Objective:To compare the surgical outcomes,improvement in renal function and complications between early stent removal(2 weeks)and late stent removal(4 weeks)after pediatric open pyeloplasty.Methods:A total of 72 open...Objective:To compare the surgical outcomes,improvement in renal function and complications between early stent removal(2 weeks)and late stent removal(4 weeks)after pediatric open pyeloplasty.Methods:A total of 72 open pyeloplasty were included in the study.Forty-three underwent late stent removal(Group 1)and 29 underwent early stent removal(Group 2).Pre-operative and post-operative follow-up data were compared to see the effect of early stent removal on the postoperative drainage pattern at 6 months after surgery and improvement in split function of affected kidney.The complications between the two groups were also compared.Results:Both the groups were matched with respect to age,sex,side and antero-posterior diameter of pelvis.Pre-operative mean split function in Group 1 was 42%(26%e54%)while it was 39%(19%e42%)in Group 2(pZ0.37).Postoperative improvement in drainage pattern was seen in 69 out of 72(96%)patients,41 out of 43(95%)in Group 1 and 28 out of 29(97%)in Group 2.Improvement in split function occurred in 35 of 38(97%)in Group 1 and 23 of 26(88%)patients in Group 2(pZ0.51).Complications were seen in nine out of 72(12.5%)patients.Incidence of complication in Group 1 was 16%(7/43)and Group 2 was 7%(2/29),and relative risk was 2.36.Conclusion:A shorter duration of double J stenting is as effective as a longer stenting period in terms of surgical success outcomes and improvement in split renal function along with a decreased risk of stent related complications.展开更多
Introduction: Obstructive complication after pyeloplasty or ureteral reimplant surgery is a rare though worrisome problem in pediatric urology. These are often complex patients with complicated post-operative courses ...Introduction: Obstructive complication after pyeloplasty or ureteral reimplant surgery is a rare though worrisome problem in pediatric urology. These are often complex patients with complicated post-operative courses that at times require interventional radiology procedures. The current literature is lacking in guiding principles to manage these complications. In this study we have reviewed these difficult to manage patients at our children’s hospital over the past 15 years. Methods: A list of patients who underwent interventional radiology procedures to place nephrostomy tubes or internal double-J ureteral stents was compared a list of patients undergoing pyeloplasty or reimplant procedures. These lists were cross-referenced to a list of patients undergoing cystoscopic removal of double-J stents. This small patient group does not represent all complications but those with radiology intervention. Results: At our institution, during the years 1998-2011 we performed 458 pyeloplasties and 3003 open ureteral reimplant procedures. 14 (0.4%) met all of the inclusion criteria. The long term outcome of these problems showed 11 of these patients went on to stability or improvement with either percutaneous drainage or JJ stent placement alone, and three of the reimplant patients ultimately required redo surgery. Of our pyeloplasty patients only three required percutaneous nephrostomy tube, and one went on to JJ stent placement (0.66% of pyeloplasties). No patients in the pyeloplasty group needed surgical revision. Of patients how had undergone ureteral reimplantation, with or without tapering, seven of them underwent interventional radiology procedures (0.23% of reimplant patients). Conclusion: Pediatric urology patients with persistent obstruction after pyeloplasties and ureteral reimplantation surgery with or without tapering who needed interventional radiology rescue procedure resolved or stabilized in 11 of 14 patients. Surgical revision was performed in only 3 of our 14 patients after months of conservative trial after interventional radiologic procedures.展开更多
Anderson-Hynes dismembered ureteropyeloplasty has been the gold standard surgical treatment for ureteropelvic junction obstruction (UPJO) caused either by crossing renal vessel or by a stenotic junction in children. N...Anderson-Hynes dismembered ureteropyeloplasty has been the gold standard surgical treatment for ureteropelvic junction obstruction (UPJO) caused either by crossing renal vessel or by a stenotic junction in children. Nowadays it is still discussed which could be the best surgical approach. All the techniques actually used have the goal to improve functional outcome and to reach better results in terms of reducing traumatic damage, postoperative pain and therefore reduction of hospitalization. We are presenting our experience in the treatment of UPJO by open dismembered pyeloplasty with a minimal invasive approach using the Alexis®(Applied Medical, Rancho Santa Margherita, CA) autostatic wound retractor.展开更多
