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Pelvi-ureteric anastomosis is a critical step to ensure good outcome of pyeloplasty. Continuous suturing technique, especially for laparoscopic surgeries, may offer faster operative time while allowing water-tight anastomosis and remains an alternative to interrupted suturing technique. There has been mixed data on comparison of outcomes of continuous and interrupted suturing techniques. This systematic review and meta-analysis aim to assess the outcomes of pyeloplasty based on continuous and interrupted suturing techniques. Following protocol registration on PROSPERO (CRD42021269706), a systematic review was performed in accordance with Cochrane Collaboration. A literature search was performed in September 2021 across Medline, EMBASE, Scopus, Cochrane Library, and ClinicalTrials.gov. Records comparing pyeloplasty outcomes between continuous and interrupted suture techniques were included. Five studies were identified for inclusion (2 prospective, 3 retrospective). Three studies involved pediatric patients. Three studies exclusively assessed laparoscopic technique. Four outcomes were meta-analyzed: operative time, length of stay, complications, and pyeloplasty failure. Interrupted sutures had longer OR time (mean difference 33.14 min [95% CI 29.35-36.94], p < 0.0001) and length of stay (mean difference 1.08 days [95% CI 0.84-1.32], p < 0.0001). However, there were similar complication (OR 1.73 [95% CI 0.98-3.06], p = 0.06) and failure rates (OR 1.21 [95% CI 0.43-3.43], p = 0.71) between the two suture types. The overall risk of bias in the studies was high. While limited by the number of studies available, continuous sutures for pelvi-ureteric anastomosis appear to confer benefits of faster operative time and decreased length of stay without increasing complication rates or failures. [ABSTRACT FROM AUTHOR]

Objective: To compare the postoperative outcomes including the cosmetic results of robotic-assisted laparoscopic pyeloplasty (RALP) performed with and without assistant port in pediatric population. Methods: 47 patients with ureteropelvic junction obstruction consecutively underwent RALP were stratified as: three-port (Group 1, n = 26) and four-port (Group 2, n = 21). In Group 1, no assistant port was placed and double-J stent was introduced with the aid of an angiocatheter via the percutaneous route. In group 2, an assistant port was placed. The Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale(VSS), Satava, Clavien classification systems, and success rates were compared. Results: We found similar success rates for both groups (group 1:96.2%, group 2:100%). Two groups were similar in terms of improvement in the postoperative anteroposterior diameter of the renal pelvis and parenchymal thickness. There was no difference in terms of perioperative and postoperative complication rates (group 1:19.2%, group 2:9.5%). The total PSAS was significantly lower in Group 1 (p < 0.008). No difference was observed for VSS and OSAS. Conclusions: Using an assistant port does not improve the success or complications of RALP, while the cosmetic outcomes are inferior to three-port RALP in children. We suggest avoiding the use of assistant port during RALP in children. [ABSTRACT FROM AUTHOR]

Ureteropelvic junction obstruction is a common condition encountered by the pediatric urologist, and treated with pyeloplasty when indicated. Recent technological advancements and a shift across all surgical fields to embrace minimally invasive surgery have led to increased utilization of minimally invasive pyeloplasty. Conventional laparoscopy is a reasonable choice, but its use is limited by the technical challenges of precise suturing in a confined space and the associated considerable learning curve. Robotic technology has simplified the minimally invasive approach to pyeloplasty, offering enhanced visualization and improved dexterity with a fairly short learning curve. As utilization of robotic pyeloplasty continues to increase, we sought to critically assess the literature on this approach. We begin with a review of the technical aspects of robot-assisted laparoscopic pyeloplasty including tips for surgical proficiency and patient safety. Outcomes and complications from the contemporary literature are reviewed, as well as special considerations in the pediatric population including infant pyeloplasty, cost concerns, training, and postoperative diversion/drainage. [ABSTRACT FROM AUTHOR]

