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 thi...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.展开更多
Objective: To detect bacteriuria or funguria by urine culture taken from the renal pelvis directly before Anderson-Hynes pyeloplasty. Methods: 290 patients who underwent Anderson-Hynes pyeloplasty for ureteropelvic ju...Objective: To detect bacteriuria or funguria by urine culture taken from the renal pelvis directly before Anderson-Hynes pyeloplasty. Methods: 290 patients who underwent Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction (UPJO) were included in a retrospective analysis. Urine was obtained directly before the renal pelvis was opened, and was carried to the laboratory for bacterial culture. Clinical features were analyzed to evaluate risk factors for bacteriuria or funguria by comparing patients whose urine yielded positive cultures to those whose urine cultures were negative for bacteria or yeast. Results: Eighteen patients (6.2%) had positive urine cultures, including six cultures positive for Escherichia coli (E. coli), four for Pseudomonas aeruginosa, three for klebsiella pneumoniae, one for maltophilia monad, one for Enterococcus faecium, one for Candida albicans, one for Candida parapsilosis, and one for yeast not otherwise specified. Bacteriuria or funguria was significantly correlated with four clinical features: fever, urinary urgency, and history of nephrostomy or pyeloplasty. Conclusions: Bacteriuria or funguria was less common in children with UPJO, and the majority of organisms were identified as Escherichia coli, Pseudomonas aeruginosa, or Klebsiella pneumoniae. Prophylactic antibacterial agents were probably necessary in those patients who had signs of urinary tract infection (UTI), or history of nephrostomy or pyeloplasty.展开更多
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 Me...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 1<sup>st</sup>, 2013 to December 31<sup>st</sup>, 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.展开更多
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 datab...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.展开更多
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...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.展开更多
文摘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.
文摘Objective: To detect bacteriuria or funguria by urine culture taken from the renal pelvis directly before Anderson-Hynes pyeloplasty. Methods: 290 patients who underwent Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction (UPJO) were included in a retrospective analysis. Urine was obtained directly before the renal pelvis was opened, and was carried to the laboratory for bacterial culture. Clinical features were analyzed to evaluate risk factors for bacteriuria or funguria by comparing patients whose urine yielded positive cultures to those whose urine cultures were negative for bacteria or yeast. Results: Eighteen patients (6.2%) had positive urine cultures, including six cultures positive for Escherichia coli (E. coli), four for Pseudomonas aeruginosa, three for klebsiella pneumoniae, one for maltophilia monad, one for Enterococcus faecium, one for Candida albicans, one for Candida parapsilosis, and one for yeast not otherwise specified. Bacteriuria or funguria was significantly correlated with four clinical features: fever, urinary urgency, and history of nephrostomy or pyeloplasty. Conclusions: Bacteriuria or funguria was less common in children with UPJO, and the majority of organisms were identified as Escherichia coli, Pseudomonas aeruginosa, or Klebsiella pneumoniae. Prophylactic antibacterial agents were probably necessary in those patients who had signs of urinary tract infection (UTI), or history of nephrostomy or pyeloplasty.
文摘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 1<sup>st</sup>, 2013 to December 31<sup>st</sup>, 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.
文摘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.
文摘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.
