Management and Outcome of Ureteropelvic Junction Obstruction in Senegalese Children

Introduction: The ureteropelvic junction obstruction is a rare congenital malformation of the upper urinary tract. We report its management and outcome at Senegal’s main pediatric surgical department. Patients and Methods: We conducted a descriptive review of all patients managed in our pediatric surgical department at Albert Royer National Children’s Hospital Centre from January 1st, 2013 to December 31st, 2017. Results: Thirty patients were included in our study. The mean age was three years. Males were more affected (sex ratio of 2.75). The prenatal diagnosis was made in 23% of cases using prenatal ultrasonography. An abdominal mass was the circumstance of discovery in 36% of cases, and lumbar contact and renal sloshing were found in 66% of cases. There was no renal function impairment in 93% of cases. Urinary tract infection occurred in 50% of cases. Ultrasonography (100%) and urinary computed tomography (56%) were used to diagnose. A temporary nephrostomy was performed in 23% of cases, and as definitive treatment, an open Anderson-Hynes procedure was performed in 96% as a nephrectomy was made in a patient. Early postoperative complications were encountered in 56% of cases: urinary tract infection (36%), surgical site infection and anastomotic stenosis (6% both), and urinoma and textiloma (both in 3%). A patient died from sepsis. After a mean follow-up of 12 months, no additional complication was reported. Conclusion: Ureteropelvic junction obstruction was frequently diagnosed late, and its management carried unneglectable morbidity in our environment. A laparoscopic approach would be a solution to improve its outcome.

Small incision combined with laparoscopy for ureteropelvic junction obstruction： comparison with retroperitoneal laparoscopic pyeloplasty

Background Laparoscopic dismembered pyeloplasty is technically feasible for ureteropelvic junction （UP J） obstruction although it is still challenged by its technical difficulty and time-consuming. In this study, we compared the initial results of retroperitoneal laparoscopic pyeloplasty versus a combined laparoscopic dissection and open reconstruction through a small incision in the treatment of UPJ obstruction.Methods Sixty-four patients with primary UPJ obstruction underwent pyeloplasty： 32 patients underwent laparoscopic procedure and 32 patients underwent open assisted laparoscopic surgery including two steps, ie, laparoscopic dissection of the UPJ transperitoneally and then pyeloplasty via an extended small incision. The demographic data and intraoDerative, postoperative and follow-up conditions of patients were compared between the two groups.Results Preoperative data were comparable in the patients of the two groups. The operative time was shorter （60.9 minutes vs 157.7 minutes, P 〈0.0001） and the complication rate was lower （9.4% vs 31.3%, P 〈0,05） in the open assisted group than in the laparoscopic group. The estimated blood loss （42.3 ml vs 47.8 ml）, time to have normal diet （37.6 hours vs 33.8 hours）, and hospital stay （6.7 days vs 6.2 days） were equivalent, The operative success rate was 97% for the open assisted group and 91% for the laparoscopic group. Conclusions The procedure of combined small incision with laparoscopy for UPJ obstruction is technically easy, and the results are promising. It can be used as an alternative to conventional procedures.

Retroperitoneal laparoscopic nondismembered pyeloplasty for uretero-pelvic junction obstruction due to crossing vessels: A matched-paired analysis and review of literature

Objective:To compare laparoscopic Anderson-Hynes pyeloplasty(LAHP)and retroperitoneal laparoscopic YV-pyeloplasty(LRYVP)in ureteropelvic junction obstruction(UPJ)in presence of a crossing vessels(CV).Methods:Our database showed 380 UPJO-cases,who underwent laparoscopic retroperitoneal surgery during the last 2 decades including 206 non-dismembered LRYVP,157 dismembered pyeloplasties LAHP,and 17 cases of laparoscopic ureterolysis.Among them 198 cases were suitable for a matched-pair(2:1)analysis comparing laparoscopic retroperitoneal non-dismembered LRYVP(Group 1,n Z 131)and dismembered LAHP(Group 2,n Z 67)in presence of a crossing vessel.Patients were matched according to age,gender,kidney functions,and obstruction grade.Complications were graded according to modified Clavien-classification.Results:Comparative data were similar between both groups(LRYVP vs.LAHP)including mean operating time(112 min vs.114 min),complication rates(4.2%vs.7.3%)mainly Grade 1e2 according to Clavien classification,and success rates(90%vs.89%).These results reflected in the reviewed literature indicate that LRYVP provides the advantage of minimal dissection in case of CV with similar outcome.However,redundant pelvis and anteriorly crossing vessels still require a dismembered pyeloplasty LAHP.Conclusion:LRYVP has achieved similar results compared with the previous golden standard of open surgery,especially in case of crossing vessels apart from presence of a redundant pelvis or anteriorly crossing vessel.This can be further improved when using the small access retroperitoneoscopic technique respectively mini-laparoscopy.

