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Background: Horseshoe kidney is the most common renal fusion anomaly, occurring in approximately 1 in 500 individuals worldwide. It is characterized by abnormalities in kidney position, rotation, and vascular supply. While often asymptomatic, horseshoe kidneys can lead to urological complications, primarily due to ureteric obstruction and impaired urinary drainage.Although ureteropelvic junction obstruction (UPJO) is uncommon in horseshoe kidneys, its occurrence presents unique diagnostic and management challenges. This case explores the etiology, clinical presentation, and surgical management of UPJO in a patient with a horseshoe kidney, highlighting the critical role of urologists in addressing these anatomical and functional complexities. Case presentation: We report the case of a 3-month-old African male infant who presented with a two-month history of excessive crying and symmetrical abdominal distension. Radiological evaluation revealed a horseshoe kidney with decreased parenchymal thickness in the left kidney and marked hydronephrosis of the pelvis and calyces, with abrupt cessation at the left ureteropelvic junction. Surgical correction of the obstruction was performed successfully. The patient was followed for six months, during which he remained symptom-free with normal renal function tests. Conclusion: Ureteropelvic junction obstruction in a horseshoe kidney presents unique anatomical challenges. Symptomatic cases require thorough imaging for diagnosis and surgical planning. Pyeloplasty is the typical surgical intervention, meticulously planned to address these complexities. This ensures effective relief of obstructions and proper urinary drainage. [ABSTRACT FROM AUTHOR]

Objective: The study aims to assess the long-term outcomes of pyeloplasty performed for ureteropelvic junction obstruction (UPJO) with giant hydronephrosis (GH). Method: Data of 94 patients with ipsilateral UPJO patients who underwent pyeloplasty were analyzed. Patients’ demographic characteristics, pre-, and postoperative anteroposterior diameters (APDs) of their kidneys, parenchymal thickness (PT) ratio (PT of ipsilateral/contralateral kidneys) of kidneys, differential renal function (DRF) and surgical outcomes were compared between the GH (group of patients with AP diameter of at least 50 mm as measured on two ultrasonographys with thinner PT than ½ of the contralateral kidney) and the non-GH groups. Results: Six female, and 18 male children were included in the GH (mean APD: 60.46±9.25 mm), and the remaining 21 female, and 49 male patients in the non-GH group were used as controls. Preoperative PT ratios and DRFs were found to be impaired in the GH group compared to the non-GH group (p<0,05). No significant differences were found between the groups in terms of age, gender, laterality of pyeloplasty, operative success. APD and PT ratios of GH and non-GH groups of patients. APD and PT ratios were found to improve significantly after pyeloplasty (p<0.05). GH patients who underwent pyeloplasty before 1 year of age experienced significant improvement in their DRFs and PT ratios, while these parameters did not improve in older children who underwent pyeloplasty. Conclusion: Long-term outcomes of pyeloplasty are satisfactory in pediatric UPJO patients with GH, and their DRFs were stable even in late renograms. Early relief of the obstruction improves PT and renal functions in GH patients younger than 1 year of age. [ABSTRACT FROM AUTHOR]

