Endopyelotomy still has an important role in the management of ureteropelvic junction obstruction

Samarasekera, Dinesh; Chew, Ben H.

doi:10.5489/cuaj.11032

Cited by 13 publications

(6 citation statements)

References 38 publications

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“…While abdominal surgery is required for open, laparoscopic and robot assisted approaches, EP probably has the lowest invasiveness [12]. Even though EP has been replaced by other approaches in many institutions, several experts in the field still advocate this technique [13]; especially, as few literature is available summarizing the evidence on all approaches. Notwithstanding that meta-analyses have been published comparing individual studies for two treatment options, these provides limited guidance in the current situation with multiple approaches available for UPJO which must be evaluated against each another.…”

Section: Introductionmentioning

confidence: 99%

Surgical approaches for treatment of ureteropelvic junction obstruction – a systematic review and network meta-analysis

Uhlig¹,

Uhlig

Trojan³

et al. 2019

BMC Urol

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BackgroundMultiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach.MethodsA systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques.ResultsA total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05–0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31–0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41–0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22–0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min–163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min–164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min–151.58 min, p = 0.003).ConclusionsMultiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.

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Section: Introductionmentioning

confidence: 99%

Surgical approaches for treatment of ureteropelvic junction obstruction – a systematic review and network meta-analysis

Uhlig¹,

Uhlig

Trojan³

et al. 2019

BMC Urol

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“…However, antegrade endopyelotomy has a low success rate in comparison with that of open and laparoscopic pyeloplasty (12). In addition, a variety of factors, such as the existence of crossing veins, length of the obstruction, and degree of hydronephrosis, affect the success of endopyelotomy (13). Bleeding and urosepsis, in addition to the risk of colon or pleura scarring, during PNL are considered additional disadvantages (14).…”

Section: Discussionmentioning

confidence: 99%

Laparoskopik Pyeloplasti Ve Pyelolitotomi Operasyonlarında Taş Çıkarılmasında Fleksible Sistoskop Kullanımı

Bitkin¹,

Aydın²,

Akgüneş³

et al. 2019

Yeni Üroloji Dergisi

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Objective: Laparoscopic pyeloplasty and laparoscopic pyelolithotomy are widely used in the treatment of ureteropelvic junction (UPJ) obstructions and renal stones in the urology field. Flexible cystoscopy can be used simultaneously with these methods for removal of calyceal stones in patients with UPJ obstructions. The present study assessed the usefulness of these surgical procedures. Material and Methods: Between February 2016 and October 2017, 7 patients underwent stone removal with a flexible cystoscope during laparoscopic pyelolithotomy and laparoscopic pyeloplasty. The durations of the operations and hospital stays, blood loss, preoperative and postoperative complications, and follow-up times were evaluated. Results: Five of seven patients had renal stones with UPJ obstruction. Two patients had calyceal stones in the lower calyx , in addition to renal pelvic stones. The mean age of the patients was 36.8 (18-73) years. The stone-free rate was 85.7%. The mean duration of the operation was 153.5 (105-230) min, and the duration of the hospital stay was 4.4 (3-7) days. There were no intraoperative or postoperative complications. Conclusion: Laparoscopic pyeloplasty and pyelolithotomy, with simultaneous use of flexible cystoscopy in UPJ obstruction patients with kidney stones and patients with multiple renal stones is a feasible treatment option, with a high success rate.

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“…Patients with length of stricture >2 cm are less likely to have a successful outcome after endopyelotomy [ 12 , 18 ]. Ravery et al [ 11 ] found that the mean length of obstruction in patients who had a recurrence was longer than that of patients who were cured.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Retrograde Balloon Dilatation and Laparoscopic Pyeloplasty for Treatment of Ureteropelvic Junction Obstruction: Results of a 2-Year Follow-Up

Chen

Xue

et al. 2016

PLoS ONE

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ObjectiveTo evaluate the efficacy of laparoscopic pyeloplasty relative to retrograde balloon dilatation for the treatment of ureteropelvic junction obstruction (UPJO).MethodsThis retrospective study enrolled UPJO patients with stricture length < 2 cm who had been treated with laparoscopic pyeloplasty (LP; 44 cases) or balloon dilatation (BD; 38 cases) from Jan 2010 to Jan 2012, according to patients’ preference after consultation. Demographics and clinical parameters were collected. Patients were followed-up at 3, 6, 12, and 24 months. Ultrasonography, intravenous urography, and diuretic renography were applied to evaluate the remission of hydronephrosis.ResultsBoth groups were comparable with respect to age, UPJO location, gender, and other baseline parameters. Compared to the LP group, patients receiving BD experienced significantly shorter operative time, analgesia time, hospital stay, and urethral catheter indwelling time, and less cost (P<0.001). Three and 6 months after their respective procedures, the success rates of the LP (97.7%, both) and BD (94.7% and 86.8%) groups were similar, and at 12 and 24 months the long-term success rate of LP (95.5%, both) was better than that of BD (78.9% and 71.0%).ConclusionsLP showed better long-term success rate than did BD in the management of UPJO with length of stricture < 2 cm. Considering that BD is more minimally invasive, simpler and easier to perform, and costs less, we recommend it for some selective UPJO patients as the first-line therapy.

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Endopyelotomy still has an important role in the management of ureteropelvic junction obstruction

Cited by 13 publications

References 38 publications

Surgical approaches for treatment of ureteropelvic junction obstruction – a systematic review and network meta-analysis

Surgical approaches for treatment of ureteropelvic junction obstruction – a systematic review and network meta-analysis

Laparoskopik Pyeloplasti Ve Pyelolitotomi Operasyonlarında Taş Çıkarılmasında Fleksible Sistoskop Kullanımı

Comparison of Retrograde Balloon Dilatation and Laparoscopic Pyeloplasty for Treatment of Ureteropelvic Junction Obstruction: Results of a 2-Year Follow-Up

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