Day‐case catheterless and drainless minimal‐access pyeloplasty in adults: A single‐center experience of 13 years

Murali, Vinodh; Donati-Bourne, Jack; Thomas, Megan; Luscombe, Christopher J.; Golash, Anurag; Fernando, Herman

doi:10.1111/iju.14493

Cited by 3 publications

(1 citation statement)

References 13 publications

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“…The non-stenting had advantages such as no anesthesia required to remove the stent, no stent-related complications, early mobilization, and increased patient satisfaction 31,32 with equivalent anastomotic results and long-term surgical outcome success. 33 The rate of infection, stricture, encrustation or calculus formation, tissue injury, bleeding, dislodgement, stent migration, longer hospital stay, and costs were found to be higher with stenting. 34 Our all cases had intra-operative JJ stent which was removed after four weeks.…”

Section: The Renal Function May Not Be Improved After Pyeloplasty If ...mentioning

confidence: 92%

Functional outcome after transperitoneal laparoscopic pyeloplasty at a tertiary care center, Nepal

Regmi,

Bhattarai,

Maharjan

et al. 2023

J Patan Acad Health Sci

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Introduction: Pyeloplasty is the gold standard surgical treatment for Pelvic-Ureteric Junction Obstruction (PUJO). Laparoscopic pyeloplasty has gained popularity in recent years because it is less invasive, has better cosmesis, and reduces hospital stays with an equivalent success rate compared to open pyeloplasty. This study was designed to find out the success rate of laparoscopic transperitoneal pyeloplasty in cases with unilateral PUJO. Method: This was a retrospective study, which included four years of data on patients who underwent laparoscopic pyeloplasty from 1 Jan 2019 to 31 Dec 2022 in the Department of Urology, Bir Hospital, National Academy of Medical Sciences, Nepal. Ethical approval was obtained. Microsoft Excel was used for descriptive analysis, frequency, and percentage of clinical and demographic data for age, gender, and site. Pre- and post-operative data of differential renal function (DRF) based on the radio-isotope renography and their association were compared using the χ2 test. A p-value of <0.05 was considered statistically significant. Result: Out of 25 cases, renal function improvement was observed in 18(72%), stable in 6(24%), and deteriorated in 1(4%) cases based on DRF analysis. Male to female ratio was 13:12, the mean age was 26 y (8-60 y), and the left side was 14(60%). A mean improvement of DRF of 3.1% was observed in the age group of >30 y, and a mean improvement of DRF of 4.3% was also observed in the cases with DRF ≤30%. Conclusion: The laparoscopic pyeloplasty showed excellent functional outcomes in the majority of the cases with PUJO.

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Section: The Renal Function May Not Be Improved After Pyeloplasty If ...mentioning

confidence: 92%

Functional outcome after transperitoneal laparoscopic pyeloplasty at a tertiary care center, Nepal

Regmi,

Bhattarai,

Maharjan

et al. 2023

J Patan Acad Health Sci

View full text Add to dashboard Cite

show abstract

Editorial Comment to Day‐case catheterless and drainless minimal‐access pyeloplasty in adults: A single‐center experience of 13 years

Inamoto

Azuma

2021

Int J of Urology

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The overall complication rate was low, and similar to that reported in other studies. 16 There was no increased incidence of UTIs or fibrosis secondary to the routine stent insertion in our series. The overall subjective success rate of 91% and objective success rates of 86% were comparable to those of our previous study. Thus, this large-volume, long-term study proposes that catheterless and drainless minimal-access day surgery is safe and should be considered in all patients with ASA scores of 1 and 2 with adequate social support.This study has some limitations, including those inherent in its retrospective observational design. One possible bias is that the technique has evolved over the course of the years included in the study period and the procedure was performed by more than one surgeon, which can potentially lead to different outcomes.To the best of our knowledge, this is the largest singlecenter series of day-case minimal access pyeloplasty. We confirm our previously reported observation (for pure laparoscopy) that routine drains or urethral catheters are not required in minimal-access pyeloplasty (laparoscopic, with or without robotic assistance), which facilitates early recovery and day-case discharge without compromising long-term surgical outcomes. Further large randomized controlled studies are required to prospectively evaluate outcomes.

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Obstacles and sustainability of enhanced recovery after surgery in pediatric laparoscopic pyeloplasty

Zhu,

Lai,

et al. 2024

Front. Pediatr.

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ObjectivesPrevious studies on Enhanced Recovery After Surgery (ERAS) in pediatric Laparoscopic Pyeloplasty (LP) lacked clear control cases and discussed the obstacles in the implementation process. This article details the obstacles and lessons learned during the implementation of ERAS in patients with ureteropelvic junction obstruction (UPJO).MethodsAn ERAS protocol was implemented in the UPJO population undergoing LP, which included preoperative, intraoperative, and postoperative management. The clinical data of ERAS program Before Implementation (BI) and After Implementation (AI) were collected and analyzed retrospectively.ResultsA total of 107 patients (BI 46, AI 61) were enrolled. Compared with the BI group, the AI group had an earlier normal diet (19.83 h vs. 9.53 h, p < 0.001), ambulation (39.10 h vs. 12.70 h, p < 0.001), resumption of defecation (89.88 h vs. 27.90 h, p < 0.001), less need for additional analgesia (19.5% vs. 1.6%, p = 0.002) and shorter postoperative hospital stay (POS) (6.00 d vs. 1.91 d, p < 0.001) without increasing complications and readmission rates. Patients in the AI group had a median protocol score of 17 (IQR 16–18), and the compliance rate of the ERAS protocol was negatively correlated with the length of POS (R2 = 0.69, p < 0.001).ConclusionsThe application of ERAS in pediatric LP is feasible and sustainable, with the potential for even greater impact as compliance improves. Common barriers were uncertain start time of surgery, lack of knowledge of ERAS among pathway participants, and support from anesthesiologists. Pre-determining the start time of surgery, strengthening preoperative education and positive communication among team members can help to promote the full implementation of ERAS program.

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Day‐case catheterless and drainless minimal‐access pyeloplasty in adults: A single‐center experience of 13 years

Cited by 3 publications

References 13 publications

Functional outcome after transperitoneal laparoscopic pyeloplasty at a tertiary care center, Nepal

Functional outcome after transperitoneal laparoscopic pyeloplasty at a tertiary care center, Nepal

Editorial Comment to Day‐case catheterless and drainless minimal‐access pyeloplasty in adults: A single‐center experience of 13 years

Obstacles and sustainability of enhanced recovery after surgery in pediatric laparoscopic pyeloplasty

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