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

Uhlig, Annemarie; Uhlig, Johannes; Trojan, Lutz; Hinterthaner, Marc; Hammerstein‐Equord, Alexander von; Strauß, Arne

doi:10.1186/s12894-019-0544-7

Cited by 19 publications

(13 citation statements)

References 49 publications

(96 reference statements)

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“…Direct comparisons between LP and RAP have mostly been observational in nature[ 50 ] and randomized trials comparing the two techniques are few. [ 51 ] Until recently, systemic reviews and meta-analysis comparing LP with RAP reported conflicting results. [ 52 ] However, Uhlig et al .…”

Section: Resultsmentioning

confidence: 99%

“…recently performed a network meta-analysis of mostly adult patients with UPJO comparing the outcomes of open pyeloplasty, LP, RAP and endopyelotomy. [ 51 ] The authors report that RAP is associated with a significantly higher operative success rate compared to the LP, while the risk of peri-operative complications, urine leak, re-operation rate, blood transfusion rate and LOS were comparable. On including only the studies reporting 1-year follow up (13 of 24 studies), no difference in success rates was found between LP and RAP.…”

Section: Resultsmentioning

confidence: 99%

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Role of laparoscopy in the era of robotic surgery in urology in developing countries

Bansal

Chaturvedi

Maheshwari

et al. 2021

Indian Journal of Urology

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With the rapid expansion of robotic platforms in urology, there is an urgent and unmet need to review its cost and benefits in comparison to the traditional laparoscopy, especially in reference to a developing country. A nonsystematic review of the literature was conducted to compare the outcomes of pure laparoscopic and robot-assisted urologic procedures. Available literature over the past 30 years was reviewed. Robot-assisted surgery and laparoscopy were found to have similar outcomes in the areas of radical prostatectomy, partial and radical nephrectomy, radical cystectomy, retroperitoneal lymph node (LN) dissection, inguinal LN dissection, donor nephrectomy, and kidney transplantation. Robot-assisted surgery was found to be significantly costlier than pure laparoscopy. In the absence of a clear advantage of robot-assisted surgery over pure laparoscopy, lack of widespread availability and the currently prohibitive cost of robotic technology, laparoscopic urological surgery has a definite role in the developing world.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Role of laparoscopy in the era of robotic surgery in urology in developing countries

Bansal

Chaturvedi

Maheshwari

et al. 2021

Indian Journal of Urology

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“…A more recent systematic review of 26 retrospective and prospective studies showed no statistically significant differences between RALP and LP with respect to operative time (OR = −12.12; 95% CI −41.08–16.84; p = 0.412), and length of stay (OR = −0.87; 95% CI −3.23–1.49; p = 0.471). 30 …”

Section: Perioperative Outcomesmentioning

confidence: 99%

“…RALP and LP yielded analogue results regarding overall mid and long-term complications (OR = 1; 95% CI 1–1; p = NA), urinary leakage (OR = 0.57; 95% CI 0.24–1.36; p = 0.206), transfusion rate (OR = 0.44; 95% CI 0.02–10.32; p = 0.613) and re-operation rate (OR = 0.32; 95% CI 0.01–8.24; p = 0.494). 41 …”

Section: Complicationsmentioning

confidence: 99%

<p>Comparison of Safety, Efficacy and Outcomes of Robot Assisted Laparoscopic Pyeloplasty vs Conventional Laparoscopy</p>

Mantica¹,

Ambrosini²,

Parodi³

et al. 2020

RRU

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Pyeloplasty is considered the gold standard for the management of ureteropelvic junction obstruction in cases of flank pain, recurrent stone formation or infection, and deteriorating renal function. Over the last two decades, minimally invasive techniques such as robotic (RALP) and laparoscopic pyeloplasty (LP) have become increasingly popular and have been moderately replacing the open approach. This paper aims to provide a comprehensive up-to-date review on safety, efficacy and outcomes regarding robotic repair of UPJO compared to the conventional laparoscopic procedure. RALP represents a viable and innovative alternative to conventional LP with a comparable success and complication rate both in adult and in paediatric fields. The robotic approach seems to add further technical advantages when compared to conventional LP but sustains a higher costs. Currently, the choice to adopt one of the different minimally invasive approaches depends on the surgeon’s preference or experience, and on institutional availability.

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“…Several methods can be used to treat UPJO, including open pyeloplasty (OP), endoscopic pyelotomy (EP), laparoscopy (LP) and robot assisted pyeloplasty (RP). The success rate of RP is the highest, the complication of LP is lower than that of OP, the success rate of EP is relatively low, but the operation time is the shortest of all surgical methods [ 6 ]. In clinical work, the management of crossing vessels has always been a difficult challenge in laparoscopic pyeloplasty (LP).…”

Section: Introductionmentioning

confidence: 99%

Crossing vessels with suspension versus transposition in laparoscopic pyeloplasty of patients with ureteropelvic junction obstruction: a retrospective study

Zhang

Chen

et al. 2021

BMC Urol

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Purpose To compare the effects of two different methods of laparoscopic pyeloplasty for the treatment of crossing vessels. Methods From January 2016 to August 2019, 33 patients with ureteropelvic junction obstruction (UPJO) underwent laparoscopic pyeloplasty at our center, including 21 men and 12 women, ranging from 14 to 66 years of age. There were 20 and 13 cases on the left and right sides, respectively. Patients underwent laparoscopic pyeloplasty (Anderson-Hynes operation). During the operation, either a Hem-o-lok clip suspension or transposition was used to treat the crossing vessels. The double-J stent was removed 8 weeks after the operation. The clinical data of patients were collected and follow-ups were regularly performed after the operation. Results All the crossing vessels were successfully preserved, and none of them were severed during the operation. The average operation time was 210.6 ± 58.9 min in this group and the average time to manage the crossing vessel was 8.0 ± 3.5 min, 5.9 ± 1.4 min in the suspension group, and 11.7 ± 3.0 min in the transposition group. The dilation of the affected side was 4.8 ± 1.5 cm before operation and 1.2 ± 1.3 cm 3 months after operation. The difference was statistically significant (P < 0.05). Follow-up to February 2020 showed no significant changes in the kidney size in all patients and hydronephrosis was relieved. Conclusion For UPJO patients with crossing vessel compression, the method of Hem-o-lok suspension or vascular transposition can be used to relieve crossing vascular compression and improve the success of pyeloplasty.

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

Cited by 19 publications

References 49 publications

Role of laparoscopy in the era of robotic surgery in urology in developing countries

Role of laparoscopy in the era of robotic surgery in urology in developing countries

<p>Comparison of Safety, Efficacy and Outcomes of Robot Assisted Laparoscopic Pyeloplasty vs Conventional Laparoscopy</p>

Crossing vessels with suspension versus transposition in laparoscopic pyeloplasty of patients with ureteropelvic junction obstruction: a retrospective study

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