Functional, morphological and operative outcome after pyeloplasty in adult patients: Laparoscopic versus open

Merder, Erkan; Sabuncu, Kenan; Altunrende, Fatih

doi:10.1177/0391560320987921

Cited by 3 publications

(4 citation statements)

References 24 publications

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“…Недостатком лапароскопической пиелопластики можно считать продолжительность операции, связанную с особенностью формирования интракорпорального шва. Одним из возможных осложнений лапароскопической пиелопластики может быть несостоятельность анастомоза с формированием мочевых затеков и инфицированием, что в конечном итоге влияет на эффективность операции в виде развития рестенозов [8,16,17]. В данной работе в группе пациентов с предстентированием мы отметили меньший процент (5,9%) несостоятельности анастомоза, где потребовалось дополнительное дренирование полостной системы почки путем перкутанной нефростомии, во второй группе мы наблюдали трех подобных пациентов (16,1%), однако данное осложнение не повлияло на эффективность хирургического лечения, при этом этап формирования анастомоза в группе предстентированных пациентов технически был проще выполним и не требовал дополнительной конвергенции анастомозируемых краев.…”

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“…сообщили о лапароскопической пиелопластике, с того времени количество вмешательств, выполненных подобным доступом, значительно возросло [6,7]. В сравнении с открытой лапароскопическая пиелопластика имеет схожую эффективность при меньшей потребности в анальгетиках и сроках реабилитации, хотя при этом увеличивается время операции [8].…”

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“…В литературе встречаются редкие упоминания о положительном влиянии предстентирования на результаты пиелопластики за счет развития пассивной дилатации на фоне арефлексии мочеточника [8,13].…”

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Estimation of the results of laparoscopic pyeloplasty in primary strictures of the pelvic-ureteral segment.

Panferov,

Bekreev,

Malkhasyan

2023

ECU

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Introduction. In 1993, W.W. Schuessler et al. laparoscopic pyeloplasty was reported, and since that time the number of interventions performed with such access has increased significantly. Laparoscopic pyeloplasty does not exclude possible complications, including early ones - urinary congestion, anastomosis failure and distant ones, restenosis and obliteration of the ureteral lumen, which can develop as a result of ischemia due to excessive tissue tension. There are isolated references in the literature about the positive effect of prestenting on the results of pyeloplasty. Objective. Estimate the results of laparoscopic pyeloplasty in patients without prestenting and with prestenting. Materials and methods. A retrospective analysis of the treatment of 73 patients with stricture of the pelvic ureteral segment is presented. All patients were divided into two groups: I (main) – 17 patients whose upper urinary tract was drained by a ureteral stent at the time of surgery, II (control) - 56 patients who had not previously had upper urinary tract drainage. Results. The results, nature and frequency of complications of laparoscopic pyeloplasty in patients with and without prestenting are analyzed. The average operation time in group I was about 153.85 minutes, in group II - 116.7 minutes, the average drainage time in group I was 22.1 hours, in group II - 30.8 hours. Requirement for analgesics: group I – 48.5 mg/day, group II – 56.2 mg/day. In group I, one complication (5.9%) of category 1 was recorded - an attack of pyelonephritis and one case of complications (5.9%) of category 3a (urinoma). In group II, 6 cases (10.7%) of category 1 complications, 9 cases (16.1%) of category 3a complications were recorded. The results according to MSCT, performed 3 months after surgery, demonstrated restoration of patency at the level of the ureteropelvic segment. Conclusions. Prestenting of the ureter reduces the frequency of postoperative complications during laparoscopic pyeloplasty and eliminates the need for additional mobilization of the kidney for the formation of ureteropyeloanastomosis without excessive tension.

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Estimation of the results of laparoscopic pyeloplasty in primary strictures of the pelvic-ureteral segment.

Panferov,

Bekreev,

Malkhasyan

2023

ECU

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“…Merder et al compared the results of open pyeloplasty and laparoscopic pyeloplasty in adults and reported a decrease in hydronephrosis 6 months after the surgery in 58% and 52.9% of the patients, respectively. 32 Studies have shown that a significant number of adults with UPJO are symptomatic. 18,33 Although the main symptom is pain, recurrent urinary tract infections can also be observed in this patient group.…”

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confidence: 99%

The Success of Pyeloplasty in Adult Patients with Ureteropelvic Junction Obstruction: A Retrospective Clinical Study

İLKTAÇ¹,

ERSÖZ²,

Doğan³

et al. 2022

J Reconstr Urol

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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.

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Surgical intervention and long-term renal outcomes of congenital ureteropelvic junction obstruction in a young adult cohort

Stewart,

Olson,

Lechner

et al. 2024

Int Urol Nephrol

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To evaluate the impact of surgical intervention on long-term renal outcomes for adult patients with congenital ureteropelvic junction obstruction (UPJO). MethodsWe queried service members diagnosed with UPJO from the United States Military Health System electronic health records from 2005 to 2020. We assessed demographic, laboratory, radiology, surgical intervention, and outcome data. We evaluated the impact of surgical intervention on renal function based on the estimated glomerular ltration rate (eGFR), hypertension (HTN, de ned as any prescription for blood pressure [BP] medication and/or average of two BP readings ≥ 130/80mmHg more than 2 weeks apart), and changes in renal excretory function on radionuclide scans. ResultsWe identi ed 108 individuals diagnosed with congenital UPJO; mean follow-up of 7 years. Mean age at diagnosis was 25 years; 95% male; 69% White, 15% Black. At diagnosis, median BP was 130/78mmHg and mean eGFR 93ml/min/1.73m 2 . Subsequently, 85% had pyeloplasty and 23% had stent placement. There were no signi cant differences in mean eGFR pre-and post-intervention (94 vs 93 ml/min/1.73m 2 , respectively; p = 0.15) and prevalence of de ned HTN (59% vs. 61%, respectively; p = 0.20). Surgical intervention for right-sided UPJO signi cantly reduced the proportion of patients with delayed cortical excretion (54% pre vs. 35% post, p = 0.01) and T½ emptying time (35 min vs. 19 min, p = 0.009). Similar trends occurred with left-sided UPJO but were not signi cant. ConclusionSurgical intervention was not associated with signi cant differences in the long-term outcomes of kidney function and HTN prevalence in our young adult cohort. However, renal excretory function improved on radionuclide scans.

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Functional, morphological and operative outcome after pyeloplasty in adult patients: Laparoscopic versus open

Cited by 3 publications

References 24 publications

Estimation of the results of laparoscopic pyeloplasty in primary strictures of the pelvic-ureteral segment.

Estimation of the results of laparoscopic pyeloplasty in primary strictures of the pelvic-ureteral segment.

The Success of Pyeloplasty in Adult Patients with Ureteropelvic Junction Obstruction: A Retrospective Clinical Study

Surgical intervention and long-term renal outcomes of congenital ureteropelvic junction obstruction in a young adult cohort

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