Background: Common causes of complications of laparoscopic pyeloplasty in children include anastomotic stricture, poor drainage due to high ureteropelvic anastomosis, and torsion of ureter. Herewith, we described our modified technique of paraumbilical three-port laparoscopic dismembered pyeloplasty (PTLDP) to minimize these complications.Patients and Methods: Data from 62 patients (age: 1-180 months, median: 12 months) with ureteropelvic junction obstruction (UPJO) who underwent pyeloplasty using our modified technique of PTLDP between February 2014 and September 2014 at our institution were reviewed. The key steps of our modified method involve identifying the lowest point of the renal pelvis and the lateral aspect of the ureter to guarantee a low pelviureteric and correct orientation anastomosis, and using a 4-0 silk for assistant suturing to avoid crushing of the anastomotic tissue.Results: All surgeries were successfully completed without conversion. Three patients required an accessory port for the anastomosis. All the patients achieved complete clinical or radiologic resolution after the operation. The mean operative time was 103.4 min, and mean estimated blood loss was 14.4 mL. Mean postoperative differential function of affected kidney was 43.0 ± 16.3 % (range 24-100 %), increased from 39.7 ± 18.0 % (range 18-100 %), preoperatively (p < 0.001). The success rate was 100 % at a mean follow-up of 18.3 ± 2.9 (range 13-25) months.Conclusions: Our modified technique of PTLDP is safe and feasible and to allow high success rate for the treatment of pelviureteric junction obstruction in children. [ABSTRACT FROM AUTHOR]

Objectives: Our objectives were to: (1) delineate factors associated with surgery at <1 year and (2) determine if early intervention was associated with increased risk of readmission. Methods: We conducted a retrospective review of children age 0-18 years with a diagnosis of UPJ obstruction who underwent pyeloplasty from 1/1/1999 to 9/1/2009 using the PHIS database. Data collected included patient factors (race, gender, insurance type, APR-DRG severity of illness) and hospital factors (annual case volume, census region, academic status). Outcomes assessed were: age at surgery and hospital readmission within 1 year of surgery. Data were analyzed using logistic regression and Cox PH for multivariate analyses. Results: 4499 children met study criteria. Minority race (OR 1.55), male gender (OR 1.49), public insurance (OR 1.37), high severity of illness (OR 3.60), Southern region (OR 1.44), and low hospital volume (OR 1.37) were significant predictors of early surgery ( p < 0.05). Only early surgery (HR 2.42; 95 % CI 1.67-3.49 2.42) was associated with increased risk of readmission. Conclusions: In children with UPJ obstruction, age at surgery is associated with patient demographic and hospital factors. Early surgery is associated with higher rates of readmission, suggesting that variations in age at surgery may be associated with significant differences in outcomes. [ABSTRACT FROM AUTHOR]

Background: Scar-free abdominal wall surgery is a research hotspot in recent years. This study presented surgical skills of transumbilical laparoendoscopic single-site pyeloplasty (LESS-P) for pediatric patients with ureteropelvic junction obstruction (UPJO) and its clinical application. Methods: Twenty-four pediatric patients with UPJO had transumbilical LESS-P performed by the same surgeon from June to December 2010. Among them, 16 were males and 8 females aged from 2 to 62 months with average of 14 months. Eighteen patients had obstruction on the left ureteropelvic junction and six on the right. The renal pelvis and ureter were anastomosed using 5-0 absorbable sutures and a double-J ureteric stent was placed through the anastomotic stoma. Results: All operations were successful. None was converted to open surgery and no additional sheath tube or incision besides umbilicus was needed. No intraoperative complications occurred. Ectopic blood vessels were found in two cases during surgery. The mean operative time was 145 min, and the average blood loss about 10 ml. Abdominal drainage tubes were remained for 2-9 days after surgery. The mean postoperative hospital time was 7 days. Two patients had postoperative urinary fistula, which naturally disappeared at 4 and 7 days of postoperation, respectively. Ultrasound and diuretic renal scintigraphy in follow-up found 23 patients had significantly decreased renal pelvis diameter. Although the other one showed no obvious change, but diuretic renography showed significantly improved excretion as indicated by increased glomerular filtration rate from 29 ml/min before surgery to 46 ml/min 6 months after surgery. Conclusion: Pediatric transumbilical LESS-P is not only safe and effective but also can well meet patient's aesthetic desire for scar-free abdominal wall. [ABSTRACT FROM AUTHOR]

