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Briony K Varda, Ye Wang, Benjamin I Chung, Richard S Lee, Michael P Kurtz, Caleb P Nelson, Steven L Chang
INTRODUCTION: Since 2010, there have been few new data comparing perioperative outcomes and cost between open (OP) and robotic pyeloplasty (RP). In a post-adoption era, the value of RP may be converging with that of OP. OBJECTIVE: To 1) characterize national trends in pyeloplasty utilization through 2015, 2) compare adjusted outcomes and median costs between OP and RP, and 3) determine the primary cost drivers for each procedure. STUDY DESIGN: We performed a retrospective cohort study using the Premier database, which provides a nationally representative sample of U...
February 22, 2018: Journal of Pediatric Urology
Ruiyang Jiang, Steven Wolf, Muhammad H Alkazemi, Gina-Maria Pomann, J Todd Purves, John S Wiener, Jonathan C Routh
INTRODUCTION: The surgical comorbidity assessment is important for patient risk stratification, counseling, and research. In adults, risk assessment indices, such as the Charlson Co-morbidity Score (CCS) or Van Walraven Index (VWI), are well established. In pediatrics, however, risk assessment indices are scarce. Recently, a pediatric-specific risk assessment index, the Rhee index, was developed to discriminate mortality for pediatric general surgery patients. Currently, there is no validated risk assessment tool in pediatric urology...
February 26, 2018: Journal of Pediatric Urology
Dapeng Jiang, Zhoutong Chen, Houwei Lin, Maosheng Xu, Hongquan Geng
OBJECTIVES: This study was performed to analyze the predictive factors of a contralateral operation after initial pyeloplasty in patients with antenatally detected bilateral ureteropelvic junction obstruction. METHODS: Patients with prenatally diagnosed bilateral ureteropelvic junction obstruction who underwent initial pyeloplasty (aged <12 months at initial pyeloplasty) were offered to participate in the study. Patients were recruited from January 2012 to December 2015...
March 8, 2018: Urologia Internationalis
Cosimo Bleve, Valeria Bucci, Maria Luisa Conighi, Francesco Battaglino, Lorenzo Costa, Lorella Fasoli, Elisa Zolpi, Salvatore Fabio Chiarenza
Horseshoe kidney (HSK) is a congenital defect of the urinary tract that occurs in 0.25% of the general population. Laparoscopic Vascular Hitch (LVH) according to Hellstrom-Chapman represent an alternative approach in treatment of extrinsic hydronephrosis by crossing vessels (CV) in pediatric age. In our Department from 2006 to 2016, 36 children with extrinsic-Uretero-Pelvic-Junction (UPJ)-Obstruction (UPJO) underwent laparoscopic vessels transposition. Over the last 4years, we have treated three patients with extrinsic hydronephrosis in HSK; two males and one female respectively of 6, 7 and 8years...
December 13, 2017: La Pediatria Medica e Chirurgica: Medical and Surgical Pediatrics
Adriana M Pedraza Bermeo, Ana María Ortiz Zableh, Mariangel Castillo, Jaime Francisco Pérez Niño
INTRODUCTION: Postobstructive diuresis (POD) is a polyuric state in which large quantities of salt and water are eliminated after solving a urinary tract obstruction. These patients are at increased risk of severe dehydration, electrolytic disturbances, hypovolemic shock, and death. Ureteropelvic junction obstruction (UPJO) is the most common etiology of collecting system dilatation in the fetal kidney, and a significant number of patients require pyeloplasty. There are limited data regarding prognostic risk factors for POD in this scenario...
February 20, 2018: Journal of Pediatric Urology
Christina P Carpenter, Ashley Rawson, David S Hains, Dana W Giel
Nephrogenic diabetes insipidus (NDI), a rare cause of polyuria and polydipsia in children, is usually managed with medications and careful monitoring of water intake. We present a child who was incidentally found to have right hydronephrosis secondary to ureteropelvic junction obstruction, and was subsequently also diagnosed with NDI. After being medically managed, he underwent open right pyeloplasty. His polydipsia abated within one month of surgery, and he has done well off of medications since that time...
February 27, 2018: Urology
Vadivalagia Nambi Sivakumar, Venkatraman Indiran, Babu Peter Sathyanathan
Objective: The aim of this study was to evaluate and compare the diagnostic accuracy of dynamic contrast- enhanced magnetic resonance imaging (dMRI) and isotope renogram in the functional evaluation of pelviureteric junction obstruction (PUJO). Material and methods: Forty-two patients included in the study were investigated with isotope renogram and subsequently, subjected to dMRI. Time-activity curves were generated for both isotope renogram and dMRI. Out of the 42 cases, 9 cases were conservatively managed...
