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Background: Conventionally, diuretic isotope renogram is used to establish and quantify severity of the obstruction in pelvi-ureteric junction obstruction. Doppler ultrasonography too assesses obstruction by evaluating the resistive index (RI) and resistive index ratio (RIR) in the intrarenal vasculature of the kidneys. This study aimed to note correlation between RI, RIR on Doppler ultrasonography and perfusion index (PI) on diuretic isotope renogram in suspect unilateral pelvi-ureteric junction obstruction in infants. A prospective study (2016–2019) in infants with suspect unilateral hydronephrosis, i.e. anteroposterior pelvic diameter (APPD) > 15 mm, divided into Group A (0–6 months) and Group B (6–12 months) based on the age at diagnosis. The RI, RIR and PI were noted at diagnosis, at 3 and 6 months, post-interventions and the correlation assessed. Results: 37/94 with hydronephrosis were included in the study. 30 among these underwent surgical intervention. A decrease in RI and RIR and increase in PI following surgery were documented at follow-up. Also, the improvement was statistically more significant in the first 3 months following intervention. Conclusions: An increased RI and RIR and a decreased PI are good indicators of obstruction in unilateral hydronephrosis in infants. The decline in RI with increase in PI following relief of obstruction shows a positive correlation between the two. Doppler sonography may be effective in monitoring unilateral hydronephrosis with unobstructed or equivocal renogram curves and consequently negate the need for repeated nuclear scans. [ABSTRACT FROM AUTHOR]

Synchronous renal malignancies are seldom encountered or diagnosed post-renal resection. A combination of renal cell carcinoma (RCC) and urothelial carcinoma (UC) is most commonly reported. Typically, the RCC subtype is clear-cell RCC; however, a combination of collecting duct carcinoma (CDC) and UC has rarely been reported in the existing literature. Here, we present two cases of synchronous renal malignancy, specifically a combination of CDC and UC, in the ipsilateral kidney. [ABSTRACT FROM AUTHOR]

Ureteral strictures, which can be caused by ureteral injury, radiation therapy, ureterolithiasis, urinary tract infections, and ureteral endometriosis, typically require ureteral reconstruction. Although tissue engineering, autologous alternative tissue transplantation, and surgical techniques applying various flaps have been carried out for ureteral regeneration, all with some success, each method has its advantages and disadvantages. As an alternative, we created the first artificial ureter structures using only live cells and grafted them into healthy rat ureters. Spheroids were created using normal human dermal fibroblasts and human umbilical vein endothelial cells and subsequently laminated using a bio-three-dimensional printer. After molding the laminated spheroids into tubular structures, the artificial ureters were transplanted into live rats. After 2–12 weeks, the animals were sacrificed and their gross and pathological features were examined. In the artificial ureteral lumen of rats with Grade 0-1 hydronephrosis, regeneration of the ureteral epithelium was observed, the thickness of which increased over the course of the experiment. Regeneration of the muscular layer was also observed, extending from the normal ureteral side toward the artificial ureter structure over time. However, complete regeneration was not observed at the end of 12 weeks. Although ureteral peristalsis was noted in all cases, it was weaker than expected. Therefore, we achieved short-segment ureteral regeneration using a cell-only structure. This finding suggests that by applying alternative strategies to this method, such as changing the cell type and composition, regeneration over the entire length of the ureter may be possible in the future. Until now, ureteral regeneration techniques have been dominated by the use of high-molecular-weight compounds and autologous tissues, and there have been no reports of regeneration using structures made entirely of cells. This is the first report of ureteral regeneration using a tubular structure made from stacked spheroids. Although this study only attained short-segment ureteral regeneration, regeneration of the ureter over a much longer proportion of its length can be achieved in the future by applying other strategies, such as changing the cell type. This study provides a foundation to achieve the future goal of complete regeneration. [Display omitted] [ABSTRACT FROM AUTHOR]

This scoping review was conducted based on the Joanna Briggs Institute's theoretical framework and registered with the Open Science Framework (https://osf.io/b27wc). The study analyzed 29 manuscripts published between 2013 and 2023, focusing on imaging exams to synthesize evidence on the anatomy and clinical correlations of the upper urinary tract. The results revealed significant findings, highlighting the intrarenal pelvis as a possible predictive indicator of urinary loss after partial nephrectomy. This emphasizes the importance of anatomical assessment of the renal pelvis. Brödel's avascular plane has been categorized into three types relevant to pre-surgical patient planning. Multiple renal arteries and venous variations have also been reported, including retro-aortic and circum-aortic renal veins. A movable section related to the ureter was described in the perirenal space, delimited by the point of intersection with the gonadal vessels. The ureteropelvic and ureterovesical junctions were found to be anatomical points susceptible to ureteral constriction. On the other hand, the point at which the ureter crosses the iliac vessels is no longer considered a site prone to ureteral obstruction. The authors emphasize the need to adopt a standardized terminology to describe the anatomical variations of the blood vessels related to the kidney. Using diverse and unclear terms can hinder teaching and research in this area and lead to inaccuracies. From the authors' perspective, imaging exams have enhanced anatomical accuracy, benefiting the teaching of human anatomy and significantly contributing to continuous medical breakthroughs. [ABSTRACT FROM AUTHOR]

An adult female Russian tortoise (Testudo horsfieldii) was admitted to a veterinary clinic with a 1-week history of anorexia and lethargy. Physical examination revealed significant dehydration and generalized dysecdysis. Blood parameters were all within species-reported limits. Radiography revealed an increased amount of soft tissue opacity within the coelomic cavity and a distinct loss of serosal detail. A large cavitated mass was detected ultrasonographically in the right coelom and a tentative diagnosis of kidney pathology was made. Using computed tomography and magnetic resonance imaging, a partly mineralized heterogeneous mass was seen in the right coelom. After stabilization, a transplastron coeliotomy was performed. A 7 × 5 cm mass, including associated cysts, was removed. The tortoise died 8 h postoperatively and post-mortem examination revealed a urothelial carcinoma arising from the renal pelvis. To the authors' knowledge, this is the first report in a tortoise of urothelial carcinoma, which has rarely been reported in reptiles. [ABSTRACT FROM AUTHOR]

