vegetables and fruits delayed the onset of dementia associated with AD [54,55]. Although N -methyl D-aspartate receptor antagonists and cholinesterase inhibitors have been widely used for treating the symptoms of AD, these drugs have not shown promising results, and their usage is limited due to their undesirable side effects.…”

Comparative study between ureter first approach and conventional open Anderson-Hynes pyeloplasty in paediatric patients: A prospective randomised study

“…They thought that such approach can also standardize the steps of pyeloplasty surgery and could reduce the surgical mistakes that may happen to newer surgeons or residents (13). There were multiple modifications of conventional A-H pyeloplasty aiming at reducing complications and make the procedure easier to perform (14)(15)(16). Recently, the advancements in urologic laparoscopy make feasible complex procedures, as pyeloplasty, that could be performed laparoscopically with the advantage of short hospital stay, less pain postoperatively and reduced morbidity but with longer operative time.…”