Background and Objectives: Pyelo-Ureteral Junction Syndrome (PUJS) is the most common obstructive malformation of the upper urinary tract in children and adults. The standard treatment is open pyeloplasty using the Ku...Background and Objectives: Pyelo-Ureteral Junction Syndrome (PUJS) is the most common obstructive malformation of the upper urinary tract in children and adults. The standard treatment is open pyeloplasty using the Kuss-Anderson technique. Because of the minimally invasive nature of the laparoscopic approach, it has become the approach of choice for the management of this pathology. We present the results of laparoscopic transperitoneal pyeloplasty used in the management of PUJS. Materials and Methods: This was a retrospective study from 2015 to 2020, including 26 patients who underwent laparoscopic transperitoneal pyeloplasty for PUJS. Results: Twenty-six patients, including 18 (69.2%) men and 6 (30.8%) women, with a mean age of 35.42 ± 13.62 years, were treated. Renal colic was the primary symptom in the majority of the cases (22, 84.6%)). The diagnosis was confirmed in all patients through an abdominal CT scan, which revealed that all 26 patients had hydronephrosis. Half of the patients (50.0%) were classified as Valayer-Cendron Type II, and eight (30.8%) patients had associated stones. Seventeen (65.4%) patients had pathologies on the left side, and all patients were treated using the Kuss-Anderson technique with a median operating time of 108.5 (90.0 - 136.0) minutes. The uncrossing of lower pole vessels was performed in 10 patients. The average duration of hospitalisation was 2.23 ± 0.82 days. No conversion was observed, and after an average follow-up of 53.69 days, the success rate was 92.3%. Conclusion: Laparoscopic pyeloplasty is a minimally invasive technique of choice for the treatment of pyelo-ureteral junction obstruction. It is dependable, repeatable, and produces good functional outcomes that are equal to those of traditional surgery.展开更多
The reserved judgment can be broadly categorized into three types: Re-Do, Re-Set, and Natural Flowing Case (i.e. step by step in Re-Try). Hori et al. constructed the Bayes-Fuzzy Estimation and demonstrated that system...The reserved judgment can be broadly categorized into three types: Re-Do, Re-Set, and Natural Flowing Case (i.e. step by step in Re-Try). Hori et al. constructed the Bayes-Fuzzy Estimation and demonstrated that system theory can be applied to the possibility of Markov processes, and that decision-making approaches can be applied to sequential Bayes estimation. In this paper, we focus on the Natural Flowing Case within reserved judgment. Here, the possibility of oblique (or principal) factor rotation is considered as a part of the tandem fuzzy system that follows step by step for sequential Bayes estimation. Ultimately, we achieve a significant result whereby the expected utility can be calculated automatically without the need to construct a utility function for reserved judgment. There, this utility in Re-Do can be calculated by the prior utility, and that utility in Re-set does not exist by our research in this paper. Finally, we elucidate the relationship between fuzzy system theory and fuzzy decision theory through an applied example of Bayes-Fuzzy theory. Fuzzy estimation can be applied to only normal making decision, but it is impossible to apply abnormal decision problem. Our Vague, specially Type 2 Vague can be applied to abnormal case, too.展开更多
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...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.展开更多
Goal: To evaluate the results and complications of open pyeloplasty according to Anderson-Hynestechnic. Patients and Methods: We conducted a retrospective study from 2000 to 2014. The study included 36 cases of openin...Goal: To evaluate the results and complications of open pyeloplasty according to Anderson-Hynestechnic. Patients and Methods: We conducted a retrospective study from 2000 to 2014. The study included 36 cases of opening the ureteropyelic junction operated pit syndrome according to Anderson-Hynes technique. Results: Lumbotomy was used in all patients. A pelvic pyelolithotomy for lithiasis was performed in two patients (5.5%) and unwinding of a lower polar pedicle in 3 cases (8.3%). The average duration of response was 119 ± 15 min. The average length of hospital stay was 11.2 ± 3 days. Patients were followed for a mean of 10 months. Thirty-five patients were asymptomatic and in one case lower back pain persisted. IVU to 6 months showed a permeable junction in 97.2% of cases. Seven patients (19.4%) had short-term complications. Ureteropelvic stenosis was the only complication in the medium and long term in one case (2.8%). The success rate of the Pyeloplasty was 97.2%. Conclusion: The open pyeloplasty as Anderson-Hynes remains the treatment of choice in our context SJPU with great results. The indications tend to decrease in favor of laparoscopic pyeloplasty.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
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
Objective: Evaluate pyeloplasty according to Küss-Anderson-Hynes at the urology-andrology department of the Sino-Guinean Friendship Hospital. Patient and Method: This is a 3-year prospective descriptive study fro...Objective: Evaluate pyeloplasty according to Küss-Anderson-Hynes at the urology-andrology department of the Sino-Guinean Friendship Hospital. Patient and Method: This is a 3-year prospective descriptive study from January 1, 2018 to December 31, 2020. It focused on a sample of 21 patients, who had undergone pyeloplasty according to Küss-Anderson-Hynes. Results: The averages age of the patients was 24.24 years. Lumbar pain was the main reason for consultation in 71.43% of cases. pyeloplasty according to Küss-Anderson-Hynes alone was performed in 76.20% of cases. It was associated with lower pole vessel uncrossing in 14.29% of cases and in 9.52% of cases with pyelolithotomy. The main Postoperative complications consisted of surgical site infections (23.81%) and fistula of the pyelo-ureteral junction (9.52%). The result of the pyeloplasty evaluated after three years, was qualified as good in 13 patients (86.67%), conversely the result was declared bad in 2 patients or 13.33%. During the follow-up period, postoperatively, we had lost sight of 6 patients. Conclusion: Pyeloplasty according to Küss-Anderson-Hynes in addition to its excellent results reported by the literature was the only therapeutic alternative performed during this study. However, its indications are considerably reduced with the advancement of laparoscopy.展开更多