Purpose: We sought to evaluate the impact of repeat transurethral resection of bladder tumor prior to radical cystectomy on oncologic outcomes in a contemporary cohort at a tertiary care center. Materials and Methods: An Institutional Review Board approved review of 657 patients diagnosed with muscle-invasive bladder cancer who underwent radical cystectomy at our institution for clinical stage T2 urothelial carcinoma between 2005 and 2017 was performed. Patients with and without repeat transurethral resection of bladder tumor were matched 1-to-1 by propensity score. Matching was done by age, gender, receipt of neoadjuvant chemotherapy, preoperative hydronephrosis, variant histology, lymphovascular invasion, or carcinoma in situ on index transurethral resection of bladder tumor. Results: A total of 548 patients with muscle-invasive bladder cancer were included after matching (2 groups of 274 patients). Kaplan-Meier estimates of recurrencefree and overall survival demonstrated no significant difference based upon performance of repeat transurethral resection of bladder tumor (P = 1.0 and P = .3, respectively). When outcomes were stratified by pathology of repeat transurethral resection of bladder tumor specimens, those with pT0 had superior recurrence-free and overall survival compared to those with residual muscle invasive disease (P < .001 and P = .001, respectively). Notably, more than 60% of patients who were pT0 on repeat transurethral resection of bladder tumor had residual disease at the time of radical cystectomy. Conclusions: Repeat transurethral resection of bladder tumor prior to radical cystectomy, irrespective of receipt of neoadjuvant chemotherapy, was not associated with improved survival outcomes in this propensity score matched muscle-invasive bladder cancer cohort. The absence of residual tumor on pathological evaluation of repeat transurethral resection of bladder tumor specimen was prognostic and was associated with improved survival outcomes. However, a large percentage of patients with pT0 disease on repeat transurethral resection of bladder tumor had residual disease on radical cystectomy pathology. [ABSTRACT FROM AUTHOR]

Background: Endovascular renal denervation reduces blood pressure (BP). We explored an alternative approach to renal denervation using radiofrequency energy delivered across the renal pelvis utilizing the natural orifice of the urethra and the ureters.Methods: This open-label, single-arm feasibility study enrolled patients with uncontrolled hypertension despite antihypertensive drug therapy. The primary effectiveness endpoint was the change in ambulatory daytime systolic BP (SBP) 2 months following renal pelvic denervation.Results: The 18 patients (mean age 56±12 years) enrolled were taking an average of 2.7 antihypertensive drugs daily. Renal pelvic denervation reduced mean daytime SBP by 19.4 mm Hg (95% CI, -24.9 to -14.0, P<0.001) from its baseline of 148.4±8.7 mm Hg. Mean nighttime (-21.4 mm Hg [95% CI, -29.5 to -13.3]) and 24-hour (-20.3 mm Hg [95% CI, -26.2 to -14.5]) SBP each fell significantly (P<0.001) as did the corresponding diastolic BPs (P<0.001). Office SBP decreased from 156.5±12.3 mm Hg by 22.4 mm Hg (95% CI, -31.5 to -13.3, P<0.001) by 2 months. Office SBP decreased over time (P=0.001 by linear trend test) starting by day 1 with a decrease of 8.3 mm Hg (95% CI, -16.9 to 0.3, P=0.057). There were no serious adverse events. Mild transitory back pain followed the procedure. Serum creatinine decreased by 0.08 mg/dL (P=0.02) and estimated glomerular filtration rate increased by 7.2 mL/min/1.73m2 (P=0.03) 2 months following ablation procedure.Conclusions: Based on these initial findings, a well-powered, sham-controlled trial of renal pelvic denervation to more fully establish its safety and effectiveness is now justified in patients with uncontrolled hypertension despite drug therapy.Registration: URL: https://www.Clinicaltrials: gov; Unique identifier: NCT05440513. [ABSTRACT FROM AUTHOR]

A 63‑year‑old female presented to our hospital with progressive allograft dysfunction, declining urine output and fluid overload. She had undergone a second transplant 4 months before. Her evaluation revealed partial pelviureteric obstruction in her ultrasound. She underwent a renal biopsy which revealed BK virus infection. The pelviureteric obstruction improved with oral diuretics and her mycophenolate sodium was discontinued. The case illustrates a rare urological manifestation of BK virus infection which can present with symptomatic allograft dysfunction early posttransplantation. [ABSTRACT FROM AUTHOR]

Purpose: UGN-101 (mitomycin for pyelocalyceal solution) is a recently approved chemoablative treatment for low-grade (LG) upper tract urothelial carcinoma (UTUC). While approved for retrograde or antegrade administration, previous reports discuss only patients treated by retrograde approach. We report our techniques for antegrade administration along with early outcomes from our cohort of patients who have undergone UGN-101 administration via nephrostomy. Materials and Methods: UGN-101 is administered as 6 weekly instillations in patients who have undergone endoscopic ablation of LG UTUC. We outline our approach in patients thought to have LG UTUC from initial ureteroscopy to nephrostomy placement, UGN-101 administration and eventual nephrostomy removal. We discuss early durability of response along with adverse events with special attention to ureteral strictures. Results: Eight patients underwent antegrade UGN-101 administration during the study period, all of whom underwent followup ureteroscopy with complete response in 4 patients. Three patients reported 5 adverse eventsd3 grade 1, 1 grade 2 requiring 1 week delay of treatment and 1 asymptomatic ureteral stricture. Median followup was 7 months. Conclusions: We outline our approach for antegrade administration of UGN-101 and discuss early results along with adverse events. Future studies should evaluate our method's potential to increase patient comfort, improve logistics and decrease risk of adverse events. [ABSTRACT FROM AUTHOR]

We investigated the pathological characteristics of renal dysplasia with hydronephrosis and congenital ureteral stricture in two calves. Macroscopically, the affected kidneys were enlarged and the renal calyces were dilated and associated with ureteral strictures. Histopathologically, multifocal regions of mesenchyme were observed in the renal medulla. This mesenchyme was weakly eosinophilic with haematoxylin and eosin, blue with Alcian blue and pale blue with Masson's trichrome, and was immunopositive for vimentin and smooth muscle actin, consistent with persistent mesenchyme. There was asynchronous differentiation of the renal cortex characterized by immature glomeruli, immature tubules and arteriolar proliferation. Similar persistent mesenchyme was observed in the ureteral walls with ureteral stricture, and the ureteral musculature or smooth muscle bundles had a disorganized arrangement. Congenital ureteral stricture appeared to have caused ureteral obstruction and hydronephrosis. The lesions may represent a new phenotype of renal dysplasia with concomitant congenital ureteral stricture in Holstein-Friesian calves. [ABSTRACT FROM AUTHOR]

