Ureter-first Approach and Reduction of Pelvis: Standardizing Handling of Ureteropelvic Junction During Pyeloplasty

Nayyar, Rishi; Kumar, Prashant; Panaiyadiyan, Sridhar; Seth, Amlesh

doi:10.1016/j.urology.2021.10.030

Cited by 2 publications

(3 citation statements)

References 19 publications

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“…During our search, we found only one study describing ureter first approach technique. Nayyar et al (13) in their study that included fifty-one patients that had repair using ureter first approach technique found that there were no failures after follow up of cases that required reintervention. They concluded that ureter approach could prevent unnecessary tissue loss if a wrong incision was done and could allow good tension-free anastomosis in all cases especially the uncommon ones like low insertion of the ureter and long segment of UPJO.…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that ureter approach could prevent unnecessary tissue loss if a wrong incision was done and could allow good tension-free anastomosis in all cases especially the uncommon ones like low insertion of the ureter and long segment of UPJO. They thought that such approach can also standardize the steps of pyeloplasty surgery and could reduce the surgical mistakes that may happen to newer surgeons or residents (13). There were multiple modifications of conventional A-H pyeloplasty aiming at reducing complications and make the procedure easier to perform (14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

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Comparative study between ureter first approach and conventional open Anderson-Hynes pyeloplasty in paediatric patients: A prospective randomised study

Fathi

Elgammal

Abouelgreed

et al. 2023

Arch Ital Urol Androl

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Background: Uretero-pelvic junction obstruction is the most common form of congenital anomaly of the kidney and urinary tract with an incidence of about 1/1.000-1.500 of births and the aetiology and pathogenesis of this anomaly are still unclear until now. Methods: This is a prospective randomized comparative study conducted from March 2022 to December 2022. Thirty children with uretero-pelvic junction obstruction were included and randomly divided into two groups according to a 1:1 ratio (computer-generated randomization, single blind). Fifteen cases (12 males and 3 female) were subjected to ureter first approach pyeloplasty, and another fifteen (9 males and 6 female) were subjected to conventional Anderson Hynes pyeloplasty. Results: The mean age of all patients was 6.7 ± 5.4 years in ureter first approach group and 5.1 ± 4.3 years in conventional Anderson-Hynes pyeloplasty group. There were no significant differences between the two groups regarding age, gender, presentation, side, preoperative renogram and post-operative renogram. Also, there were no significant differences between the two groups regarding operative time (in first group 110.3 ± 12.4 and in the second group 111.2 ± 12.0 with p < 0.836), pre and post-operative complication rate. Two cases of urinary tract infections in the first group, one of them having fever, and four cases in the second group, two of them having fever (p < 0.651); four cases of loin pain in the first group and one case in the second group (p < 0.330); one case in the first group having pro- longed leakage of urine for 7 days in post-operative period (p < 0.309). However GFR and t 1⁄2 improved significantly after operation in both groups (p < 0.001). Conclusions: Ureter first approach is a simple and effective procedure in children with good short term outcomes and could be done safely especially for beginners and less expert surgeons. Finally, it can overcome the problem of long ureteric stricture that may be found intraoperatively because you can shift easily to a flap procedure and complete a tension free anastomosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparative study between ureter first approach and conventional open Anderson-Hynes pyeloplasty in paediatric patients: A prospective randomised study

Fathi

Elgammal

Abouelgreed

et al. 2023

Arch Ital Urol Androl

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“…Preoperative planning, the creation of strict step-by-step surgical protocols, in turn, avoids several negative factors that can affect the outcome of treatment. For example, it reduces the probability of anastomosis tension [19]. It is also impractical to reduce (resect) the pelvis during pyeloplasty because it does not affect the outcome of the operation [20].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of laparoscopic pyeloplasty and impact of an enhanced recovery protocol

Beloborodov,

Vorobev,

Kalyagin

et al. 2024

ELECTRON J GEN MED

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Purpose: The study aims to analyze the enhanced recovery protocol’s (ERP) effectiveness in a comparative study of elective surgeries for ureteropelvic junction obstruction (UPJO). Methods: The prospective study included 30 patients with UPJO who underwent laparoscopic pyeloplasty in 2018-2021. Results: Postoperative complications developed rarely, and their frequency and severity were comparable. Independent predictors of UPJO recurrence were the spine osteochondrosis >II period (HR 13.97; 95% CI 1.26; 154.8; p=0.032), the concretions self-discharge (HR 28.49; 95% CI 1.78; 455.62; p=0.018), surgical operation duration > 110 minutes (HR 44.7; 95% CI 3.95; 505.4; p=0.002) and previous nephrostomy (HR 1.07; 95% CI 1.02; 1.13; p=0.002). Conclusions: In the surgical treatment of UPJO, it is advisable to use ERPs, as this allows achieving a better treatment quality with comparable results.

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Ureter-first Approach and Reduction of Pelvis: Standardizing Handling of Ureteropelvic Junction During Pyeloplasty

Cited by 2 publications

References 19 publications

Comparative study between ureter first approach and conventional open Anderson-Hynes pyeloplasty in paediatric patients: A prospective randomised study

Comparative study between ureter first approach and conventional open Anderson-Hynes pyeloplasty in paediatric patients: A prospective randomised study

Outcomes of laparoscopic pyeloplasty and impact of an enhanced recovery protocol

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