Transperitoneal laparoscopic pyeloplasty in children: does upper urinary tract anomalies affect surgical outcomes?

Abstract

ObjectiveTo 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 MethodsMedical records of 82 consecutive children submitted to transperi-toneal 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. Patients were di-vided into 2 groups: normal anatomy (group 1) and complex cases (group 2). Demographics, perioperative data, outcomes and complications were recorded and analyzed.ResultsMean age was 8.9 years (0.5-17.9) for group 1 and 5.9 years (0.5-17.2) for group 2, p=0.08. The median operative time was 200 minutes (180-230) for group 1 and 203 minutes (120-300) for group 2, p=0.15. Major complications (Clavien ≥3) were 4 (5.6%) in group 1 and 1 (6.3%) in group 2, p=0.52. No deaths or early postoperative complications such as: urinoma or urinary leakage or bleeding, occurred. The success rate for radiologic improvement and flank pain improvement was comparable between the two groups. Re-garding hydronephrosis, significant improvement was present in 62 patients (93.4%) of group 1 and 10 cases (90.9%) of group 2, p=0.99. The median hospital stay was 4 days (IQR 3-4) for group 1 and 4.8 days (IQR 3-6) for group 2, p=0.27.ConclusionsTransperitoneal laparoscopic pyeloplasty is feasible and effective for the management of UPJO associated with renal or urinary tract anomalies.

Hydronephrosis due to ureteropelvic junction obstruction in left pelvic kidney

“…В доступной литературе нам удалось обнаружить всего несколько публикаций посвящённых описанию лапароскопического трансперитонеального доступа к ОпУс на фоне тазовой дистопии почки, основанных на отдельных клинических наблюдениях [3][4][5][6][7]. Авторы декларируют, что лапароскопический подход является эффективным и безопасным у детей с гидронефрозом тазово-дистопированной почки на фоне ОпУс только в руках квалифицированных специалистов.…”

“…В исследованиях [4][5][6][7][8], посвящённых ОпУс тазово-дистопированной почки, продемонстрировано, что наиболее частой причиной нарушения уродинамики в пУс является высокое отхождение мочеточника в сочетании с мальротацией почки.…”

Minimal Invasive Treatment in Pelvic-Ureteric Junction Obstruction: A Comprehensive Review

“…13 , 34 In addition, laparoscopic pyeloplasty resulted in a similar success rate in PUJO cases with concomitant anomalies found in children, such as horseshoe kidney, pelvic kidney, or duplex collecting system. 35 However, this depends greatly on the experience of the surgeon. 13 A meta-analysis by Uhlig et al showed that laparoscopic pyeloplasty had a lower complication rate and a similar success rate, but a longer operating time compared to open pyeloplasty.…”

Evaluation of the clinical value of retroperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction in infants

“…[7,8] With the rapid advent of minimally invasive surgical techniques, transperitoneal laparoscopic pyeloplasty (TLP) through a transperitoneal route has been described in both adults and children. [9] Retroperitoneal laparoscopic pyeloplasty (RLP) for UPJO is an advanced method for the treatment of children. However, reports of this technique are more common in children than in infants younger than 2 years old because some authors think that the operating space is too narrow and the operation is too difficult in infants.…”