Purpose: To assess the influence of the method for stent placement, the duration of stenting, and the presence of bladder drainage on the complication rate of open pyeloplasty.Patients and Methods: Complications were, retrospectively, compared in 228 consecutive open pyeloplasties performed at institution A using a trans-pyelostomic 6-Fr splint/stent for 5 days and no bladder drainage, and 150 consecutive open pyeloplasties performed at institution B using a trans-nephrostomic 6-Fr splint/stent for 9 days plus bladder drainage.Results: Median age at surgery was comparable between groups. The overall complication rate was 13% and was comparable at the two institutions, but for the presence of perioperative bleeding that was more common when the stent was placed trans-nephrostomically (institution B) and the rate of stent dislodgements, which was lower at institution A, perhaps due to some technical details aiming to prevent any inadvertent traction on the stent. Additional procedures, such as double J internal stent insertion, were required in <2% of cases.Conclusions: A 5-day period of stenting after open pyeloplasty is generally enough. Trans-nephrostomic and trans-pyelostomic stent placement is equally effective. However, the former can be associated with a slightly higher bleeding rate. Details during stent placement are keys to avoid postoperative dislodgement and malfunctioning. Systematic bladder drainage seems unnecessary. [ABSTRACT FROM AUTHOR]

Purpose: To present a new technique of retroperitoneoscopic Anderson-Hynes dismembered pyeloplasty (AHDP) in infants and children with ureteropelvic junction obstruction (UPJO) based on our clinical experience.Methods: From March 2003 to February 2007, retroperitoneoscopic AHDP was performed in 60 (44 boys and 16 girls) UPJO infants and children with a three-port lateral retroperitoneal approach. The retroperitoneal space was entered via a 1-cm longitudinal incision beneath the 12th rib and further developed by a glove balloon. Video-retroperitoneoscopy was undertaken with a 5-mm laparoscope between the mid axillary line and 1 cm away from the superior border of iliac crest. Dismembered pyeloplasty was carried out with the Anderson-Hynes anastomosis where 5-0 or 6-0 vicryl sutures were over a double-J ureteric stent. Anastomosis was completed with freehand intracorporeal suture techniques. Follow-up studies were conducted by intravenous urography and renal ultrasonography.Results: Among the 60 patients (62 sides) with retroperitoneoscopic AHDP, only the first two cases were converted to open surgery due to difficulties in developing the retroperitoneal space, and the remaining cases succeeded. The average operative time was 70 +/- 12.6 min (ranging from 55 to 130 min), the average estimated blood loss was 10 +/- 2.2 ml (ranging from 5 to 20 ml), and the average postoperative hospital stay was 7 +/- 1.3 days (ranging from 3 to 15 days). Aberrant artery vessel was intraoperatively observed in seven patients. Postoperative urinary leakage occurred in two patients, but spontaneously disappeared on the 6th and 11th days after the surgery, respectively; and one of them underwent open surgery for recurrent UPJO 8 months later. During an average follow-up period of 24 months, we performed radiographic assessment by intravenous urography and found that all the cases showed good results except the patient who underwent open surgery later.Conclusions: Our experience with retroperitoneoscopic AHDP demonstrates that this technique is safe, effective and time saving for treating UPJO in infants and children. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic pyeloplasty in children has been proven to be safe and effective, with comparable results to open surgery. Due to the extension of laparoscopic indications from ablative to reconstructive procedures requiring endoscopic suturing, most centres have plateaued within their learning curve. Based on our own experience with a little more than 100 cases, we focus on the complications and the definitive learning curve of laparoscopic pyeloplasty in children.Materials and Methods: A total of 103 laparoscopic pyeloplasties were performed during the period January 2002 to June 2008. Of these, 102 underwent laparoscopic dismembered pyeloplasty and one underwent laparoscopic vascular hitch for crossing lower pole vessels. Intraoperative incidents/complications were analysed using the Satava classification, and the postoperative complications according to the Clavien classification.Results: Intraoperative incidents occurred in 2.91% of the cases, mostly without consequences for the child including faulty port placement needing placement of an extra port and umbilical port side bleed. Postoperative complications occurred in 11.65% children and included prolonged ileus, prolonged urinary leak, fever, haematuria and recurrent ureteropelvic junction (UPJ) stenosis. Recurrent UPJ stenosis occurred in 4.85% of children needing reoperation.Conclusions: Laparoscopic pyeloplasty in children is not only feasible, but safe and effective. Intraoperative incidents occur in up to 3% of the cases, and complications in 12.9-15.8%. Increased experience, training and knowledge regarding the incidence and management of complications will be able to further reduce these in the future. [ABSTRACT FROM AUTHOR]

