Endopyelotomy: Comparison of Ureteroscopic Retrograde and Antegrade Percutaneous Techniques

Introduction: Pelviureteric junction (PUJ) obstruction and concomitant renal calculus disease may coexist. We present our experience with simultaneous laparoscopic pyeloplasty and pyelolithotomy in such patients. Method: 20 patients (20 renal units) underwent transperitoneal laparoscopic pyeloplasty and concomitant pyelolithotomy at our institution. An initial dismembering of the PUJ followed by removal of the calculi with rigid or semi-rigid graspers were done. Calyceal stones were removed with the aid of a flexible cystoscope, rigid/flexible ureteroscope and simultaneous fluoroscopy. The pyeloplasty was subsequently performed in all cases. Result: A median of 2 stones (range 1–12) were recovered from the 20 renal units. Complete stone clearance was possible in 15/20 patients (75%). Three patients underwent subsequent extracorporeal shock-wave lithotripsy and 2 required percutaneous nephrolithotomy. All patients were rendered stone-free at 6 months’ follow-up. Diuretic renography at follow-up revealed improved drainage in 18/20 (90%) patients; 2 patients had an equivocal drainage pattern but their symptoms disappeared. Conclusion: Laparoscopic pyeloplasty with concomitant pyeloplasty is feasible and effective, however patients must be counseled about the possibilities of ancillary procedures to achieve complete stone clearance.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Laparoscopic Pyeloplasty with Concomitant Pyelolithotomy – Is It an Effective Mode of Treatment?

Srivastava

Singh²,

Gupta³

et al. 2008

“…percutaneous and endoscopic endopyelotomy. These procedures, although associated with lower morbidity, have a success rate of about 15-20% lower than that of open pyeloplasty [2,3] . To minimize the morbidity associated with open pyeloplasty and reduce the uncertainty over the results of the minimally invasive approach, Schuessler et al [4] first reported dismembered laparoscopic pyeloplasty (LPP) in 1993.…”

Section: Introductionmentioning

confidence: 98%

Laparoscopic Pyeloplasty: A Versatile Alternative to Open Pyeloplasty

Srivastava¹,

Singh²,

Maheshwari³

et al. 2009

Objective: To report the safety, efficacy and versatility of laparoscopic pyeloplasty (LPP) in treatment of pelviureteric junction obstruction (PUJO). Patients and Methods: From January 2002 to November 2006, 185 patients (186 units; 182 with primary and 4 with secondary PUJO) underwent LPP (transperitoneal approach in 184; retroperitoneal approach in 2). A double J stent was placed antegradely in 121 (68.4%) units, cystoscopically in 50 units (28.2%), and 6 units (3.4%) were stentless. Patients were followed up clinically, with additional diuretic renogram. Results: Surgery was completed laparoscopically in 177 units, and conversion was required in 9 (4.8%) units. Pyeloplasty was dismembered in 143 units, Foley YV plasty in 26 units, and Fenger pyeloplasty in 8 units. The median estimated blood loss, operative time and hospital stay were 50 ml, 180 min and 4 days, respectively. Overall, 18 (9.6%) patients had complications. Improvements in drainage patterns of 167 out of 177 units (94.3%) were shown on a renal scan at a median follow-up of 39 months (range: 3–63 months). Conclusion: LPP is a safe, effective and versatile method for treatment of PUJO, which is applicable to all age groups, even in the presence of secondary stones, crossing vessels and secondary PUJO.

“…However, it is possible to extract a series of conclusions from these studies. When it is not possible to introduce a larger stent, it is preferable to use a smaller one [9,[16][17][18] . Smaller stents [19] .…”

Section: Discussionmentioning

confidence: 99%

Ureteral Double-J Wire Stent Effectiveness after Endopyelotomy: An Animal Model Study

Soria

Delgado²,

Rioja³

et al. 2010

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.