目的探讨不同麻醉维持方式对加速康复外科(enhanced recovery after surgery,ERAS)模式下机器人辅助小儿肾盂成形手术围术期的影响。方法选取2020年10月至2021年10月于解放军总医院第七医学中心接受机器人辅助腹腔镜下肾盂成形术的3~12...目的探讨不同麻醉维持方式对加速康复外科(enhanced recovery after surgery,ERAS)模式下机器人辅助小儿肾盂成形手术围术期的影响。方法选取2020年10月至2021年10月于解放军总医院第七医学中心接受机器人辅助腹腔镜下肾盂成形术的3~12岁肾积水患儿纳入研究。随机分为静脉麻醉维持组(n=30)和吸入麻醉维持组(n=29)。比较两组患儿的围术期血流动力学、术后苏醒时间、苏醒期躁动评分和疼痛情况、术后不良反应的差异性。统计学方法采用重复测量方差分析、t检验、秩和检验、χ^(2)检验或Fisher确切概率法。结果①重复测量方差分析显示,静脉组与吸入组麻醉维持患儿围术期不同时间点平均动脉压[气腹5 min:(83±10)、(81±8)mmHg,拔管后即刻(:81±10)、(87±8)mmHg]、心率[切皮前:(78±16)、(88±11)次/min,拔管后即刻(:123±18)、(125±13)次/min]比较,差异均有统计学意义(平均动脉压:F组内=10.174,P<0.001;F_(组间)=4.880,P=0.031;F_(交互)=2.393,P=0.042;心率:F组内=61.159,P<0.001;F_(组间)=15.956,P<0.001;F_(交互)=5.129,P<0.001)。②静脉组麻醉维持患儿术后拔管时间显著长于吸入组[(31±13)、(23±7)min,t=2.872,P=0.006]。③两组患儿拔管后各时间段的躁动评分比较,差异均无统计学意义(P值均>0.05)。静脉组麻醉维持患儿术后1 h无痛比例显著高于吸入组(66.7%、37.9%,Z=-2.262,P<0.05)。④两组患儿术后不良反应发生率比较,差异无统计学意义(P>0.05)。结论在ERAS模式下行机器人辅助腹腔镜下肾盂成形术的儿童中,与吸入麻醉维持相比,静脉麻醉维持患儿苏醒时间较长,但围术期血流动力学更稳定,术后疼痛程度更低。展开更多
文摘Objective:To compare the surgical outcomes,improvement in renal function and complications between early stent removal(2 weeks)and late stent removal(4 weeks)after pediatric open pyeloplasty.Methods:A total of 72 open pyeloplasty were included in the study.Forty-three underwent late stent removal(Group 1)and 29 underwent early stent removal(Group 2).Pre-operative and post-operative follow-up data were compared to see the effect of early stent removal on the postoperative drainage pattern at 6 months after surgery and improvement in split function of affected kidney.The complications between the two groups were also compared.Results:Both the groups were matched with respect to age,sex,side and antero-posterior diameter of pelvis.Pre-operative mean split function in Group 1 was 42%(26%e54%)while it was 39%(19%e42%)in Group 2(pZ0.37).Postoperative improvement in drainage pattern was seen in 69 out of 72(96%)patients,41 out of 43(95%)in Group 1 and 28 out of 29(97%)in Group 2.Improvement in split function occurred in 35 of 38(97%)in Group 1 and 23 of 26(88%)patients in Group 2(pZ0.51).Complications were seen in nine out of 72(12.5%)patients.Incidence of complication in Group 1 was 16%(7/43)and Group 2 was 7%(2/29),and relative risk was 2.36.Conclusion:A shorter duration of double J stenting is as effective as a longer stenting period in terms of surgical success outcomes and improvement in split renal function along with a decreased risk of stent related complications.
文摘Introduction: Obstructive complication after pyeloplasty or ureteral reimplant surgery is a rare though worrisome problem in pediatric urology. These are often complex patients with complicated post-operative courses that at times require interventional radiology procedures. The current literature is lacking in guiding principles to manage these complications. In this study we have reviewed these difficult to manage patients at our children’s hospital over the past 15 years. Methods: A list of patients who underwent interventional radiology procedures to place nephrostomy tubes or internal double-J ureteral stents was compared a list of patients undergoing pyeloplasty or reimplant procedures. These lists were cross-referenced to a list of patients undergoing cystoscopic removal of double-J stents. This small patient group does not represent all complications but those with radiology intervention. Results: At our institution, during the years 1998-2011 we performed 458 pyeloplasties and 3003 open ureteral reimplant procedures. 14 (0.4%) met all of the inclusion criteria. The long term outcome of these problems showed 11 of these patients went on to stability or improvement with either percutaneous drainage or JJ stent placement alone, and three of the reimplant patients ultimately required redo surgery. Of our pyeloplasty patients only three required percutaneous nephrostomy tube, and one went on to JJ stent placement (0.66% of pyeloplasties). No patients in the pyeloplasty group needed surgical revision. Of patients how had undergone ureteral reimplantation, with or without tapering, seven of them underwent interventional radiology procedures (0.23% of reimplant patients). Conclusion: Pediatric urology patients with persistent obstruction after pyeloplasties and ureteral reimplantation surgery with or without tapering who needed interventional radiology rescue procedure resolved or stabilized in 11 of 14 patients. Surgical revision was performed in only 3 of our 14 patients after months of conservative trial after interventional radiologic procedures.
文摘Anderson-Hynes dismembered ureteropyeloplasty has been the gold standard surgical treatment for ureteropelvic junction obstruction (UPJO) caused either by crossing renal vessel or by a stenotic junction in children. Nowadays it is still discussed which could be the best surgical approach. All the techniques actually used have the goal to improve functional outcome and to reach better results in terms of reducing traumatic damage, postoperative pain and therefore reduction of hospitalization. We are presenting our experience in the treatment of UPJO by open dismembered pyeloplasty with a minimal invasive approach using the Alexis®(Applied Medical, Rancho Santa Margherita, CA) autostatic wound retractor.