Introduction: Several algorithms exist for the management of prenatally diagnosed hydronephrosis due to ureteropelvic junction obstruction (UPJO). We utilize a conservative and practical approach emphasizing observation, with less frequent use of renal flow scans (RFS). We reviewed the results of 143 pediatric patients with congenital UPJO managed at our institution, focusing on surveillance and selective utilization of RFS, according to a standardized protocol.Materials and Methods: Charts of all infants with prenatally detected UPJO treated surgically or followed conservatively according to our protocol were reviewed. Patients were initially evaluated with ultrasound (US), voiding cystourethrogram, and RFS. Successive follow-up was with interval US. RFS was reserved for those with worsening hydronephrosis or that which failed to improve on US by 1 year. Radiographic studies and operative reports were examined. Gender, side of UPJO, degree of hydronephrosis, mode of management, and current status of the patients were noted.Results: The records of 143 patients and a total of 198 renal units (RU) were reviewed. The male:female ratio was 2.7. UPJO was unilateral in 88 (61%) patients and occurred more frequently on the left side (68%). Obstruction was bilateral in 55 (39%) patients. Initial US grade of hydronephrosis was Grade 1 in 56 RU (28%), Grade 2 in 51 RU (26%), Grade 3 in 50 RU (25%) and Grade 4 in 41 RU (21%). 178 RU (90%) were followed conservatively, while open dismembered pyeloplasty was the initial therapeutic approach in 20 RU (10%). The mean age at the time of surgery was 15.95+/-14.60 weeks (range 2-60). Indications included low differential renal function (DRF) (n=12), absence of tracer clearance from the renal pelvis (n=2), parental preference (n=3), and acute renal failure (n=3). Postoperative course was uneventful during 33.43+/-33.53 months (range 2-120) with favorable US and RFS results. In conservatively managed patients, mean follow-up time was 14.94+/-14.35 months (range 1.5-142). Spontaneous resolution of hydronephrosis was observed in 87 RU (49%), while 10 RU (5.6%) eventually required surgery for worsening appearance or function on US or RFS, respectively (n=8), symptom development (n=3), and/or parental preference due to persistently prolonged T1/2 (n=4). Seventy-two RU (40.4%) remain under surveillance with improvement (47.2%) or stable hydronephrosis (47.2%) in 94.4%. Decreased DRF occurred in 1 RU. Nine RU (5%) were lost to follow-up. With application of this algorithm, only 12% of patients underwent two or more RFS.Conclusion: Pyeloplasty may be performed safely in infants when indicated; however, the majority of children with UPJO can be managed conservatively. Spontaneous resolution of hydronephrosis and/or favorable prognosis was encountered in 87% of conservatively managed RU. The use of a standard US grading system, selective utilization of follow-up renal function testing, and parental compliance are important factors in successful management. [ABSTRACT FROM AUTHOR]

To evaluate the results of the treatment in patients with antenatally detected unilateral ureteropelvic junction obstruction. Ninety-three patients were analyzed according to the radiologic and scintigraphic findings and mode of the treatment. Fifty-eight patients were treated surgically while 29 patients were followed conservatively. All patients were reevaluated at the first year of the treatment with diuretic renogram (DR). Follow-up procedure was finished at first postoperative year in surgically treated patients, while mean follow-up duration was 14.9+/-6.9 months for the conservatively treated group. In the operated group, pelvic diameter was greater than 20 mm on ultrasound and overall rate of mean split renal function was 38.65+/-9.55% on DR and 39.65+/-12.55% at first postoperative year. In the conservatively treated group, mean split renal function was 46.17+/-3.42 at the beginning and 47.48+/-4.00 at first year of follow-up. Sixty-three percent of the patients underwent pyeloplasty while 83% of them were showing obstructive pattern on DR. We believed that surgery should be done in renal units which showed pelvic diameter greater than 20 mm and less than 40% of split renal function, while others might be followed conservatively, with or without an obstructive pattern on DR. [ABSTRACT FROM AUTHOR]

To assess whether symptomatic unilateral ureteropelvic junction obstruction (SUUPJO) affects somatic growth and, if so, the parameters associated with it, 61 children (54 boys and 7 girls) who underwent pyeloplasty for SUUPJO without any other associated urological abnormalities were retrospectively studied. Height was compared with standard growth charts and was considered to be affected if it was below 2.00 Z-score. Such children were considered group B and the rest group A. Mean (±SD) age at presentation and mean (±SD) split renal function (SRF) (%) of the affected kidney were 6.0 ± 4.0 years and 27.3 ± 13.2, respectively, for the entire group. Somatic growth was affected in 16 (12 boys, 4 girls) children (26.2%). Urinary tract infection (UTI) was the presenting symptom in 11 (69%) and 5 (11%) children in groups B and A, respectively. Impaired somatic growth had no association with age at presentation or SRF, but a significant association (P < 0.001) was found with UTI. The mean post-surgery height percentile (2.92 ± 4.85) over a mean follow-up of 3.37 ± 1.86 years was significantly (P < 0.005) better compared with pre-surgery height percentile (0.67 ± 0.96) in group B, indicating catch-up growth after surgery. In SUUPJO, somatic growth is affected. Presentation with UTI has a significant association, and height significantly improves after surgery in these patients. [ABSTRACT FROM AUTHOR]