Purpose: Our goal was to evaluate long-term safety and durability of response to UGN-101, a mitomycin-containing reverse thermal gel, as primary chemoablative treatment for low-grade upper tract urothelial carcinoma. Materials and Methods: In this open-label, single-arm, multicenter, phase 3 trial (NCT02793128), patients ≥18 years of age with primary or recurrent biopsy-proven low-grade upper tract urothelial carcinoma received 6 once-weekly instillations of UGN-101 via retrograde catheter to the renal pelvis and calyces. Those with complete response (defined as negative ureteroscopic evaluation, negative cytology and negative forcause biopsy) 4e6 weeks after the last instillation were eligible for up to 11 monthly maintenance instillations and were followed for ≥12 months with quarterly evaluation of response durability. Durability of complete response was determined by ureteroscopic evaluation; duration of response was estimated by the Kaplan-Meier method. Treatment-emergent adverse events (TEAEs) were monitored. Results: Of 71 patients who initiated treatment, 41 (58%) had complete response to induction therapy and consented to long-term followup; 23/41 patients (56%) remained in complete response after 12 months (95% CI 40, 72), comprising 6/12 (50%) who did not receive any maintenance instillations and 17/29 (59%) who received ≥1 maintenance instillation. Kaplan-Meier analysis of durability was estimated as 82% (95% CI 66, 91) at 12 months. Ureteric stenosis was the most frequently reported TEAE (31/71, 44%); an increasing number of instillations appeared to be associated with increased incidence of urinary TEAEs. Conclusions: Durability of response to UGN-101 with or without maintenance treatment is clinically meaningful, offering a kidney-sparing therapeutic alternative for patients with low-grade disease. [ABSTRACT FROM AUTHOR]

We began using the da Vinci single port (SP) robot for pediatric urologic surgeries at our institution due to limited access to the multiport robot. Availability of this technology has allowed us to schedule cases in a timelier fashion and increase access to minimally invasive urologic surgery for children in our area. Here, we report our technique for transperitoneal SP robotic pyeloplasty in the case of a 7 year-old boy with left ureteropelvic junction obstruction. Our technique was refined over a series of 10 patients under the age of 18. Highlights of the SP RALP technique include one 3 cm, concealed incision over the pubic tubercle, gentle frog leg positioning and burping of the boom to create optimal angle for robotic docking, and use of a "floating dock" to obtain 10 cm distance from target anatomy which is essential in smaller pediatric patients. SP pyeloplasty is safe and feasible in children and offers a concealed single incision alternative to the multiport approach. [ABSTRACT FROM AUTHOR]

Soft markers were originally introduced to prenatal ultrasonography to improve the detection of trisomy 21 over that achievable with age-based and serum screening strategies. As prenatal genetic screening strategies have greatly evolved in the last 2 decades, the relative importance of soft markers has shifted. The purpose of this document is to discuss the recommended evaluation and management of isolated soft markers in the context of current maternal serum screening and cell-free DNA screening options. In this document, "isolated" is used to describe a soft marker that has been identified in the absence of any fetal structural anomaly, growth restriction, or additional soft marker following a detailed obstetrical ultrasound examination. In this document, "serum screening methods" refers to all maternal screening strategies, including first-trimester screen, integrated screen, sequential screen, contingent screen, or quad screen. The Society for Maternal-Fetal Medicine recommends the following approach to the evaluation and management of isolated soft markers: (1) we do not recommend diagnostic testing for aneuploidy solely for the evaluation of an isolated soft marker following a negative serum or cell-free DNA screening result (GRADE 1B); (2) for pregnant people with no previous aneuploidy screening and isolated echogenic intracardiac focus, echogenic bowel, urinary tract dilation, or shortened humerus, femur, or both, we recommend counseling to estimate the probability of trisomy 21 and a discussion of options for noninvasive aneuploidy screening with cell-free DNA or quad screen if cell-free DNA is unavailable or cost-prohibitive (GRADE 1B); (3) for pregnant people with no previous aneuploidy screening and isolated thickened nuchal fold or isolated absent or hypoplastic nasal bone, we recommend counseling to estimate the probability of trisomy 21 and a discussion of options for noninvasive aneuploidy screening through cell-free DNA or quad screen if cell-free DNA is unavailable or cost-prohibitive or diagnostic testing via amniocentesis, depending on clinical circumstances and patient preference (GRADE 1B); (4) for pregnant people with no previous aneuploidy screening and isolated choroid plexus cysts, we recommend counseling to estimate the probability of trisomy 18 and a discussion of options for noninvasive aneuploidy screening with cell-free DNA or quad screen if cell-free DNA is unavailable or cost-prohibitive (GRADE 1C); (5) for pregnant people with negative serum or cell-free DNA screening results and an isolated echogenic intracardiac focus, we recommend no further evaluation as this finding is a normal variant of no clinical importance with no indication for fetal echocardiography, follow-up ultrasound imaging, or postnatal evaluation (GRADE 1B); (6) for pregnant people with negative serum or cell-free DNA screening results and isolated fetal echogenic bowel, urinary tract dilation, or shortened humerus, femur, or both, we recommend no further aneuploidy evaluation (GRADE 1B); (7) for pregnant people with negative serum screening results and isolated thickened nuchal fold or absent or hypoplastic nasal bone, we recommend counseling to estimate the probability of trisomy 21 and discussion of options for no further aneuploidy evaluation, noninvasive aneuploidy screening through cell-free DNA, or diagnostic testing via amniocentesis, depending on clinical circumstances and patient preference (GRADE 1B); (8) for pregnant people with negative cell-free DNA screening results and isolated thickened nuchal fold or absent or hypoplastic nasal bone, we recommend no further aneuploidy evaluation (GRADE 1B); (9) for pregnant people with negative serum or cell-free DNA screening results and isolated choroid plexus cysts, we recommend no further aneuploidy evaluation, as this finding is a normal variant of no clinical importance with no indication for follow-up ultrasound imaging or postnatal evaluation (GRADE 1C); (10) for fetuses with isolated echogenic bowel, we recommend an evaluation for cystic fibrosis and fetal cytomegalovirus infection and a third-trimester ultrasound examination for reassessment and evaluation of growth (GRADE 1C); (11) for fetuses with an isolated single umbilical artery, we recommend no additional evaluation for aneuploidy, regardless of whether results of previous aneuploidy screening were low risk or testing was declined. We recommend a third-trimester ultrasound examination to evaluate growth and consideration of weekly antenatal fetal surveillance beginning at 36 0/7 weeks of gestation (GRADE 1C); (12) for fetuses with isolated urinary tract dilation A1, we recommend an ultrasound examination at ≥32 weeks of gestation to determine if postnatal pediatric urology or nephrology follow-up is needed. For fetuses with urinary tract dilation A2-3, we recommend an individualized follow-up ultrasound assessment with planned postnatal follow-up (GRADE 1C); (13) for fetuses with isolated shortened humerus, femur, or both, we recommend a third-trimester ultrasound examination for reassessment and evaluation of growth (GRADE 1C). [ABSTRACT FROM AUTHOR]

