Objectives: The aim of this experimental study was to assess the possibility of decreasing the size of the ureteral stents used after an endopyelotomy. To this end, an experimental study was performed which compared a ureteral double-J wire stent versus a standard 7F ureteral stent after endopyelotomy. Methods: Twenty healthy female pigs were randomly divided into 2 groups: group I (double pigtail ureteral stent 7F) and group II (lumenless ureteral double-J wire stent, Zebrastent™, 0.035 inches in diameter). Percutaneous, endoluminal ultrasonographic and fluoroscopic studies were analyzed during the 3 different phases of the study. The first phase included premodel documentation of normal urinary tracts and laparoscopic ureteropelvic junction (UPJ) obstruction induction. During the second phase, 6 weeks later, diagnosis and endopyelotomy were carried out. Sixteen weeks after the obstruction treatment, follow-up imaging studies and postmortem evaluations of all animals were performed. Results: After the sonographic and fluoroscopic assessments, we determined the success rate for each group: 80% for group I and 90% for group II. No significant statistical differences were evident in the evolution of the diameter of the UPJ between groups. Better healing of the UPJ and a lower level of retroperitoneal repercussions were seen in group II. Conclusions:The ureteral double-J wire stent (Zebrastent) has been shown to be highly effective after endopyelotomy. This means that it is possible to reduce the size of ureteral stents after endopyelotomy with the advantages that this entails. Double-J ureteral stents probably act as a scaffold rather than a mold.
Endoluminal ultrasonography provides excellent information regarding ureteral and periureteral anatomy. Among the two techniques evaluated in the study, laparoscopic pyeloplasty caused the lesser reaction at the reconstructed area. Fibrous replacement at the muscle-adventitia layers and periureteral area may be useful as indicators of the better therapeutic technique as well as for the assessment of post-therapeutic ureteral evolution and recurrences.
Resumen
Introducción: la pieloplastia laparoscópica es un procedimiento mínimamente invasivo empleado para solucionar quirúrgicamente estenosis, bloqueo u obstrucción de la unión ureteropélvica o pieloureteral. Objetivo: explorar los diferentes modelos de entrenamiento en cirugía mínimamente invasiva para pieloplastia laparoscópica que se encuentran reportados en la literatura. Materiales y métodos: se revisó la literatura con búsqueda sistemática en PubMed, Google Académico y SciELO, mediante la declaración PRISMA y la combinación de los descriptores médicos en salud Model training AND laparoscopic pyeloplasty. Además, se empleó GoPubMed para obtener información bibliométrica que contextualizara las redes de investigación y publicación entre los diferentes modelos de entrenamiento para pieloplastia laparoscópica. Resultados: Se incluyeron 17 referencias en la búsqueda sistemática de la literatura con los que se realizó la discusión a partir de la usabilidad, la estética y el tiempo operatorio de la pieloplastia laparoscópica. Conclusión: Todos los modelos de entrenamiento contribuyen a que los operadores disminuyan los tiempos quirúrgicos, alcanzando valores próximos a la pieloplastia laparoscópica in situ, inclusive, a la pieloplastia abierta. De forma particular, los modelos anatomopatológicos elaborados con modelamiento de siliconas logran un notable acercamiento a la realidad morfológica a partir de la estética de las estructuras y permiten aumentar el número de intentos quirúrgicos y la cantidad de horas de práctica.
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