Robot-assisted laparoscopic pyeloplasty (RALP) has been increasingly utilized in the treatment of pediatric ureteropelvic junction obstruction (UPJO) with reported success rates of >95%. Complex renal anatomy can make some cases challenging to reconstruct. To evaluate outcomes of children undergoing RALP with aberrant renal anatomy and compare it to those with simple renal anatomy. An IRB approved prospective registry was queried to retrospectively identify all patients who underwent robotic pyeloplasty at our institution from 2012 to 2022. Patients undergoing re-do pyeloplasty were excluded. Complex anatomy was defined as horseshoe kidney, ectopic/pelvic kidney, duplex collecting system, fully bifid renal pelvis and severe malrotation (≥180°). A comparative analysis of baseline demographics, pre-operative clinical/radiological characteristics, intra and post-operative details, and long-term success was performed between those patients with complex anatomy and those without. Of 405 total robotic pyeloplasty's, 375 patients (378 total pyeloplasty; 353 simple, 22 complex) met inclusion criteria. 27 re-do were excluded from analysis. The complex pyeloplasty cohort included 9 horseshoe kidneys, 8 duplex collecting systems, 3 ectopic/pelvic kidneys and 2 kidneys with severe malrotation. There was no difference in age (58 vs 31 months; p = 0.38), procedure time (203 vs 207 min; p = 0.06), length of stay (1.4 vs 1.3 days; p = 0.99), or success (91.6% vs 100%; p = 0.24) between the simple and complex groups. Etiology of obstruction differed significantly between groups - high insertion was more common (3.9% vs 18.2%, p = 0.02) and intrinsic narrowing was less common (60.1% vs 36.4%, p = 0.04) in patients with complex anatomy. A multivariate logistic regression was adjusted for age, gender, etiology of obstruction, preoperative differential renal function and post-operative complications and found no difference in success between complex and simple RALP. The findings showed no significant differences in age, procedure time, length of hospital stay, or success rates between the two groups. Specifically, the success rates were 91.6% for the complex group and 100% for the simple group (p = 0.24), indicating comparable efficacy. However, the etiology of obstruction varied significantly, with high ureteral insertion more common in the complex anatomy group (18.2% vs. 3.9%, p = 0.02) and intrinsic narrowing less common (36.4% vs. 60.1%, p = 0.04). Despite these differences, multivariate logistic regression, adjusted for confounders, confirmed no difference in success rates between the groups. RALP is a safe and efficacious approach in patients with complex anatomy with success rates comparable to index patients. High ureteral insertion does appear to be more common in patients with complex anatomy undergoing pyeloplasty. Simple anatomy vs Complex anatomy children undergoing RALP N Simple Anatomy Complex anatomy p-value 353 22 Age at surgery in months, Median (IQR) 58 (16.5–131.4) 31 (10.1–127.8) 0.38 Gender 0.71 Male 239 (67.7%) 14 (63.6%) Female 114 (32.3%) 8 (36.4%) Etiology of obstruction Other 5 (1.4%) 0 (0%) 0.02 Crossing vessel 123 (34.6%) 10 (45.5%) 0.36 Intrinsic narrowing 214 (60.1%) 8 (36.4%) 0.04 High insertion 14 (3.9%) 4 (18.2%) 0.02 Procedure time (min), mean (SD) 203.6 (49.3) 207.5 (52.2) 0.06 30 day post-operative complication 40 (11.2%) 4 (18.2%) 0.31 Required additional endoscopic procedure 26 (7.3%) 0 (0%) 0.38 Required additional surgery 13 (3.7%) 0 (0%) 1.00 Follow-up time (months), median (IQR) 16.8 (9.1–32_ 17.04 (9.4–27.2) 0.98 Success 326 (91.6%) 22 (100%) 0.24 [ABSTRACT FROM AUTHOR]

Purpose: The study aims to determine the possible improvement in cortical transit time (CTT) after surgery in infants with antenatally diagnosed ureteropelvic junction obstruction (UPJO), and investigate the correlation of CTT with preoperative renal function and parenchymal thickness. Patients and methods: Medical charts of 32 antenatally diagnosed children with UPJO operated on between 2014 and 2021 were reviewed. Patients' demographics, preoperative and postoperative anteroposterior diameter (APD), parenchymal thickness (PT) ratio, differential renal function (DF), drainage patterns and CTT were compared to determine operative benefit. Preoperative CTT of each patient was also grouped as severely delayed (> 6 min) and moderately delayed (3–5 min) and compared. The correlation between the preoperative CTT and preoperative DF and PT ratio was investigated. Results: The median age of the patients was 8.8 months (1–24 months). The CTT (mean: 6.8 ± 3.0 min) was prolonged before surgery and was significantly improved (mean 4.6 ± 1.0 min) after the operation (p < 0.001). A significant negative correlation was detected between the CTT and preoperative DF and between the CTT and preoperative PT ratio. Preoperative DF was found significantly impaired in patients within the severely prolonged CTT group compared to those within the moderately prolonged CTT group. Significant improvement in DF was detected in patients in the severely prolonged CTT group after surgery. Conclusion: CTT is a parameter to prove relief of obstruction in patients with antenatally diagnosed UPJO after surgery. CTT is negatively correlated with preoperative DF and PT ratio. Severely prolonged CTT may be considered to be an indication of early surgical intervention. [ABSTRACT FROM AUTHOR]