In a histopathological study of the renal crest (RC) of kidneys of cats with chronic kidney disease (CKD), 58/90 (64%) had epithelial proliferation. Of these, 33 cats had hyperplasia of the collecting duct (CD) epithelium (CDH) alone, eight had hyperplasia of the urothelium covering the RC (RCUH), of which one had concurrent abaxial renal pelvic urothelial hyperplasia (UH), and eight had both CDH and RCUH. CDH or RCUH were present in five cats with marked dysplasia of the CD epithelium (CDD) and four cats with invasive carcinomas, which also had epithelial dysplasia. All nine cats with marked dysplasia or neoplasia of the RC also had substantially altered RC contours due to focal haemorrhage, papillary necrosis or fibrosis. Three of the carcinomas had a strong desmoplastic response. In control cats, both urothelial (RC and renal pelvis) and tubular (CD and distal tubular) cells were immunopositive for cytokeratin (CK; AE1/AE3), tubular epithelial cells were positive for vimentin (Vim) and aquaporin 2 (Aq2), while urothelial cells were positive for p63. PAX8 immunolabelling was difficult to validate. CD and UH labelling was similar to control tissue. While urothelial dysplasia had the same immunolabelling pattern as UH and control tissue, CDD was generally immunonegative for Aq2. As immunolabelling of the four carcinomas did not distinguish between tubular and urothelial origin, with three positive for both Vim and p63, all were broadly designated as RC carcinomas. Overall, proliferative epithelial lesions are common in cats with CKD and form a continuum from simple hyperplasia to neoplasia of the urothelium or CD of the RC. [ABSTRACT FROM AUTHOR]

Sarcomatoid renal pelvis carcinoma (SRPC) is a rare variant of RPC. We aimed to summarize the clinicopathological features and prognostic factors of SRPC. In this retrospective study, we collected data from 24 patients with SRPC who were treated at the Department of Urology, Affiliated Hospital of Qingdao University between 2008 and 2021. The clinicopathological features of the patients were obtained from their medical records to evaluate the diagnosis, prognostic factors, and response to systemic therapy. Immunohistochemical staining revealed that cytokeratin was expressed in 19 patients with SRPC, while vimentin was expressed in all patients. Computer tomography showed these tumors as low-density (n = 12) or mixed-density masses, with or without necrotic areas (n = 12). All patients showed different degrees of enhancement on computed tomography. Lymph node metastasis was present in 6 patients and distant metastasis in 5. The median survival of all patients was 28 months. Patients without metastasis had a median survival of 46 months compared with 18 months in those with metastasis (P < 0.05). Necrosis had no significant influence on prognosis (P > 0.05). The median survival of patients with and without hydronephrosis was 18 and 104 months (P < 0.05). Among patients without metastasis, those without hydronephrosis survived longer than those with hydronephrosis (104 vs 18 months, P < 0.05), and necrosis had no effect on prognosis. In patients with metastasis, necrosis and hydronephrosis had no effect on prognosis (P > 0.05). The prognosis of SRPC is poor, and the clinical stage, particularly the presence of distant metastasis, has a significant impact on prognosis. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Since the first laparoscopic radical nephroureterectomy performed by Clayman in 1991, the surgical technique has improved and the indications of laparoscopic radical nephroureterectomy can be extended to locally advanced diseases . The first radical cystectomy performed for bladder cancer was reported by Sanchez de Badajoz in 1995. Laparoscopic approach has been increasingly used as an alternative to open radical cystectomy with promising functional and oncological results. Materials and Methods. We present a case of laparoscopic radical nephroureterectomy and anterior pelvic exenteration with extended lymphadenectomy in a patient with high-grade upper urinary tract carcinoma, recurrent highgrade non-muscle invasive bladder cancer, and a previous left open nephroureterectomy with bladder cuff removal and lymphadenectomy. The partial exenteration and the extended lymphadenectomy were successfully performed with laparoscopic approach in this particular case of high-grade urothelial carcinoma. Results. The final histopathology exam revealed high-grade urothelial carcinoma of the renal pelvis pT3N0MxL0V0R0, urothelial carcinoma non-invasive of the ureter pTaG2, urothelial carcinoma microinvasive pT1G1 of the urinary bladder with squamous cell carcinoma in situ pTis, squamous cell carcinoma in situ of the cervix. We discuss the operative steps and the techniques performed to optimize the oncological results in the laparoscopic approach for high risk urothelial carcinoma. Conclusions. Laparoscopic radical nephroureterectomy accompanying radical cystectomy, hysterectomy, and bilateral salpingo-oophorectomy with extended lymphadenectomy for multifocal high-risk urothelial carcinoma is oncologically safe, technically feasible, and can safely be performed for urinary system exenteration in patients with multifocal urothelial tumors, even though the patient will be anephric at the end of the surgery with need for hemodialysis. [ABSTRACT FROM AUTHOR]

Ureteral stents are a fundamental element in the arsenal of urologists from their appearance until now. Due to the widespread usage of ureteral catheters, a number of possible complications such as migration, infection, encrustation, calcification, and fragmentation have been noted. In this manuscript, we present a case of a 70-year-old female patient who was admitted to the emergency room with bilateral flank pain for about 7 days and fragments of ureteral stent protruding through the urethra. The urine analysis showed leukocyturia, proteinuria, and microscopic hematuria. The X-ray highlighted multiple fragments of double J stent on the projection area kidneys and bladder. CT examination described atrophic kidneys with pelvic dilatation and ureteral catheter parts in both renal pelvis and bladder. Cystoscopy was performed under local anesthesia, residual ureteral stents fragments were removed from the bladder, and bilateral double J stents were placed for hydronephrosis remission. Bilateral double J stents were extracted after 3 weeks during a scheduled endoscopic procedure when the residual parts of double J were also evacuated by ureteroscopy from both kidneys. The postoperative evolution was favorable, simple. The particularity of the case is given by the fragmentation of the ureteral stents bilaterally in the same period of time. [ABSTRACT FROM AUTHOR]

