Laparoscopic Pediatric Pyeloplasty: Trends in Regions of the Russian Federation

Bondarenko, S.; Kagantsov, Ilya M.; Сизонов, В. В.; Акрамов, Н. Р.; Пирогов, А В; Саблин, Д. Е.; Суров, Р. В.; Баранов, Ю. В.

doi:10.21886/2308-6424-2020-8-1-5-13

Cited by 3 publications

(3 citation statements)

References 9 publications

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Section: Discussionmentioning

confidence: 99%

“…During the first part of this study period, younger patients were mostly treated by the open access method until the laparoscopic technic had become sufficiently safe and effective also in smaller children. [24] The Hellstrom [7] and Chapman [9] techniques have certain limitations. While the Hellstrom technique is limited by the lack of paravasal tissue required for reliable fixation of the LPCV to the pelvis after vessel mobilization, the Chapman technique can only be used if the pelvis is sufficiently dilated for invaginating the anterior wall and creating a tunnel for LPCV fixation.…”

Section: Discussionmentioning

confidence: 99%

“…While laparoscopic access is the method of choice for all children nowadays, this technique was largely reserved for older children in the past. During the first part of this study period, younger patients were mostly treated by the open access method until the laparoscopic technic had become sufficiently safe and effective also in smaller children [24] …”

Section: Discussionmentioning

confidence: 99%

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Transposition and fixation of lower pole crossing vessel in children with ureteropelvic junction obstruction

et al. 2021

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Chapman and Hellstrom techniques are typically employed to transpose renal lower pole crossing vessels (LPCVs). Both procedures have certain limitations. We investigated the midterm outcomes in pediatric patients in whom LPCV-induced ureteropelvic junction obstruction was treated with either dismembered Anderson-Hynes pyeloplasty or upward transposition coupled with a new technique to fix the LPCV. We retrospectively compared Anderson-Hynes pyeloplasty to the new technique in terms of outcome. LPCV transposition was considered feasible in patients in whom the diuretic loading test revealed a decrease in the pelvic volume after correction of vascular compression as well as absence of structural changes in the ureteropelvic junction (UPJ) and hemodynamic compromise of the lower renal pole. The fascial flap was passed below the LPCV to form a “hammock”. The free edge of the flap was sutured to its base. Group 1 consisted of 102 (69.9%) patients (median age: 7.9 years) undergoing dismembered Anderson-Hynes pyeloplasty, while group 2 included 44 (30.1%) patients (median age: 8.4 years) treated with upward transposition and the new technique to fix the LPCV. No intra-operative complications or conversions occurred in either group. Redo-pyeloplasty was performed in 3 (2.9%) children of group 1 and 1 (2.3%) child of group 2. Renal ultrasonography conducted 12 months after surgery revealed similar anteroposterior diameters of the renal pelvis in groups 1 (7.9 ± 8.1 mm) and 2 (6.0 ± 2.9 mm). Patients in both groups showed a non-significant median increase in differential renal function at follow-up after at least 1 year after surgery (group 1: 36% [33.3; 40.5] vs 36.5% [35.3; 41.0]; group 2: 41% [37.5; 46.0] vs 43% [39; 46]). In our patients, the new technique for laparoscopic or open fixation of the obstructing vessel after transposition was effective, reproducible, and devoid of limitations typical for the Chapman and Hellstrom techniques. We recommend Anderson-Hynes pyeloplasty in children with a history of hydronephrosis diagnosed antenatally, recurrent abdominal pain, intra-operative absence of peristalsis across the UPJ, high location of the UPJ at the renal pelvis, or intra-operative absence of volume reduction of the renal pelvis upon furosemide testing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Transposition and fixation of lower pole crossing vessel in children with ureteropelvic junction obstruction

et al. 2021

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Pyeloplasty effectiveness in cases of ureteropelvic junction obstruction in children: methodology and assessment parameters

2021

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The article presents the analysis of published data (Scopus, Web of Science, PubMed/MedLine, The Cochrane Library, and eLIBRARY databases) devoted to the study of existing criteria for assessment of pyeloplasty effectiveness. Published sources most often refer to the dynamics of reduction of the renal collecting system (RCS) and postoperative renal functional status as the assessment criteria. However, there are no consistent values, which could be employed as assessment criteria indicating success as soon as they are registered. The tools used to estimate RCS reduction are not standardized in terms of research techniques, projection of RCS dilatation measurement, and the locations between which renal and pelvic anatomic structures are measured. A variety of approaches to measuring the anteroposterior renal pelvis dimension in children with hydronephrosis tends to blur the analysis of actual pyeloplasty results. This review of published sources demonstrates the lack of agreement as regards the criteria for assessment of pyeloplasty effectiveness. There is a pressing need for appropriate steps to harmonize ultrasonography methods, to standardize the anatomic landmarks for measurement, and to define the criteria to be used to assess the effectiveness of pyeloplasty.