January 2018: Turkish Journal of Urology
P K Saha, M S Hossain, K C Ghosh, M S Alam, S Nabi, B K Saha, F H Pathan
Ureteral stent placement is a common procedure in urologic practice. Forgotten, encrusted D/J stents represent a difficult problem for urologists. The major complications are infection, impaired renal function, migration, encrustation, stone formation and multiple fragmentation of stent. A consensus on the best therapeutic approach is still lacking. Here we present our experience with endoscopic management of this challenging problem and discuss the multimodal endourologic approaches for treating forgotten, encrusted ureteral stents...
January 2018: Mymensingh Medical Journal: MMJ
Alexander Light, Sandeep Karthikeyan, Sachan Maruthan, Oussama ElHage, Hansjörg Danuser, Prokar Dasgupta
OBJECTIVE: To analyse the current difference between dismembered robotic-assisted pyeloplasty (RP) and laparoscopic pyeloplasty (LP) in the treatment of pelvi-ureteric junction obstruction (PUJO) patients as of June 26 2017, focusing on operative time, length of hospital stay, complication rate, and success rate. PATIENTS AND METHODS: We searched PubMed, Medline, and Embase databases, consulted experts, reviewed reference lists, used the related articles PubMed feature, and reviewed scientific meeting abstracts for eligible articles from 1993 to June 26 2017...
February 17, 2018: BJU International
Mary K Wang, Yi Li, Rachel E Selekman, Thomas Gaither, Anne Arnhym, Laurence S Baskin
INTRODUCTION: Patients undergo pediatric urologic surgery as infants and young children. OBJECTIVE: The purpose of the study was to evaluate the evolution of surgical scars over several years in order to inform parents and surgeons on the true cosmetic impact of pediatric surgery and evaluate patient scar satisfaction. STUDY DESIGN: This was a cross-sectional study where patients who have undergone urologic surgery at a young age are evaluated years later for scar satisfaction via an abbreviated validated questionnaire...
January 9, 2018: Journal of Pediatric Urology
Minki Baek, Mesrur Selcuk Silay, Jason K Au, Gene O Huang, Rodolfo A Elizondo, Kathleen Puttmann, Nicolette K Janzen, Abhishek Seth, David R Roth, Chester J Koh
BACKGROUND: Re-do pyeloplasty after failed open or laparoscopic ureteropelvic junction (UPJ) obstruction correction can be a challenging procedure because of scar formation at the previous anastomosis site and decreased vascularity of the ureter. This study compared the perioperative parameters for pediatric robot-assisted laparoscopic (RAL) primary and re-do pyeloplasties with an emphasis on the intra-operative parameters. MATERIALS AND METHODS: We compared the perioperative parameters of pediatric RAL procedures performed by a single surgeon at a tertiary care children's hospital for both primary ureteropelvic junction obstruction (UPJO) and recurrent UPJO after a previous open or laparoscopic procedure over 2013-2015...
February 6, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
N V Polyakov, N G Keshishev, Sh Sh Gurbanov, M V Grigoreva, S A Serebryannyi, A V Kazachenko, B Ya Alekseev
AIM: To evaluate the effectiveness of laparoscopic repair of primary strictures of ureteropelvic junction (UPJ) depending on baseline renal function of the ipsilateral kidney. MATERIALS AND METHODS: The study analyzed results of 134 patients (78 women and 56 men, age from 18 to 56 years) who underwent various types of laparoscopic repair of the UPJ stricture from 2012 to 2015. Depending on the surgical technique all patients were divided into three groups: group 1 (n=34) underwent spiral flap technique by Culp and DeWeerd, group 2 (n=59) - Anderson-Hynes pyeloplasty and group 3 (n=41) had antevasal dismembered pyeloplasty...
December 2017: Urologii︠a︡
João Arthur Brunhara, Paulo Renato Marcelo Moscardi, Marcos Figueiredo Mello, Hiury Silva Andrade, Paulo Afonso Carvalho, Bruno Nicolino Cezarino, Francisco Tibor Dénes, Roberto Iglesias Lopes
OBJECTIVE: to assess the feasibility and outcomes of laparoscopic pyeloplasty in children with complex ureteropelvic junction obstruction (UPJO) and compare to children with iso-lated UPJO without associated urinary tract abnormalities. MATERIAL AND METHODS: Medical records of 82 consecutive children submitted to transperitoneal laparoscopic pyeloplasty in a 12-year period were reviewed. Eleven cases were con-sidered complex, consisting of atypical anatomy including horseshoe kidneys in 6 patients, pelvic kidneys in 3 patients, and a duplex collecting system in 2 patients...
