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.

Subadventitial resection of the ureterd-new method for surgical corrections of the ureteropelvic junction and ureterovesical junction obstructions

Objective:The aim of our study was to examine results of pyeloplasty using the new methoddsubadventitial resection of the ureter with preservation of the ureteral artery proposed by us and the possibility of using this method in one-stage surgery with ureteropelvic junction(UPJ)and ureterovesical junction(UVJ)obstructions or vesicoureteral reflux.Methods:A retrospective analysis of 108 patients with hydronephrosis(including two patients with hydroureteronephrosis)who received treatment from March 1998 to March 2020 was carried out,with an average follow-up period of 36 months.Dismembered pyeloplasty using a subadventitial technique with preservation of ureteral blood supply was performed in 108 patients(including bilateral in two cases).In one patient with UPJ and UVJ obstructions and in one patient with UPJ obstruction and vesicoureteral reflux subadventitial resection of the ureter were performed in both segments.Results:All patients managed to preserve the integrity of the ureteral artery during dismembered pyeloplasty,and two patients simultaneously underwent ureterocystostomy by subadventitial resection of the ureter.The method of pyeloureteroplasty with subadventitial resection of the ureter makes it possible to improve long-term results in patients with hydronephrosis,including those with lesions of the UPJ and UVJ segments.In all cases,it was feasible to achieve a decrease in the degree of hydronephrosis.Postoperative complications were observed in five cases(4.6%),in none of which there were complications associated with the surgical technique,and were eliminated without loss of renal function.Conclusion:Our 22 years of experience shows that the technique of subadventitial resection of the ureter allows us to preserve the ureteral blood circulation during dismembered pyeloplasty and thus creates conditions for prevention of restenosis of UPJ and for single-stage ureteroplasty on the upper and lower ureteral segments.