Nonintubated Anderson-Hynes Repair of Ureteropelvic Junction Obstruction in 60 Patients

Abstract

We reviewed our experience with 68 consecutive Anderson-Hynes ureteropyeloplasties. The 64 infants, children and young adults ranged from 2 days to 28 years old (median age 2 years), and 28 were less than 1 year old. Intubation was used in only 4 patients: 2 who also underwent ureteral reimplantation for vesicoureteral reflux, 1 with stones in the renal pelvis and 1 with pyonephrosis. We successfully repaired 60 of 64 nonintubated renal units (93.4 per cent). Temporary postoperative ureteral stenting was required for extravasation from 8 renal units (12.5 per cent). Two patients later underwent repeat ureteropyeloplasty for recurrent obstruction. Nephrectomy was performed for pyonephrosis in 1 patient and for a nonfunctioning kidney that had exhibited poor function preoperatively in 1. Prolonged ileus necessitated extended hospitalization in 3 patients (4.6 per cent). We conclude that nonintubated dismembered ureteropyeloplasty for uncomplicated, primary ureteropelvic junction obstruction can be performed safely and successfully, and should be considered the standard treatment. Positioning of the Penrose drain is critical to avoid urinoma formation. When persistent urinary leakage occurs temporary diversion is easy and well tolerated. Hospital stay averaged 12.1 days for patients with extravasation compared to 4.3 days when no extravasation occurred. Immediate preoperative retrograde pyelography did not seem to contribute to postoperative urinary extravasation by causing edema of the ureteral orifice.

Anderson-Hynes Pyeloplasty in Children: Nonintubated Versus Intubated

“…The difference of hospital stay between the nonintubated and intubated pyeloplasty was highly significant (P<0.01). This study correlated with the other studies 2,5,7 . The study conducted by Nguyen 2 proved that postoperative hospital stay after nonintubated and intubated A-H pyeloplasty was 4.3 days and 12 days respectively.…”

“…Although there are many types of surgical procedures done for the correction of this anomaly, the AndersonHynes pyeloplasty is the most common 2 but controversy remains regarding the diversion of urine after A-H pyeloplasty 3 . Now a days, there is an increasing trend to do the A-H pyeloplasty nonintubatedly in children 2,4,5 . Because most of the surgeons believe that nephrostomy/ pyelostomy tube or stent are found to be unnecessary if watertight closure of the anastomosis is achieved 3 .…”

“…Because most of the surgeons believe that nephrostomy/ pyelostomy tube or stent are found to be unnecessary if watertight closure of the anastomosis is achieved 3 . Moreover intubated A-H pyeloplasty has been alleged to have more disadvantages, e.g, more postoperative hospital stay, increased incidence of postoperative urinary tract infection, difficulties in patient mobilization 2,4,5,6 . They also assumed that the patency of the pelviureteric anastomosis is best ensured by encouraging the urine to pass through the anastomosis as early as possible 4 .…”

Minimally Invasive Pyeloplasty in Horseshoe Kidneys with Ureteropelvic Junction obstruction: A case series

“…Nevertheless, open surgery success rates in horseshoe kidneys were less favorable than in orthotopic kidneys, ranging from 55 to 80% (9,10) compared to over 90% respectively (11,12). In comparison, success rates of endopyelotomy in horseshoe kidneys range from 66-75% based on three small series, each containing just 3-4 patients (1,13,14).…”

Cost‐effective laparoscopic pyeloplasty: Single center experience

“…[1][2][3][4] However, it is associated with open surgery postoperative morbidity, pain, prolonged convalescence and a prominent skin incision. Various minimally invasive techniques for repairing obstructed UPJ, such as percutaneous antegrade and endoscopic retrograde approaches, have success rates that are 10-25% lower than those of open pyeloplasty [4][5][6][7][8][9] and are not suitable for patients with a large renal pelvis, poor renal function, high insertion of ureter, concomitant renal stones, extrinsic vessels, or for patients who have failed endourologic procedures.…”