Urinary tract dilations (UTDs) are the most frequent prenatal renal anomaly. The spectrum of etiologies causing UTD ranges from mild spontaneously resolving obstruction to severe upper and lower urinary tract obstruction or reflux. The early recognition and management of these anomalies allows for improved renal endowment prenatally and ultimately better outcome for the child. The role of the general obstetrician and pediatrician is to recognize potential prenatal and postnatal cases addressed to their practice and to refer patients to specialized pediatric nephrology and urology centers with a sense of the urgency of such a referral. The aim of this paper is to offer clinical recommendations to clinicians regarding the management of neonates and children born with prenatally detected UTD, based on a consensus between Swiss pediatric nephrology centers. The aim is to give suggestions and recommendations based on the currently available literature regarding classifications and definitions of prenatal and postnatal UTD, etiologies, prenatal and postnatal renal function evaluation, investigations, antibiotic prophylaxis, and the need for referral to a pediatric nephrologist and/or urologist. The overarching goal of a systematic approach to UTD is to ultimately optimize kidney health during childhood and improve long-term renal function prognosis. [ABSTRACT FROM AUTHOR]

Background: Ureteral spatulation, the first ureteral suture, and double-J stenting may be challenging and time-consuming in laparoscopic pyeloplasty, especially in small children. We aimed to present our comparative results of the extracorporeal ureteral spatulation, suturing, and stenting (EUSSS) technique in mini-laparoscopic pyeloplasty (MLP) and the conventional intracorporeal technique in prepubertal children. Methods: The data of 46 prepubertal pediatric patients (< 12 years) who underwent laparoscopic pyeloplasty by a single surgeon between January 2021 and October 2023 were retrospectively reviewed. The patients were divided into two groups: who underwent EUSSS-MLP (Group-1, n = 26) and who underwent conventional intracorporeal pyeloplasty (Group-2, n = 20). Results: The mean age of all patients was 5.3 years (4.8 ± 2.8 years in Group-1 and 6.0 ± 2.1 years in Group-2 p = 0.126). The mean duration of ureteral preparation plus double-J stenting was 5.7 ± 1.6 min in Group-1 and 19.2 ± 4.1 min in Group-2 (p < 0.0001). The mean duration of surgery was statistically significantly higher in Group-2 (p = 0.034). There was no significant difference in terms of postoperative complications (p = 0.482). Laparoscopic pyeloplasty was successful in 42 (91.3%) patients, with no statistically significant difference between the two groups (Group-1: 24 (92.3%), Group-2:18 (90%), p = 0.783). Conclusion: Extracorporeal ureteral preparation and double-J stenting can be safely and effectively preferred in MLP for prepubertal children. [ABSTRACT FROM AUTHOR]