Down syndrome is associated with several comorbidities, including intellectual disability, growth restriction, and congenital heart defects. The prevalence of Down syndrome–associated comorbidities is highly variable, and intellectual disability, although fully penetrant, ranges from mild to severe. Understanding the basis of this interindividual variability might identify predictive biomarkers of in utero and postnatal outcomes that could be used as endpoints to test the efficacy of future therapeutic interventions. The main objective of this study was to examine if antenatal interindividual variability exists in mouse models of Down syndrome and whether applying statistical approaches to clinically relevant measurements (ie, the weights of the embryo, placenta, and brain) could define cutoffs that discriminate between subgroups of trisomic embryos. Three commonly used mouse models of Down syndrome (Dp(16)1/Yey, Ts65Dn, and Ts1Cje) and a new model (Ts66Yah) were used in this study. Trisomic and euploid littermate embryos were used from each model with total numbers of 102 for Ts66Yah, 118 for Dp(16)1/Yey, 92 for Ts65Dn, and 126 for Ts1Cje. Placental, embryonic, and brain weights and volumes at embryonic day 18.5 were compared between genotypes in each model. K-mean clustering analysis was applied to embryonic and brain weights to identify severity classes in trisomic embryos, and brain and placental volumetric measurements were compared between genotypes and classes for each strain. In addition, Ts66Yah embryos were examined for malformations because embryonic phenotypes have never been examined in this model. Reduced body and brain weights were present in Ts66Yah, Dp(16)1/Yey, and Ts65Dn embyos. Cluster analysis identified 2 severity classes in trisomic embryos—mild and severe—in all 4 models that were distinguishable using a putative embryonic weight cutoff of <0.5 standard deviation below the mean. Ts66Yah trisomic embryos develop congenital anomalies that are also found in humans with Down syndrome, including congenital heart defects and renal pelvis dilation. Statistical approaches applied to clinically relevant measurements revealed 2 classes of phenotypic severity in trisomic mouse models of Down syndrome. Analysis of severely affected trisomic animals may facilitate the identification of biomarkers and endpoints that can be used to prenatally predict outcomes and the efficacy of treatments. [ABSTRACT FROM AUTHOR]

Background: Hepatoid adenocarcinoma arising from urological system is extremely rare, and the pathogenesis and therapeutic regimen have been poorly understood. Case report: we report a unique case of ɑ-fetaprotein (AFP)-producing neoplasm of renal pelvis associated with nephrolithiasis. A 59-year-old male patient was diagnosed with right renal tumor and nephrolithiasis with no evidence of lesions in his digestive or reproductive system. He was successfully treated with right laparoscopic radical nephroureterectomy and lymph node dissection. Pathology analysis showed moderately or poorly hepatocellular differentiation and adenocarcinoma differentiation with lymph node reactive hyperplasia. Immunohistochemical analysis demonstrated that the cancer cells were positive for AFP, HepPar-1, GPC3, CK7, and PLAP. The patient's recovery was on schedule and no sign of recurrence was observed for 3 months. We recently reviewed AFP-producing nongerm cell tumors in upper urinary tract and discussed the clinical aspect, morphology features, pathogenesis, and therapeutic regimen for a better understanding of this rare entity. Conclusion: The present case is the first documented of hepatoid adenocarcinoma of renal pelvis complicated with nephrolithiasis, which was treated with laparoscopic approach. The prognosis of the hepatoid adenocarcinomas arising from renal pelvis and ureter seems good. [ABSTRACT FROM AUTHOR]

The former perception of the urothelium as an impermeable barrier has been revised during the last decade, as increasing evidence of changes in urine composition during its passage of the urinary tract has been presented. Since differences in urothelial permeability between upper and lower urinary tract have been found, our aim is to demonstrate whether changes in urine composition occur during passage through the ureter. We studied consecutive urine samples from both renal pelvises in six pigs and compared them to samples from the bladder and distal ureter. We further sampled urine during storage in the bladder at a fixed volume. All samples were analysed by measuring osmolality and pH, along with the concentration of the following parameters: Na+, K+, Cl-, creatinine, urea. Urine alkalinity increased significantly during passage of the ureter. Creatinine concentration, pH and K+ increased significantly during the passage from pelvis to the bladder. All other parameters increased non-significantly during the passage to the bladder. The increase in concentration was more pronounced at low concentrations in the pelvis. During storage in the bladder, there was a significant increase in urea concentration. Changes in the composition of urine occur during its passage from the renal pelvis to the bladder and during storage in the bladder. Despite the brief transit time, significant changes in alkalinity were found already during passage through the ureter. [ABSTRACT FROM AUTHOR]

The terminology applied to canine prostatic epithelial lesions, especially carcinomas, is currently not standardized and this hampers the ability of pathologists to study the biological and clinical significance of these lesions. The aim of this review is to present the essential histomorphological diagnostic attributes of a wide spectrum of prostatic epithelial lesions in dogs. In addition to the traditionally recognized prostatic hyperplasia, hormonal atrophy, prostatitis, squamous metaplasia, adenocarcinoma and transitional cell (urothelial) carcinoma, new entities are described and discussed in order to provide veterinary pathologists with a basic atlas of common histological lesions of the canine prostate that is comprehensive and easy to use. [ABSTRACT FROM AUTHOR]