Minimally invasive open dismembered pyeloplasty technique: Miniature incision, muscle-splitting dissection, and nopelvis reduction in children

Objective:To report the outcomes and complications of open dismembered Anderson-Hynes pyeloplasty with miniature incision in treating children’s ureteropelvic junction obstruction.Methods:Between March 2007 and April 2011,109 children with a mean age of 2 years and 8 months old with ureteropelvic junction obstruction underwent open dismembered pyeloplasty.Clinical manifestations,radiographic assessments,incision size,surgery time,hospital stay,and complication rate were recorded.All patients had a documented ureteropelvic junction obstruction(having T1/2 more than 20 min in diethylenetriaminepentaacetic acid[DTPA]scan)with symptomatic stenosis or decreased kidney function(differential function<40%).Pyeloplasty was done by a retroperitoneal flank approach with miniature incision without pelvis reduction.One surgeon did all the surgeries.Success rate and complications were assessed in a 3-year follow-up.Results:Mean surgery time was 52 min(47e60 min).Incision size was 18e28 mm.Mean hospital stay was 3 days(2e8 days).The surgery was successful in 98.2%of patients with a mean follow-up time of 36 months(success was defined as disappearance of symptoms,if present,with improved ultrasound imaging results or Reno graphic parameters).The complication rate was 7.33%,including urinary leakage,double-J urethral stent dislocation and infection.Conclusion:Open dismembered pyeloplasty is a safe,technically feasible and effective therapy in treatment of children’s ureteropelvic junction obstruction.It takes a short time to do,requires a small incision and has few complications and a short recovery period.

Pelviureteric junction obstruction in adults:A systematic review of the literature

Background:Pelviureteric junction obstruction(PUJO)is a common urological disorder that can present at any stage of life.The underlying etiology in children has been well studied;however,a gap exists in the literature for the adult population.Herein,we performed a systematic review of the literature to evaluate the current evidence on the underlying etiologies of adult patients presenting with PUJO.Materials and methods:Four electronic databases were searched for relevant studies assessing the underlying etiologies of pelviureteric junction obstruction in adults.Studies were assessed for eligibility based on predefined inclusion and exclusion criteria,and a critical appraisal of methodological quality and risk of bias was performed.Finally,qualitative and quantitative data analyses were performed.Results:Twelve studies comprising a total of 513 patients with radiologically confirmed PUJO met the inclusion criteria and were included in our analysis.The most common finding was crossing vessels,which were observed in 50.5%of patients,followed by intrinsic ureteral stenosis(27.1%),adhesions(15.3%),and high insertion of the ureter(10.1%).Conclusions:The underlying etiologies of PUJO in adults remain unclear.This studyindicated that obstruction secondary to crossing vessels is the most common cause of obstruction in adults and occurs more frequently than in the pediatric population.

Robot assisted transperitoneal laparoscopic pyeloplasty

Nowadays, with laparoscope techniques increasingly developed its indications are covering more complicated medical fields. Moreover, as a camera holder, the robotic system of an automated endoscopic system for optimal positioning （AESOP） can be controlled directly by the surgeon＇s voice. It can be more effectively manipulated and more accurately control the video endoscope, which enables the unification of the operator＇s thoughts and visual field and decreases the inadvertent movements from a human assistant. It also improves the learning curve for complicated minimally invasive procedures.Between April 2003 anti December 2005, 25 patients with ureteropelvic junction （UPJ） stricture underwent robot assisted transperitoneal laparoscopic pyeloplasty.

Experience with transperitoneal laparoscopic dismembered pyeloplasty

Pyeloplasty is a standard therapy for ureteropelvic junction obstruction witha success rate of over 90% for all types of repair. In 1993 the first cases of laparoscopic repairof ureteropelvic junction obstruction via the transperitoneal approach were described. In the lastfew decades open pyeloplasty has been a standard for surgical treatment with a long-term successrate of more than 90%. The results have shown the feasibility of Anderson-Hynes dismemberedpyeloplasty. In this report, we present our experience with transperitoneal laparoscopicdismembered pyeloplasty in 18 patients with ureteropelvic junction obstruction ( UP JO ) at ourhospital between October 2001 and October 2002. All the operations were successful and the resultssatisfactory.