The functional outcome and factors influencing improvement after pyeloplasty for ureteropelvic junction (UPJ) obstruction are still debated. This retrospective study was aimed at evaluating the factors associated with functional improvement in symptomatic unilateral hydronephrosis (HDN). Patients (n=68) who underwent successful pyeloplasty for unilateral symptomatic UPJ obstruction without any other associated urological abnormality were included. Preoperative evaluation included a diuretic renogram (DR) to confirm obstruction and assess the split renal function (SRF). A follow-up DR was obtained 3 months and 1, 2, and 5 years postoperatively. An absolute increase in the differential function of the operated kidney by over 5% was considered significant; such kidneys were classified as improved (group A) and the others as unimproved (group B). The difference between the preoperative and 3-month SRF was highly significant (P < 0.001). Significant (P < 0.01) improvement in SRF continued until 1 year after pyeloplasty. Patients who presented with a mass had significantly greater improvement (P < 0.05) than those who presented with other clinical features. In group A, a significantly higher number of patients presented with a mass. It was also evident that patients aged less than 1 year showed significantly greater (P < 0.01) improvement in SRF than older patients. Thus, in unilateral symptomatic HDN with impaired function, patients who present with a mass or those in whom pyeloplasty was performed before 1 year of age showed significantly greater improvement. [ABSTRACT FROM AUTHOR]

The study examined the outcome of pyeloplasties done for decompensated ureteropelvic junction (UPJ) obstruction in infancy over a 13-year period. In a retrospective study, 186 children who underwent pyeloplasty in infancy were analysed with particular emphasis on the pre- and postoperative findings of 123I hippuran scintigraphy/diuretic renograms. The pre- and postoperative management is outlined in detail. The 186 patients underwent a total of 203 pyeloplasties during the period from January 1983 to 31 December 1996. Three children died; one required a nephrectomy. The postoperative scintigrapic results of 156 children (85%) done about 12 months after surgery were available for evaluation: 101 (64%) showed stable renal function and 43 (27%) revealed more than 5% improvement of renal function. In 12 cases (7%) renal function deteriorated after pyeloplasty by more than 5% compared to the pre-operative scintigram. It is concluded that pyeloplasty in infants is a low-risk procedure. The encouraging results of this series support early correction of UPJ obstruction. [ABSTRACT FROM AUTHOR]

Ureteropelvic junction (UPJ) obstruction is the most common urinary tract obstruction in children. Maternal ultrasonography has resulted in early diagnosis of an increasing number of neonatal cases, allowing repair of hydronephrotic kidneys before complications occur. We favor early treatment of congenital hydronephrosis, which should be performed prior to 6 months of age based on evidence of UPJ obstruction, increased pyelocaliceal dilatation, parenchymal thinning, contralateral normal kidney hypertrophy, and functional deterioration. One should not wait for evidence of progressive renal damage before making a diagnosis of obstruction. This therapeutic approach is supported by a review of the most relevant literature published on the subject and our clinical experience. None of the standard tests for measuring obstruction are ideal; hence, we recommend that the results of the different diagnostic procedures for UPJ obstruction should be examined collectively. [ABSTRACT FROM AUTHOR]

Giant hydronephrosis in a newborn as a complication of unfused, crossed renal ectopia and its successful operative correction are reported. [ABSTRACT FROM AUTHOR]

Although the evaluation of surgical procedures for the repair of ureteropelvic junction obstruction continues, open pyeloplasty is still the gold standard in the management of pediatric cases. The use of stents in open pyeloplasty is subject to discussion among pediatric urologists. To clarify this question on the basis of our experience, we retrospectively reviewed our 28 stented and 15 unstented pediatric pyeloplasty operations in terms of hospital stay, early and late complications, and success rates. While there were no differences between both groups in terms of early and late complications and success rates, hospital stay favored the unstented cases. We have concluded that routine stenting in pyeloplasty is not necessary unless a perfect anastomosis is accomplished. [ABSTRACT FROM AUTHOR]