To analyze lymph node invasion (LNI) rates according to tumor characteristics and to test the impact of LNI and its extent on cancer specific mortality (CSM) in surgically-treated non metastatic urothelial upper urinary tract carcinoma (UTUC) patients. Within the SEER database (2004–2014), we identified 2098 patients with histologically confirmed non-metastatic urothelial carcinoma of renal pelvis or ureter who underwent NU with LND. LNI rates stratified according to tumor location and stage were described. Kaplan-Meier plots illustrated CSM rates according to LNI and its extent. Multivariable Cox regression models (MCRMs) tested the effect of LNI and its extent on CSM. Of 2098 UTUC patients, who underwent nephroureterectomy with lymph node dissection, 646 (33%) had LNI. The median number of removed lymph nodes was 3 [Interquartile range (IQR): 1–7]. The median number of positive lymph nodes in patients, who harbored LNI was 1 (IQR:1–3). LNI rates according to tumor location were, respectively, 23.6% for ureteral and 36.5% for renal pelvis tumors. LNI rates according to tumor stage were 9.6, 18.0, 38.7 and 63.9%, for respectively, T1, T2, T3 and T4 UTUC. In MCRMs, LNI achieved independent predictor status for higher CSM (HR 3.00; p < 0.001). Finally, in MCRMs, number of positive lymph nodes defined as the 75th percentile (n ≥ 3) achieved independent predictor status for higher CSM (HR 1.37; p = 0.04). LNI in non-metastatic UTUC patients is the most important determinant of CSM. Number of positive lymph node is independently associated with higher CSM. In consequence, lymph node dissection can provide extensive prognostic information. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The most common fusion anomaly of the kidney with an incidence of approximately 1 in every 500 births is represented by the horseshoe kidney (HSK). The most common complication of HSK is kidney lithiasis. Uretero-pelvic junction obstruction (UPJO) occurs in 1 in every 1500 births, and the three conditions can be associated. The purpose of this case report is to present the 3D laparoscopic pyeloplasty as treatment for uretero-pelvic junction obstruction in horseshoe kidney and multiple renal calculi. Materials and Methods. We present the case of a 33 years old male patient, with surgical history of percutaneous nephrolithotomy 7 years prior and two ESWL procedures 1 year before, admitted for recurrent right lumbar pain. The CT scan revealed HSK with dilated right pelvi-calyceal system suggesting right UPJO and multiple secondary renal calculi. We opted for a 3D laparoscopic transperitoneal pyeloplasty and calculi extraction. The surgery was performed in a standard flank position using three ports (a 12 mm for the camera and two working trocars of 10 mm and 5 mm). After a difficult dissection due to postoperative fibrosis and vascular anomalies, the renal pelvis was suspended with a suture wire from the abdominal wall to avoid the need of an additional trocar. Then the pelvis was incised and 11 stones were removed under direct vision. We proceeded to perform a standard dismembered Anderson-Hynes pyeloplasty. A 6 Fr ureteric double-J stent was inserted in an antegrade fashion over a guidewire. The pelvi-ureteric anastomosis was performed with continuous 4-0 Vicryl suture. Results. The operative time was 90 minutes. There were no intraoperative complications or incidents encountered. The patient was discharged on the 4th postoperative day. The JJ stent was removed after 21 days. Conclusions. Although it is a high-complexity surgery due to the aberrant vessels, renal isthmus, modified anatomy of the kidney and secondary lithiasis, the 3D laparoscopic pyeloplasty could be an effective and safe procedure for treating UPJO in horseshoe kidney and secondary multiple renal calculi, even in patients with previous renal surgeries. The 3D vision system reduces the operative time as it ensures better depth perception and faster and more precise surgical gestures. In the cases of recurrent renal lithiasis UPJO should be considered and immediately managed in order to achieve long term healing. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The aim of this subject is to present the results of the initial experience with the minimal invasive percutaneous nephrolitoholapaxy (MIP) technique in the Urology Clinic from SCJU Arad. Materials and Methods. The Urology Clinic from SCJU Arad, reported 15 cases of renal and ureteral lithiasis who underwent MIP technique between November 2018 - February 2019. All patients signed the informed consent, blood and urine samples were collected preoperatively, in order to assess the biological status of patients. Stone size (largest diameter) was measured on x-ray, the strategy of intervention was planned by consulting the urographic or computed tomographic images, by case. Interventions were performed under spinal anesthesia and prophylactic antibiotics were administered to all patients preoperatively. An 16 Ch Storz nephroscope was used, lithotripsy being achieved with an 30 W Ho:YAG Auriga QI laser, finally a 14 Ch - balloon nephrostomy was inserted. Results. The mean age of patients was 48 years (range 24 - 72 years), the mean operative time was 47 minutes (range 35 - 59 minutes). Patients had a single stone, either located in the renal pelvis or in the middle and lower calyces. Particular cases: one case of horseshoe kidney, one case of surgical solitary kidney, one case of sepsis with patient under anticoagulant treatment, one case of pregnancy, one case of bilateral staghorn calculi with chronic renal disease and one case of stone located on the lumbar ureter. The mean stone size was 14 mm (range 8 mm - 20 mm), except the case of bilateral staghorn calculi (3.4 - 5 cm diameter, 80 minutes). The clinical and biological status of patients, analyzed postoperatively, showed no significant hemorrhage, one cases complicated with acute pyelonephritis, stone free rate was achieved in percent of 87.4%, nephrostomy ablation time between 24-48, mean hospitalization time 4 days, better tolerance and low pain for smaller nephrostomy tubes. Conclusions. MIP technique is a better alternative in the treatment of small and medium size renal stones. The postoperative complications are minimal, and the stone free rate is similar to classic percutaneous nephrolithotomy, also in selected cases and with surgeon's experience, MIP can exceed the contraindications, in order achieve maximal therapeutic results. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The aim of the study is to evaluate and present the results of flexible ureterorenoscopy with holmium laser lithotripsy as treatment for kidney stone in pelvic ectopic kidney. Materials and Methods. Twelve patients with stones below 2.1 mm located in the pelvic ectopic kidney and treated by flexible ureterorenoscopy between 2012 - 2017 were retrospectively analyzed. Demographic data, stone characteristic and perioperative measurement were collected. Patients with incomplete data in the medical records were excluded. Results. We enrolled in the study seven males and five females with a mean age of 42.5 years (23 - 58 years). All patients were treated by flexible ureterorenoscopy under spinal anesthesia. The mean stone size was 14.9 mm (10 - 21 mm). Five stones were located in the renal pelvis, three in the middle calix and four in the lower calix. Also, in three cases was noted the presence of multiple stones. Eight patients had a double J stent placed before de surgery. The mean operation time was 66.2 minutes (45 - 100 minutes). Mean hospitalization time was 3.4 days (3 - 5 days). Stone free rate was 83.3% after one procedure. Reintervention was necessary in two cases (16.6%). Minor complications as persistent hematuria was observed in two cases (16.6%) and fewer in one case (8.3%). No severe complications were recorded. Conclusions. The use flexible ureterorenoscopy with laser lithotripsy in treatment of small and medium stones occurred in patients with pelvic ectopic kidney is an effective and safe procedure. [ABSTRACT FROM AUTHOR]

Canine urothelial carcinoma (UC) is the most common type of cancer of the lower urinary tract and tends to affect elderly neutered female dogs, with a high predisposition for Scottish terriers. Tumour stroma, inflammation and necrosis are poorly characterized in canine UC and their role as prognostic factors is unknown. The aims of this study were to (1) assess histologically 381 canine UCs, with emphasis on myxoid tumour stroma, inflammation and necrosis and (2) assess possible associations between these features and the available epidemiological data as well as bladder wall muscle invasion. In 103 of 381 (27%) cases, the stroma was mixed collagenous and myxoid (fibromyxoid), which was strongly associated with invasive growth of muscle (P <0.0001). Peritumoural and intratumoural inflammation was present in 308 of 345 (89%) and 287 of 381 (75%) cases, respectively, and was mostly mild and lymphoplasmacytic. One hundred and fifteen of the 381 (30%) cases showed a variable eosinophilic inflammation and 58 of 381 (15%) presented with formations of one or several lymphoid follicles. Twenty-four percent (91 of 381) of cases had tumour necrosis, which was typically mild. In 83 of 91 (91%) cases, the necrosis was comedo-like. Moderate to severe tumour necrosis was associated with the presence of moderate to predominant fibromyxoid tumour stroma (P <0.02). The results of this study indicate that fibromyxoid stroma is common in canine UC and is a strong indicator for invasive growth of muscle, which is consistent with a poor prognosis. Based on histomorphology, tumour necrosis in canine UC is best described as comedonecrosis. [ABSTRACT FROM AUTHOR]

