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.

Eight-year follow-up of locally advanced lymphoepithelioma-like carcinoma at upper urinary tract: A case report

BACKGROUND Urinary tract lymphoepithelioma-like carcinoma is rarely seen.Although it is termed after lymphoepithelioma at the nasopharynx,it behaves more like high grade urothelial carcinoma by immunohistochemical features.Most published literatures focused on its rarity but few discussed results of long-term follow-ups.As no available guidelines are applicable,we postulated that principles should be similar to that of urothelial carcinoma at urinary tract.As of now,this work features the longest follow-up of this cancer at the upper urinary tract.CASE SUMMARY A 63-year-old female had a chief complaint of intermittent left flank pain for 2 mo,along with accompanying symptoms including vomiting and body weight loss,about 7 kg over 2 mo.Laboratory data showed normocytic anemia,mildly poor renal function,and hyperparathyroidism.Urine analysis showed mild hematuria.Computed tomography showed a 4.2-cm-width irregular mass over left renal pelvic and enlarged lymph node at the left renal hilum.Whole-body bone scan was negative of active bone lesions.Biopsy from ureteroscopy showed urothelial carcinoma.Specimen from laparoscopic nephroureterectomy with bladder cuff resection showed lymphoepithelioma-like carcinoma with muscular invasion(pT3).She took adjuvant chemotherapies of 2 cycles and full courses of radiation therapy.No recurrence was observed with designed investigative programs.CONCLUSION Locally advanced urinary tract lymphoepithelioma-like carcinoma could benefit from nephroureterectomy and bladder cuff excision in terms of recurrence-free survival.

Preservation of the kidney with delayed diagnosis of traumatic pelvi-ureteric junction disruption secondary to blunt abdominal trauma in children

Background The delayed diagnosis of pelvi-ureteric junction （PUJ） disruption in children following blunt abdominal trauma can result in loss of function of the involved kidney. We examined the potential for kidney preservation and the limits of diagnostic delays. Methods A retrospective review of 17 cases of PUJ disruption at Beijing Children＇s Hospital from 1993 to 2009 was done with respect to diagnosis, treatment and follow-up. Results The interval from trauma to diagnosis of PUJ disruption was （52＋52） days. If one case with nephrectomy was excluded, the interval from trauma to diagnosis was （40＋_20） days. The average time between injury and first treatment was （49＋_25） days. Pelvi-ureteric reanastomosis and caliceal ureterostomy were performed separately in 11 and 4 patients, respectively. Ileal replacement for ureter injuries was finally performed in one patient. Hydronephrosis of the injured kidney was reduced and the function improved in 15 out of 17 patients （88%）. Only one patient received nephrectomy and the nephrectomy rate was 5.9%. Conclusion Differential renal function at the PUJ disruption side can be saved and the rate of nephrectomy reduced by appropriate surqen/if the time to diaqnosis and first treatment is limited to within two months.