January 26, 2018: International Braz J Urol: Official Journal of the Brazilian Society of Urology
Xiao-Dong Li, Yu-Peng Wu, Yong Wei, Shao-Hao Chen, Qing-Shui Zheng, Hai Cai, Xue-Yi Xue, Ning Xu
BACKGROUND: This study aimed to identify factors predicting the recoverability of renal function after pyeloplasty in adult patients with ureteropelvic junction obstruction. METHODS: We retrospectively reviewed 138 adults with unilateral renal obstruction-induced hydronephrosis and who underwent Anderson-Hynes dismembered pyeloplasty from January 2013 to January 2016. Hydronephrosis was classified preoperatively according to the Society for Fetal Urology (SFU) grading system...
2018: Urologia Internationalis
Francisco Miguel Sánchez Margallo, Idoia Díaz-Güemes, Miguel Angel Sánchez Hurtado, Javier Sánchez Fernández, Jesús Usón Gargallo, Alvaro Serrano Pascual
The lack of globally established standards for learning urological laparoscopy has not prevented laparoscopic techniques from evolution and continuous development. Laparoscopy coexists with robotic surgery today, and in the last decade there have been many techniques that have undergone a boom with the use of a laparoscopic approach (total and partial nephrectomy, pyeloplasty, colposacropexy, etc.).We intend to evaluate the progressive incorporation of different surgical techniques in the laparoscopic learning program and, on the other hand, to analyze the evolution of training programs in urological laparoscopy to bring this type of techniques within the hospital surgical activity...
January 2018: Archivos Españoles de Urología
M Radulović, S Beatović, M Janković, Dragana Šobić-Šaranović, Vera Artiko, Boris Ajdinović
OBJECTIVE: Prenatal ultrasound (US) screening detects the hydronephrosis (HN)-dilatation of fetal renal collecting system in 1%-5% of all pregnancies. In most children, HN is detected by prenatal US screening between 18-20 gestational week. Pelvi- ureteric junction (PUJ) stenosis is the most common etiological factor of prenatal HN and requires postnatal follow-up. Diuresis renography plays important role in the follow-up by complementing morphological information obtained by US with the data about differential renal function (DRF) and drainage...
September 2017: Hellenic Journal of Nuclear Medicine
David B Bayne, Manint Usawachintachit, Thomas Chi
OBJECTIVE: To describe our ultrasound technique for confirming intraoperative, antegrade-placed ureteral stent position during laparoscopic pyeloplasty. BACKGROUND: Disadvantages of retrograde stent placement include the need to reposition the patient into and out of the lithotomy position. Antegrade stent placement can reduce procedure time but requires confirming appropriate distal placement into the bladder with cystoscopy, percutaneous drain placement, or instillation of methylthioninium chloride or indigo carmine...
January 2, 2018: Urology
Frédéric Panthier, Fabien Lareyre, Marie Audouin, Juliette Raffort
Pelvi-ureteric junction obstruction corresponds to an impairment of urinary transport that can lead to renal dysfunction if not treated. Several mechanisms can cause the obstruction of the ureter including intrinsic factors or extrinsic factors such as the presence of crossing vessels. The treatment of the disease relies on surgical approaches, pyeloplasty being the standard reference. The technique consists in removing the pathologic ureteric segment and renal pelvis and transposing associated crossing vessels if present...
January 4, 2018: International Urology and Nephrology
Rafat Shamim, Shashi Srivastava, Amit Rastogi, Kamal Kishore, Aneesh Srivastava
Background: Clonidine, opioids, β-blockers, and dexmedetomidine have been tried to attenuate stress responses during laparoscopic surgery. We evaluated the efficacy of dexmedetomidine in two different doses in attenuating stress responses on patients undergoing laparoscopic pyeloplasty. Subjects and Methods: Ninety patients were assigned to one of the three groups: Group A, Group B, and Group C. Group B received dexmedetomidine 1 mcg/kg as loading dose, followed by 0...
October 2017: Anesthesia, Essays and Researches
Kaan Gokcen, Gokhan Gokce, Gokce Dundar, Resul Cicek, Halil Gulbahar, Emin Yener Gultekin
INTRODUCTION: Ureteropelvic junction obstruction and concomitant calculus disease may coexist. We demonstrate our use of flexible renoscopy during laparoscopic pyeloplasty for caliceal stone removal. PATIENT AND METHODS: A 28-year-old female patient presented with recurrent attacks of flank pain of two years duration. When noncontrast-CT and DTPA were performed, the patient was diagnosed with ureteropelvic junction stenosis and 3 stones with a total burden of 14mm in the lower pole of right kidney...
December 18, 2017: International Braz J Urol: Official Journal of the Brazilian Society of Urology
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