Introduction: In adult patients with ureteropelvic junction obstruction (UPJO), little data exist on predicting pyeloplasty outcome, and there is no unified definition of pyeloplasty success. As such, defining pyeloplasty success retrospectively is particularly vulnerable to bias, allowing researchers to choose significant outcomes with the benefit of hindsight. To mitigate these biases, we performed an unsupervised machine learning cluster analysis on a dataset of 216 pyeloplasty patients between 2015 and 2023 from a multihospital system to identify the defining risk factors of patients that experience worse outcomes. Methods: A KPrototypes model was fitted with pre- and perioperative data and blinded to postoperative outcomes. T-test and chi-square tests were performed to look at significant differences of characteristics between clusters. SHapley Additive exPlanation values were calculated from a random forest classifier to determine the most predictive features of cluster membership. A logistic regression model identified which of the most predictive variables remained significant after adjusting for confounding effects. Results: Two distinct clusters were identified. One cluster (denoted as "high-risk") contained 111 (51.4%) patients and was identified by having more comorbidities, such as old age (62.7 vs 35.7), high body mass index (BMI) (26.9 vs 23.8), hypertension (66.7% vs 17.1%), and previous abdominal surgery (72.1% vs 37.1%) and was found to have worse outcomes, such as more frequent severe postoperative complications (7.2% vs 1.0%). After adjusting for confounding effects, the most predictive features of high-risk cluster membership were old age, low preoperative estimated glomerular filtration rate (eGFR), hypertension, greater BMI, previous abdominal surgery, and left-sided UPJO. Conclusions: Adult UPJO patients with older age, lower eGFR, hypertension, greater BMI, previous abdominal surgery, and left-sided UPJO naturally cluster into to a group that more commonly suffers from perioperative complications and worse outcomes. Preoperative counseling and perioperative management for patients with these risk factors may need to be thought of or approached differently. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the long-term outcomes of retroperitoneoscopic one-trocar-assisted pyeloplasty (OTAP) for ureteropelvic junction obstruction (UPJO) in children. Methods: This retrospective analysis included 70 pediatric cases, all under the age of 5, diagnosed with UPJO and treated with the OTAP technique between May 2011 and June 2013 by a single surgeon. A single 10 mm operative scope with a 5 mm working channel was utilized to mobilize the ureteropelvic junction (UPJ) and exteriorize it through the trocar insertion site. Subsequently, conventional Anderson–Hynes dismembered pyeloplasty was conducted extracorporeally. Patient's demographics, operative time, hospital stay, complications, and success rate were evaluated. Results: Seventy pediatric patients (65 males and 5 females) underwent OTAP, with ages at the time of operation ranging from 1 month to 5 years (mean = 22.6 ± 18.6 months). The mean operative time was 74.8 ± 15.2 min. There was a significant reduction in the mean renal pelvis size from 34.3 ± 8.1 mm preoperatively to 13.8 ± 4.7 mm postoperatively (p < 0.05). Moreover, the mean differential renal function (DRF) increased from 47.9 ± 9.8% preoperatively to 51.2 ± 5.9% postoperatively (p < 0.05). All patients experienced an uneventful postoperative recovery, with a median hospital stay of 3.4 days. The success rate was 95.7%, with a median follow-up time of 75 months (range: 6–125 months). Conclusion: OTAP is a safe and feasible minimally invasive technique to correct ureteropelvic junction obstruction in children. It could be considered as a treatment of choice for children under the age of 5 as it combines the advantages of open and retroperitoneoscopic pyeloplasty and presents excellent long-term outcomes. Trial registration number: NCT06349161 April 4th, 2024, retrospectively registered. [ABSTRACT FROM AUTHOR]

Abstract Background Horseshoe kidney is the most common renal fusion anomaly, occurring in approximately 1 in 500 individuals worldwide. It is characterized by abnormalities in kidney position, rotation, and vascular supply. While often asymptomatic, horseshoe kidneys can lead to urological complications, primarily due to ureteric obstruction and impaired urinary drainage.Although ureteropelvic junction obstruction (UPJO) is uncommon in horseshoe kidneys, its occurrence presents unique diagnostic and management challenges. This case explores the etiology, clinical presentation, and surgical management of UPJO in a patient with a horseshoe kidney, highlighting the critical role of urologists in addressing these anatomical and functional complexities. Case presentation We report the case of a 3-month-old African male infant who presented with a two-month history of excessive crying and symmetrical abdominal distension. Radiological evaluation revealed a horseshoe kidney with decreased parenchymal thickness in the left kidney and marked hydronephrosis of the pelvis and calyces, with abrupt cessation at the left ureteropelvic junction. Surgical correction of the obstruction was performed successfully. The patient was followed for six months, during which he remained symptom-free with normal renal function tests. Conclusion Ureteropelvic junction obstruction in a horseshoe kidney presents unique anatomical challenges. Symptomatic cases require thorough imaging for diagnosis and surgical planning. Pyeloplasty is the typical surgical intervention, meticulously planned to address these complexities. This ensures effective relief of obstructions and proper urinary drainage.