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Regression of renal collecting system dilatation after pyeloplasty in children: evaluation of dynamics

Kogan,

Sizonov,

Shidaev

et al. 2023

Vestn. Urol.

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АннотацияВведение. Пиелопластика у детей обеспечивает успех в 83 -97% случаях. Однако на сегодняшний день отсутствует консенсус в части определения понятия «успех» в отношении результатов пиелопластики, что исключает формирование общепринятого стандартизированного подхода к послеоперационному ведению пациентов. Цель исследования. Исследовать динамику регрессии дилатации чашечно-лоханочной системы (ЧЛС) у пациентов с обструкцией пиелоуретерльного сегмента (ОПУС) после пиелопластики. Материалы и методы. Исследована динамика регрессии дилатации ЧЛС у 69 пациентов с ОПУС после пиелопластики. Внутренняя причина ОПУС установлена у 55 (80%) пациентов, внешняя причина (конфликтный сосуд) -у 14 (20%) больных. Больные оперированы с использованием лапароскопического доступа, редукционную резекцию лоханки не выполняли. В до-и послеоперационном периодах УЗИ почек выполняли в положении на животе в состоянии волемического покоя на фоне опорожненного мочевого пузыря. Сравнивали значения ПЗР лоханки, измеренный в сагиттальной плоскости. У всех использовали наружный метод дренирования ЧЛС, который прекращали после восстановления уродинамики верхних мочевыводящих путей (ВМП) по данным пиеломанометрии. Результаты. Через 3 месяца после пиелопластики отмечается регрессия дилатации ЧЛС почки на 40%, через 6 месяцев -на 53%, через 12 месяцев -на 64% от исходного значения. У пациентов с внутренними причинами ОПУС через 3 месяца после пиелопластики отмечается регрессия дилатации ЧЛС почки на 34%, через 6 месяцев -на 42%, через 12 месяцев -на 61%, а у пациентов с внешними причинами ОПУС через 3 месяца отмечается регрессия ЧЛС на 49%, через 6 месяцев -на 56%, через 12 месяцев -на 86%. Заключение. Пред-и послеоперационное УЗИ почек при ОПУС должно выполняться в положении пациента на животе в состоянии волемического покоя на фоне опорожненного мочевого пузыря. У пациентов с уродинамически подтверждённым восстановлением проходимости ПУС через 12 месяцев после операции отмечается уменьшение дилатации ЧЛС на 61% у пациентов с внутренними причинами ОПУС и на 86% у детей с внешними причинами ОПУС от дооперационных значений. Ключевые слова: гидронефроз; обструкция пиелоуретерального сегмента; эффективность пиелопластики; передне-задний размер лоханки; ультразвуковое исследование; дети Финансирование. Исследование не имело спонсорской поддержки. Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов. Этическое заявление. Исследование выполнено в соответствии с положениями Хельсинкской декларации пересмотренной в Форталезе (Бразилия) в октябре 2013 года. Этическое одобрение. Исследование выполнено в рамках диссертационной работы, одобренной локальным независимым этическим комитетом ФГБОУ ВО РостГМУ Минздрава России (Протокол № 15/20 от 8 октября 2020 года). Информированное согласие. Родители / представители пациентов подписали информированное согласие на участие в исследовании и обработку персональных данных.

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Laparoscopic Pediatric Pyeloplasty: Trends in Regions of the Russian Federation

Cited by 3 publications

References 9 publications

Transposition and fixation of lower pole crossing vessel in children with ureteropelvic junction obstruction

Transposition and fixation of lower pole crossing vessel in children with ureteropelvic junction obstruction

Pyeloplasty effectiveness in cases of ureteropelvic junction obstruction in children: methodology and assessment parameters

Regression of renal collecting system dilatation after pyeloplasty in children: evaluation of dynamics

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