Abstract Purpose We compared endopyelotomy to redo pyeloplasty for the treatment of failed pyeloplasty in children to identify factors that may have an impact on outcome and favor one procedure over the other. Methods Of 43 patients with recurrent UPJO, EP was performed in 27 and RP was performed in 16. Age, gender, side, presentation of secondary UPJO, hospital stay, complications and success rates were compared. Success was defined as radiographic relief of obstruction as determined by ultrasound or diuretic renography at latest follow-up. Results Mean (Range) patient age was 7.2 years (range 6 months to 17 years) in EP (group 1) while 7.4 (range 6 months to 17 years) in RP (group 2). EP technique consisted of retrograde cold-knife in 17 patients, retrograde holmium laser in 8 and antegrade cold-knife in 2. RP was performed in 16 patients. All the patients with failed EP had a stricture greater than 15 mm. Mean length of the narrowed ureteral segment was 17.8 mm in the failed EP group vs 10 mm in the successful group (p < 0.001). Mean Hospital stay was 1 day for the EP group and 5 days for the RP group (p < 0.001). Mean follow-up was 17 months (range 12 to 43) after EP and 21 months (12 to 51) after RP. There was no statistical significance between both groups regarding the postoperative degree of hydronephrosis, parenchymal thickness, split renal functions and renal drainage. The overall success was (86%); the success was nonsignificantly higher in RP (93.8%) vs (81.5%) in EP. Conclusion In selected children, retrograde endopyelotomy is safe and may give comparable short-term outcomes as open redo pyeloplasty for correction of secondary UPJO after failed pyeloplasty. Narrowed ureteral segment greater than 15 mm and preoperative grade 4 hydronephrosis were factors significantly associated with a poor outcome after EP. A Level-of-Evidence rating for classifying study quality LEVEL III Retrospective comparative study. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Flexible ureteroscopy (fURS) can be a difficult intervention. It takes practice and it has a rather difficult learning curve. But, does standardizing the intervention create the premises for a better outcome, for reduced intervention time and reduced incidence of complications? A study from 2012 from Freiburg, detailed the use of what they called “The Freiburg fURS Technique”, but is the technique still coherent today, with the new advances in the technology used and with the increased experience of urologists? Our aim is to assess if the outcomes in our hospital, with our technique for fURS, are comparable with others reported. Materials and Methods. We included in the study, 101 patients with lower pole caliceal stones, with sizes ranging from 0.5 to 3 cm, for whom fURS (retrograde intrarenal surgery - RIRS) was performed. For the intervention, an Olympus digital flexible ureteroscope and single use Lithovue, 9.5 Fr, Boston Scientific flexible ureteroscopes were used. The lithotripsy was achieved using Holmium Laser (Olympus Empower H65 and Swiss LaserClast EMS). Laser fibres used – 200-270 microns. Retrieving devices – Boston Scientific Dakota. Results. Treating (dilating) the ureteral orifice was needed in 9 cases and we inserted a double-J stent preoperatively in 14 cases and performed the intervention 10-14 days after in those cases. In all cases a single guidewire which was passed all the way in to the renal pelvis and preferably in the upper pole calyx was used, instead of two as recommended in the Freiburg Technique. The semirigid ureteroscope was not used before the flexible one, although that would have been the case for a concomitant ipsilateral ureteral stone. A Ureteral Access Sheath was used in every case. Relocation of the stone to the renal pelvis or un upper pole calyx was performed in 62 patients (61.4%). We agree with the Freiburg team, that the use of a 2-access way scope would be better and also that a device for increasing water pressure is needed, but these are not mandatory. Complications were assessed using an MCCS – modified Clavien Classification System and we noted 10 patients (9.9%) with Clavien I complications, 8 patients (7.9%) with Clavien II and 1 patient with Clavien III complications (0.9%). Clavien IV complications were not encountered. The success rate was 94.1%. Conclusions. Our study intended to show that outcome is better and complications are low, indeed, using a standardized technique, but one which is continuously renewed. Of course, having a standardized technique improves the outcome and decreases the length of any operation. But we need to keep these standards up-to-date and synchronized with the new advances in technology. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Rectourinary fistula, an abnormal connection between the rectum and the bladder or urethra, may develop after radiotherapy for prostate adenocarcinoma. This type of fistula usually appears at 19-27 months after brachytherapy (BT). In this type of fistula, fibrosis and impaired tissue perfusion may represent a threat to good healing. We characterized the clinical and ultrasound (US) patterns in a patient that developed a rectourinary fistula after radical prostatectomy and BT for prostate adenocarcinoma and we summarized the clinical manifestations, US characteristics and treatment options. Materials and Methods. A 68-year-old male patient with a history of radical retropubic prostatectomy and BT was admitted to the Department of Nephrology in 2017 presenting rectoragia, low urinary tract symptoms, recurrent UTI, hypogastric and perineal pain, fecaluria. We suspected a rectourinary fistula and we performed an emergency US examination, an emergency rectosigmoidoscopy and an emergency laboratory panel. A contrast-enhanced CT scan could not be performed, as the patient was in stage IIIB chronic kidney (CKD) disease. Results. At the US examination, we noticed numerous hyperechogenic images in the bladder and both renal pelvis with comet-tail artefact in an anti-gravity position, highly suggestive for the presence of air in the urinary tract. In the kidneys, we performed longitudinal and transverse scans, in order to confirm the presence of air within the renal pelvis. Lab results revealed severe anemia, leukocytosis, neutrophylia, elevated ESR, serum creatinine 1.69 mg/dl. The rectosigmoidoscopy diagnosis was radiation proctitis with teleangiectatic vessels considered the source of rectal bleeding. Our patient was treated by endoscopic procedures in order to reduce the further risk of rectal bleeding and was hematologically stabilized by blood transfusions. We considered that the cause of the air in the urinary tract was a radiotherapy-induced rectourinary (rectovesical) fistula. Conclusions. Rectourinary fistula should always be taken into consideration as a potential complication after both radical prostatectomy and BT. In CKD patients, the complete grey-scale and Doppler US examination proved to be essential for the diagnosis of rectourinary fistula. We strongly recommend US examination as a reliable imaging investigation for the diagnosis and monitoring of this category of patients. [ABSTRACT FROM AUTHOR]