Objective: The study aims to assess the long-term outcomes of pyeloplasty performed for ureteropelvic junction obstruction (UPJO) with giant hydronephrosis (GH). Method: Data of 94 patients with ipsilateral UPJO patients who underwent pyeloplasty were analyzed. Patients’ demographic characteristics, pre-, and postoperative anteroposterior diameters (APDs) of their kidneys, parenchymal thickness (PT) ratio (PT of ipsilateral/contralateral kidneys) of kidneys, differential renal function (DRF) and surgical outcomes were compared between the GH (group of patients with AP diameter of at least 50 mm as measured on two ultrasonographys with thinner PT than ½ of the contralateral kidney) and the non-GH groups. Results: Six female, and 18 male children were included in the GH (mean APD: 60.46±9.25 mm), and the remaining 21 female, and 49 male patients in the non-GH group were used as controls. Preoperative PT ratios and DRFs were found to be impaired in the GH group compared to the non-GH group (p

Ureteropelvic junction obstruction (UPJO) is a pathological condition characterized by obstruction of the junction between the renal pelvis and ureter, often resulting in dilatation of the renal collecting system. Aberrant accessory vessels or early branching of the inferior pole vessels are the most common causes of extrinsic UPJO. The inferior mesenteric artery has not been reported as a common cause of UPJO. Here, we report the case of a 7-year-old patient with UPJO and an anomalous inferior mesenteric artery. The patient was initially diagnosed with congenital uropathy during the evaluation for primary enuresis.

Abstract Background Ureteral spatulation, the first ureteral suture, and double-J stenting may be challenging and time-consuming in laparoscopic pyeloplasty, especially in small children. We aimed to present our comparative results of the extracorporeal ureteral spatulation, suturing, and stenting (EUSSS) technique in mini-laparoscopic pyeloplasty (MLP) and the conventional intracorporeal technique in prepubertal children. Methods The data of 46 prepubertal pediatric patients (

Background: Ureteropelvic junction obstruction (UPJO) is the most common cause of antenatal hydronephrosis. Although majority of them improve with time, none of the existing diagnostic modalities can accurately predict which hydronephrotic kidney is at the risk of progressive renal damage and will benefit from early surgery. Postural variations in the anteroposterior pelvic diameter (APPD) of the hydronephrotic kidney in children during follow-up postnatal ultrasonography (USG) reflect the intrapelvic tension, which might help in predicting the need of surgery amongst these patients. Materials and Methods: We designed this prospective observational study in all unilateral UPJO patients on postural variation in the APPD of renal pelvis on ultrasonography. The mean age of all patients were 2.15 years (0-5 years) and managed at our institute at All India Institute of Medical Sciences, Bhubaneswar. The study duration was from July 2019 to May 2021. The management of these patients was done as per the standard institutional protocol and there was no deviation due to inclusion in this study. We documented the variations in postural APPD both amongst the conservatively managed group and the surgically managed group of patients. Linear correlation between two continuous variables was explored using Pearson’s correlation (if the data were normally distributed) and Spearman’s correlation (for non-normally distributed data). Results: We found a higher prone APPD than supine APPD in all these patients indicating the obstruction at ureteropelvic junction. However, in the surgical group, there was less variation in the postural APPD compared to the conservative group, and when there was no variation in the postural APPD, the need of surgery was 100%. The limitation of our study was the small sample size (n = 36). A study involving a larger population or involving multiple institutions may further add significance to our findings. Conclusion: We found less postural variation in APPD on USG to be more likely associated with severe UPJO requiring early surgery. This may indicate a non-compliant renal pelvis. However, it was statistically not significant.

Objective Methods Results Conclusion To report the application of laparoscopic single‐incision triangulated umbilical surgery (SITUS) pyeloplasty in children with ureteropelvic junction obstruction (UPJO) and compare its feasibility and efficacy with traditional three‐hole laparoscopic pyeloplasty.Data from children with UPJO who underwent SITUS between July 2018 and August 2021 were included in this retrospective study and patients who were treated with traditional laparoscopic pyeloplasty were chosen for comparison. Thirty‐two patients from SITUS group and 72 patients from traditional group were reviewed. The clinical characteristics, complications, and follow‐up results were collected and compared.The preoperative demographic data and imaging parameters, including sex, surgical side, age, BMI, and preoperative anterior–posterior pelvic diameter (APD), showed no significant differences between the two groups. The median surgical time was 135 min (IQR: 119.75–160.5) in SITUS group, while 163.5 min (IQR: 141.25–187.5) in the traditional group (p = 0.0008). Two Clavien‐Dindo III complications (6.25%) in SITUS group and 11 (15.3%) in the traditional group were recorded (p = 0.335). The success rate was 100% (32/32) in SITUS group and 94% (68/72) in the traditional group (p = 0.309).SITUS pyeloplasty is a feasible and effective laparo‐endoscopic single‐site (LESS) technique for pediatric patients with excellent cosmetic results comparable to the conventional laparoscopic pyeloplasty. More cases and longer follow‐up periods are needed to determine the exact outcomes of the modified LESS technique. [ABSTRACT FROM AUTHOR]

