Endopyelotomy for
Pelvi-Ureteric Junction
Obstruction in Children

Hl, Tan; Najmaldin, Azad; Dr, Webb

doi:10.1159/000474269

Cited by 47 publications

(14 citation statements)

References 11 publications

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“…A transverse incision has the added advantage of being parallel to Langer's lines, and thus minimise post-operative scarring. Comparing our data on DL to data published on endopyelotomy in children [9,10] shows a similar outcome in terms of early return to normal activity, minimal postoperative pain, and reduced hospital stay. The rate of postoperative PUJ obstruction is less with a DL approach.…”

Section: Discussionsupporting

confidence: 80%

Dorsal lumbotomy incision for pediatric pyeloplasty - a good alternative

Kumar

Smith

1999

Pediatric Surgery International

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This study reviews the value and benefits of the dorsal lumbotomy incision (DL) for exposure of the pelviureteric junction (PUJ) in infantile and paediatric pyeloplasty. Ninety-one children underwent pyeloplasty for confirmed PUJ obstruction between January 1993 and December 1997. The conventional loin incision (CL) (n = 60) was used as the standard, to which DL (n = 31) was compared. Information on the duration of surgery, length of hospital stay, length of time to return to full oral intake, and complications was obtained retrospectively from the hospital chart. The results were analysed using a non-parametrical statistical analysis. Follow-up was between 6 months and 5 years (median 2.4 years). The median age at surgery was 1.5 years (1 month-14 years). The median operating time was similar in both groups (95 min). The median length of stay was 3 days for the DL group compared to 7 days for the CL group (P < 0.001). The length of hospital stay had no correlation to the patient's age at surgery or the type of postoperative analgesia used. The median time to return to full oral intake and unrestricted activity in the DL group was 43 h compared to 83 h for the CL group (P < 0.001). The surgeons found that there was better exposure of the PUJ in infants in the DL group compared to the DL incision. There were no operative complications related to the DL itself. At the time of last follow-up 3 children required re-operation for a failed pyeloplasty, 2 in the DL group. The results suggest that DL is a safe and reasonable alternative to CL in paediatric pyeloplasty and probably the incision of choice in infantile pyeloplasty.

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Section: Discussionsupporting

confidence: 80%

Dorsal lumbotomy incision for pediatric pyeloplasty - a good alternative

Kumar

Smith

1999

Pediatric Surgery International

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“…The patients that had endopyelotomy for secondary obstruction had a success rate of 100% with a mean follow-up of 59 months. Tan et al [20] and Faerber et al [21] reported three patients and four patients, respectively, that underwent endopyelotomy for secondary UPJ after failed open pyeloplasty with one failure. These studies seem to support that in the pediatric population endopyelotomy is not the ideal initial treatment; however, there may be a role for treating secondary UPJO after failed pyeloplasty.…”

Section: Endoscopic Management and Minimally Invasive Surgerymentioning

confidence: 99%

Pathophysiology and treatment of ureteropelvic junction obstruction

Williams¹,

Tareen²,

Resnick

2007

Curr Urol Rep

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This paper reviews the current literature on both the pathophysiology and treatment options for ureteropelvic junction obstruction (UPJO). A medical literature search using Pubmed/Medline that addressed both the pathophysiology of UPJO and the different treatment options for the adult and pediatric population with UPJO was performed. The pathophysiology of UPJO is still unknown but appears to be multifactorial. Perhaps future molecular studies will give us an answer to the etiology and also a pathway in preventing UPJO. Treatment options have been studied in-depth, and the gold standard is open pyeloplasty. In both the pediatric and adult population, laparoscopic or robotic pyeloplasty has similar success rates to open pyeloplasty with the benefits of minimally invasive surgery. In the pediatric population, however, further studies need to be done. Endopyelotomy also has a role in the treatment of UPJO but should have strict selection criteria.

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“…This requires a wide tract to be dilated to the kidney and may not be appropriate for small children. Tan et al attempted endopyelotomy with stenting in a total of 17 children and reported success in 10 of the 13 cases in which the procedure was actually performed [8]. No major complications were reported in this study though transection of major renal vessels is a theoretical complication of this technique.…”

Section: Discussionmentioning

confidence: 57%

“…Balloon dilatation does not carry this risk and insufficient data are available to indicate whether the success rate is comparable. Tan et al comment that open pyeloplasty is not rendered more difficult by previous endopyelotomy [8].…”

Section: Discussionmentioning

confidence: 99%

Balloon dilatation of the pelviureteric junction in children: early experience and pitfalls

Wilkinson

Azmy

1996

Pediatr Radiol

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Early experience with minimally invasive procedures performed on children with pelviureteric junction obstruction is described. Balloon dilatation of the pelviureteric junction was performed in children aged between 5 months and 10 years. Ten procedures were performed in nine children, six for pelviureteric junction obstruction and four for stricture following surgical pyeloplasty. In none of the cases was a stent inserted following the procedure. In two cases the procedure was performed by antegrade approach following nephrostomy and in eight cases by retrograde approach following cystoscopy. In four cases the procedure was successful with relief of symptoms and/or improvement in radiological appearance, in three cases the radiological appearance was unchanged and in three cases the procedure resulted in complete obstruction of the pelviureteric junction requiring surgical intervention. Two of the retrograde procedures resulted in vesicoureteric junction obstruction, one requiring reimplantation and the other nephrectomy. We recommend the antegrade approach to avoid trauma to the vesicoureteric junction, and our results suggest that stenting is necessary to prevent early obstruction.

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Endopyelotomy for Pelvi-Ureteric Junction Obstruction in Children

Cited by 47 publications

References 11 publications

Dorsal lumbotomy incision for pediatric pyeloplasty - a good alternative

Dorsal lumbotomy incision for pediatric pyeloplasty - a good alternative

Pathophysiology and treatment of ureteropelvic junction obstruction

Balloon dilatation of the pelviureteric junction in children: early experience and pitfalls

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