Ureterocalicostomy for Treatment of Complex Cases of Ureteropelvic Junction Obstruction in Adults

Osman, Tarek; Eltahawy, Ihab; Fawaz, Khaled; Shoeib, Mohammad; Elshawaf, Hisham; Halaby, Rafik El

doi:10.1016/j.urology.2011.01.044

Cited by 18 publications

(8 citation statements)

References 11 publications

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“…Renal function in the affected kidney improved from a mean of 54.6% preoperatively to 60.1% postoperatively. Osman et al reported that the success rate of 22 open UCs was 73% after a mean follow-up of 26.7 months [3]. They demonstrated that preoperative factors affecting the outcome of UC were a history of endopyelotomy or pyelonephritis, renal parenchymal thickening, split renal function and the extent of scarring score.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic ureterocalicostomy for ureteropelvic junction obstruction in a 10-year-old female patient: a case report

et al. 2017

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BackgroundUreterocalicostomy is indicated mainly in cases with failed pyeloplasty or with a completely intrarenal pelvis. While there have been several case series reported in adults, laparoscopic ureterocalicostomy in pediatric cases has rarely been reported. We report a case of pure laparoscopic ureterocalicostomy for ureteropelvic junction obstruction in an Asian female child.Case presentationA 10-year-old female patient was referred to our hospital due to right high-grade hydronephrosis and a right renal stone, which was detected due to hematuria. Laparoscopic pyelolithotomy and ureterocalicostomy were indicated because of the completely intrarenal pelvis with thinning of the cortex, especially at the lower calyx. A transperitoneal approach was implemented in a lateral flank position with four trocars. After exposing the renal hilum, the renal stone was extracted without lithotripsy by making a small longitudinal incision at the ureteropelvic junction. Then, the ureter was transected, and the renal pelvis was closed. A 2-cm incision was made at the lower calyx. Uretero-caliceal anastomosis was completed in a running fashion using 5-0 absorbable sutures. The operation time was 379 min. The postoperative course was uneventful. Postoperative imaging studies showed marked improvement of the right hydronephrosis.ConclusionLaparoscopic ureterocalicostomy is a safe and feasible treatment for selected patients with complicated ureteropelvic junction obstruction, even in the pediatric population.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic ureterocalicostomy for ureteropelvic junction obstruction in a 10-year-old female patient: a case report

et al. 2017

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“…One of the most feared and frequent complication following ureterocalycostomy is recurrent obstruction. Success of UC has varied, with adult literature 60%‐77% 1,8 . and pediatric literature with a 70%‐90% success rate or greater 6,7,9–11 .…”

Section: Discussionmentioning

confidence: 99%

Pediatric robotic‐assisted laparoscopic ureterocalycostomy: Salient tips and technical modifications for optimal repair

et al. 2020

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Introduction Ureterocalycostomy is a necessary option for renal salvage in cases where conventional reconstructions have failed or as a primary option in anatomic situations such as intrarenal pelvis, malrotated, or horseshoe kidney. The primary principle of this procedure is to allow for dependent drainage. Ureterocalycostomy is often difficult due to extensive scar tissue and may be complicated by bleeding in the setting of a normal functioning lower pole cortex, compared to thin renal cortex and poor renal function as seen in end‐spectrum of the obstruction. Identification of a dependent calyx and hemostasis can be difficult when there is a normal cortical thickness. Though the vascular control of hilum is an option, we suggest some simple tips to avoid this step and optimize surgical results. We present our experience and salient technical tips with pediatric robotic‐assisted laparoscopic ureterocalycostomy and provide a step‐by‐step video. Methods Four patients underwent robotic‐assisted laparoscopic ureterocalycostomy between the years 2012 and 2016 by a single surgeon. Perioperative outcomes measured included operative time, hospital stay, pain relief, degree of hydronephrosis on postoperative ultrasound at 3 months, and renal scintigraphy as needed. We describe the operative procedure and provide tips on identifying a dependent lower pole calyx with flexible nephroscopy and needle puncture, the use of harmonic scalpel for incision of the lower pole cortex, and anastomosis by pre‐placement of interrupted sutures as the urothelium of the renal calyces is thin and friable. Results Patients ranged in age between 11 months and 14 years old. Three of four patients had one prior pyeloplasty, and one patient had two prior pyeloplasties. Mean operative time (incision to closure) was 208 minutes. No Clavien‐Dindo 30‐day complications were encountered and no patients required blood transfusion. Anatomic success was reported in all patients with a mean follow‐up of 4.46 years; however, one patient ultimately required nephrectomy despite patent anastomosis, which would not drain due to a capacious pelvis. Conclusions Robotic‐assisted laparoscopic ureterocalycostomy is feasible in re‐operative cases with extensive scaring and in patients with normal lower pole renal cortex. We offer tips to allow for safe and proficient performance of this procedure.

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“…The literature on UC comprises primarily of small case series and isolated case reports, with open surgery being the dominant treatment approach reported [10] , [11] , [12] , [13] . Different authors report variable success rates [14] depending on the indication (better in the primary setting than in the setting of previous intervention), age group (better for paediatric ≈90% [9] versus adult series 60–75% [13] ), and the endpoint chosen for follow-up (decrease with increase in the duration of follow-up).…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted ureterocalycostomy: A single centre contemporary experience in adults

Chhabra

Sudharsan

Singh

et al. 2016

Arab Journal of Urology

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ObjectiveTo present our technique and experience of robot-assisted ureterocalycostomy (RAUC) in managing secondary pelvi-ureteric junction obstruction (PUJO) in adults.Patients and methodsWe retrospectively reviewed all patients from our centre who underwent RAUC, between 2011 and 2015, for secondary PUJO resulting from previous surgical intervention. Six procedures in five patients, including a bilateral RAUC were performed. The median (range) patient age was 33.7 (18–41) years. The outcome variables included operative time, duration of hospital stay, and objective evidence of unimpeded drainage on urography.ResultsThe mean (range) operating time was 172 (144–260) min and estimated blood loss was 100 (50–250) mL. There were no conversions to open or laparoscopic surgery, and no intraoperative complications. Two patients had Clavien–Dindo Grade I complications that were managed conservatively and one patient had a Grade IIIb complication, which required balloon dilatation and re-stenting. After a median (range) follow-up of 11 (7–48) months, five of the six renal units had successful outcomes.ConclusionThe robot-assisted approach appears to be ideally suited for redo cases demanding fine dissection with meticulous suturing. In our present series of adult patients, we could safely and successfully perform RAUC with minimal morbidity. However, a larger multi-institutional outcome analysis is required to substantiate the role of the robot-assisted approach in performing UC.

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Ureterocalicostomy for Treatment of Complex Cases of Ureteropelvic Junction Obstruction in Adults

Cited by 18 publications

References 11 publications

Laparoscopic ureterocalicostomy for ureteropelvic junction obstruction in a 10-year-old female patient: a case report

Laparoscopic ureterocalicostomy for ureteropelvic junction obstruction in a 10-year-old female patient: a case report

Pediatric robotic‐assisted laparoscopic ureterocalycostomy: Salient tips and technical modifications for optimal repair

Robot-assisted ureterocalycostomy: A single centre contemporary experience in adults

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