文摘Background and Objectives: Pyelo-Ureteral Junction Syndrome (PUJS) is the most common obstructive malformation of the upper urinary tract in children and adults. The standard treatment is open pyeloplasty using the Kuss-Anderson technique. Because of the minimally invasive nature of the laparoscopic approach, it has become the approach of choice for the management of this pathology. We present the results of laparoscopic transperitoneal pyeloplasty used in the management of PUJS. Materials and Methods: This was a retrospective study from 2015 to 2020, including 26 patients who underwent laparoscopic transperitoneal pyeloplasty for PUJS. Results: Twenty-six patients, including 18 (69.2%) men and 6 (30.8%) women, with a mean age of 35.42 ± 13.62 years, were treated. Renal colic was the primary symptom in the majority of the cases (22, 84.6%)). The diagnosis was confirmed in all patients through an abdominal CT scan, which revealed that all 26 patients had hydronephrosis. Half of the patients (50.0%) were classified as Valayer-Cendron Type II, and eight (30.8%) patients had associated stones. Seventeen (65.4%) patients had pathologies on the left side, and all patients were treated using the Kuss-Anderson technique with a median operating time of 108.5 (90.0 - 136.0) minutes. The uncrossing of lower pole vessels was performed in 10 patients. The average duration of hospitalisation was 2.23 ± 0.82 days. No conversion was observed, and after an average follow-up of 53.69 days, the success rate was 92.3%. Conclusion: Laparoscopic pyeloplasty is a minimally invasive technique of choice for the treatment of pyelo-ureteral junction obstruction. It is dependable, repeatable, and produces good functional outcomes that are equal to those of traditional surgery.
文摘The reserved judgment can be broadly categorized into three types: Re-Do, Re-Set, and Natural Flowing Case (i.e. step by step in Re-Try). Hori et al. constructed the Bayes-Fuzzy Estimation and demonstrated that system theory can be applied to the possibility of Markov processes, and that decision-making approaches can be applied to sequential Bayes estimation. In this paper, we focus on the Natural Flowing Case within reserved judgment. Here, the possibility of oblique (or principal) factor rotation is considered as a part of the tandem fuzzy system that follows step by step for sequential Bayes estimation. Ultimately, we achieve a significant result whereby the expected utility can be calculated automatically without the need to construct a utility function for reserved judgment. There, this utility in Re-Do can be calculated by the prior utility, and that utility in Re-set does not exist by our research in this paper. Finally, we elucidate the relationship between fuzzy system theory and fuzzy decision theory through an applied example of Bayes-Fuzzy theory. Fuzzy estimation can be applied to only normal making decision, but it is impossible to apply abnormal decision problem. Our Vague, specially Type 2 Vague can be applied to abnormal case, too.
文摘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.
文摘Goal: To evaluate the results and complications of open pyeloplasty according to Anderson-Hynestechnic. Patients and Methods: We conducted a retrospective study from 2000 to 2014. The study included 36 cases of opening the ureteropyelic junction operated pit syndrome according to Anderson-Hynes technique. Results: Lumbotomy was used in all patients. A pelvic pyelolithotomy for lithiasis was performed in two patients (5.5%) and unwinding of a lower polar pedicle in 3 cases (8.3%). The average duration of response was 119 ± 15 min. The average length of hospital stay was 11.2 ± 3 days. Patients were followed for a mean of 10 months. Thirty-five patients were asymptomatic and in one case lower back pain persisted. IVU to 6 months showed a permeable junction in 97.2% of cases. Seven patients (19.4%) had short-term complications. Ureteropelvic stenosis was the only complication in the medium and long term in one case (2.8%). The success rate of the Pyeloplasty was 97.2%. Conclusion: The open pyeloplasty as Anderson-Hynes remains the treatment of choice in our context SJPU with great results. The indications tend to decrease in favor of laparoscopic pyeloplasty.
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.
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Objective: Evaluate pyeloplasty according to Küss-Anderson-Hynes at the urology-andrology department of the Sino-Guinean Friendship Hospital. Patient and Method: This is a 3-year prospective descriptive study from January 1, 2018 to December 31, 2020. It focused on a sample of 21 patients, who had undergone pyeloplasty according to Küss-Anderson-Hynes. Results: The averages age of the patients was 24.24 years. Lumbar pain was the main reason for consultation in 71.43% of cases. pyeloplasty according to Küss-Anderson-Hynes alone was performed in 76.20% of cases. It was associated with lower pole vessel uncrossing in 14.29% of cases and in 9.52% of cases with pyelolithotomy. The main Postoperative complications consisted of surgical site infections (23.81%) and fistula of the pyelo-ureteral junction (9.52%). The result of the pyeloplasty evaluated after three years, was qualified as good in 13 patients (86.67%), conversely the result was declared bad in 2 patients or 13.33%. During the follow-up period, postoperatively, we had lost sight of 6 patients. Conclusion: Pyeloplasty according to Küss-Anderson-Hynes in addition to its excellent results reported by the literature was the only therapeutic alternative performed during this study. However, its indications are considerably reduced with the advancement of laparoscopy.