Purpose Excessive bulking force during primary access of the ureteral access sheath may induce ureteral injury. We investigated the efficacy of preoperative α-blockade to reduce ureteral access sheath insertion force and determine the upper limit required to avoid ureteral injury. Materials and Methods In this randomized controlled trial 135 patients from a single institution who had ureteropelvic junction or renal pelvis stones and were scheduled to undergo retrograde intrarenal surgery were prospectively enrolled from December 2015 to January 2017. Of the patients 41 and 42 were randomly assigned to the control and experimental groups, respectively. The experimental group received α-blockade preoperatively. The 21 patients who were pre-stented were assessed separately. We developed a homemade device to measure maximal ureteral access sheath insertion force. Results Our ureteral access sheath insertion force measurement device showed excellent reproducibility. Higher insertion velocity resulted in greater maximal sheath insertion force. Maximal insertion force in the α-blockade group was significantly lower than in the control group at the ureterovesical junction (p = 0.008) and the proximal ureter (p = 0.036). Maximal insertion force in the α-blockade group was comparable to that in pre-stented patients. Female patients and patients 70 years old or older showed a lower maximal ureteral access sheath insertion force than their counterparts. The rate of grade 2 or greater ureteral injury was lower in the α-blockade group than in controls (p = 0.038). No injury occurred in any case in which ureteral access sheath insertion force did not exceed 600 G. Conclusions Preoperative α-blockade and slow sheath placement may reduce maximal ureteral access sheath insertion force. If the force exceeds 600 G, a smaller diameter sheath may be an alternative. Alternatively the procedure can be terminated and followed later by pre-stented retrograde intrarenal surgery. [ABSTRACT FROM AUTHOR]

Purpose Renal pelvic pressure may vary during percutaneous nephrolithotomy. We sought to determine the relationship of postoperative pain to endoscope caliber, renal pelvic pressure and hospital stay. Materials and Methods We reviewed the records of 20 percutaneous nephrolithotomies done under ureteroscopic guidance with renal pelvic pressure monitoring. The ureteroscope working channel was connected to a pressure transducer and used to determine renal pelvic pressure at baseline, when irrigating with a 26Fr rigid nephroscope and a 16Fr flexible nephroscope, and during suction. Patient demographics, operative characteristics, Likert pain scores and length of hospital stay were compared as stratified by average renal pelvic pressure. The Mann-Whitney U and Fisher exact tests were used with p <0.05 considered significant. Results A total of 220 measurements were recorded in 20 patients undergoing single access percutaneous nephrolithotomy. Mean patient age was 55.2 years (range 20 to 77) and mean body mass index was 32.4 kg/m 2 (range 18 to 53.3). Rigid nephroscopy resulted in significantly higher average renal pelvic pressure than flexible nephroscopy (30.3 vs 12.9 mm Hg, p = 0.007). Average renal pelvic pressure was 30 mm Hg or greater in 7 patients (35%) undergoing rigid nephroscopy and in none (0%) undergoing flexible nephroscopy (p <0.01). Patients exposed to an average renal pelvic pressure of 30 mm Hg or greater during rigid nephroscopy had significantly higher average pain scores (p = 0.004) and longer hospital stays (p = 0.04) than patients with renal pelvic pressure less than 30 mm Hg. Average renal pelvic pressure 30 mm Hg or greater during rigid nephroscopy was also associated with a longer skin to calyx distance (105.5 vs 79.7 mm, p = 0.03). Conclusions Knowledge of the factors that influence renal pelvic pressure and methods to control pressure extremes may improve patient outcomes during percutaneous nephrolithotomy. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The ureteropelvic junction (UPJ) dysfunction, having as consequence hydronephrosis, was traditionally treated surgically by pyeloplasty, the rate of success being 71-98%. Failure was followed by one of the following interventions: repeating pyeloplasty, replacement with ileum, ureterocalicostomy, renal autotransplantation and, lastly, nephrectomy. We evaluate the role of endopyelotomy in the management of ureteropelvic junction obstruction. Materials and Methods. In a period of 27 years (1987-2014), we performed a total of 833 endopyelotomies. In our study (1987-2002), we retrospectively identified 303 patients who underwent endopyelotomy for ureteropelvic junction obstruction, who came for regular check-ups. Patient demographics, operative information, complications and success rates were reviewed for 187 patients, who could be properly assessed, with a mean age of 51 years and mean follow-up of 44 months. Treatment success was defined as the absence of symptom recurrence and improved radiographic features on ultrasound, intravenous pyelography at most recent follow-up. Results. endopyelotomy data were analyzed in 187 patients. The success rate was 83.9%. Treatment failure occurred in 30 (16%) patients. There were 20 (10.69%) cases of ureteral hypoplasia with less favorable results. Four patients (2.13%) with renal-ureteral duplication had surgical failure at 6 to 12 months reevaluation. Four patients (2.13%) were found with renal ptosis and two patients (1.06%) with horseshoe kidney in which endopyelotomy failed. Conclusions. Antegrade endopyelotomy is a minimally aggressive surgical intervention in both children adults and the elderly. The endoscopic percutaneous approach of ureteropelvic junction allows solving of associated disorders, such as renal lithiasis. Laparoscopic and robotic assisted pyeloplasty are emerging as the gold standard of treatment for ureteropelvic junction obstruction, endopyelotomy it is the treatment of choice for failed open or laparoscopic pyeloplasty and concomitant renal calculi. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The late developments in the laparoscopic field gave urologists the chance to perform reconstructive surgery by retroperitoneal approach. Retroperinoteoscopic or laparoscopic pyeloplasties tend to replace open surgery for uretero-pelvic junction obstruction (UPJO), but require high laparoscopic skills. The purpose of the study is to evaluate our experience in terms of laparoscopic dismembered pyeloplasty for uretero-pelvic junction obstruction using transperitoneal and retroperitoneal approach. Materials and Methods. Between January 2014 and February 2017, 34 patients (p) underwent dismembered laparoscopic pyeloplasty for ureteropelvic junction obstruction at our center, 23 p by retroperitoneoscopic approach and 11 p by transperitoneal approach. A retrospective chart review was carried out, including age, sex, ASA acore, hydronephrosis grade, associated caliceal stones, operative time, hospital stay, analgetic medication and renal function. The perioperative complications were carefully graded using the Clavien-Dindo system. Results. The mean age of patients with laparoscopic dismembered pyeloplasty was 31.8 ± 8.4 years, with 32.4 ± 7.9 years for transperitoneal subgroup and 30.5 ± 7.2 for retroperitoneal approach. The mean preoperative serum creatinine was similar for both groups of patients. There was no need for open conversion. The cause of UPJO was anterior crossing vessels in 7 cases (20.5%) and caliceal stones were identified in 2 patients (18.1%) in TPP group and 3 patients (13.0%) in RPP group. The total rate of complications using the modified Clavien-Dindo classification was of 29.4% (10/34 patients). Conclusions. Retroperitoneoscopic laparoscopic dismembered pyeloplasty is superior to transperitoneal approach in terms of postoperative ileus, postoperative analgesic medication and hospital stay. In terms of success rate both approaches presented similar results. [ABSTRACT FROM AUTHOR]