Background: Ureteropelvic junction obstruction (UPJO) is the most common cause of antenatal hydronephrosis. Although majority of them improve with time, none of the existing diagnostic modalities can accurately predict which hydronephrotic kidney is at the risk of progressive renal damage and will benefit from early surgery. Postural variations in the anteroposterior pelvic diameter (APPD) of the hydronephrotic kidney in children during follow-up postnatal ultrasonography (USG) reflect the intrapelvic tension, which might help in predicting the need of surgery amongst these patients. Materials and Methods: We designed this prospective observational study in all unilateral UPJO patients on postural variation in the APPD of renal pelvis on ultrasonography. The mean age of all patients were 2.15 years (0-5 years) and managed at our institute at All India Institute of Medical Sciences, Bhubaneswar. The study duration was from July 2019 to May 2021. The management of these patients was done as per the standard institutional protocol and there was no deviation due to inclusion in this study. We documented the variations in postural APPD both amongst the conservatively managed group and the surgically managed group of patients. Linear correlation between two continuous variables was explored using Pearson's correlation (if the data were normally distributed) and Spearman's correlation (for non-normally distributed data). Results: We found a higher prone APPD than supine APPD in all these patients indicating the obstruction at ureteropelvic junction. However, in the surgical group, there was less variation in the postural APPD compared to the conservative group, and when there was no variation in the postural APPD, the need of surgery was 100%. The limitation of our study was the small sample size (n = 36). A study involving a larger population or involving multiple institutions may further add significance to our findings. Conclusion: We found less postural variation in APPD on USG to be more likely associated with severe UPJO requiring early surgery. This may indicate a non-compliant renal pelvis. However, it was statistically not significant. [ABSTRACT FROM AUTHOR]

Hydronephrosis grading systems risk stratify patients with potential ureteropelvic junction obstruction, but only some criteria are measured objectively. Most notably, there is no consensus definition of renal parenchymal thinning. The objective of this study was to assess the association between sonographic measures of renal length, renal pelvic diameter, and renal parenchymal thickness and the outcomes of a)renal hypofunction(differential renal function{DRF} <40%) and b)high-risk renal drainage(T1/2 > 40 min). An institutional database of patients who had diuretic renograms(DR) for unilateral hydronephrosis was reviewed. Only infants with Society for Fetal Urology(SFU) grades 3/4 hydronephrosis without hydroureter on postnatal sonogram and had a DR within 120 days were included. The following measurement variables were analyzed: anterior posterior renal pelvic diameter(APRPD), renal length(RL), renal parenchymal thickness(PT), minimal renal parenchymal thickness(MPT = shortest distance from mid-pole calyx to parenchymal edge), and renal pyramidal thickness(PyrT). RL, PT, MPT, PyrT measurements were expressed as ratios (hydronephrotic kidney/contralateral kidney). Multivariate logistic regression was performed for each outcome by comparing three separate renal measurement models. Model 1 : RLR, APRPD, MPTR; Model 2 : RLR, APRPD, PTR, Model 3 : RLR, APRPD, PyrTR. Individual performance of variables from the best performing model were assessed via ROC curve analysis. 196 patients were included (107 with SFU grade 3, 89 with SFU grade 4) hydronephrosis. Median patient age was 29[IQR 16,47.2] days. 10% had hypofunction, and 20% had T1/2 > 40 min 90% with hypofunction and 87% with high-risk drainage had SFU4 hydronephrosis. Model 1 exhibited the best performance, but on multivariate analysis, only APRPD and MPTR were independently associated with both outcomes. No other measure of parenchymal thickness reached statistical significance. The odds of hypofunction and high-risk drainage increase 10% per 1 mm increase in APRPD(aOR 1.1 [CI 1.03–1.2], p = 0.005; aOR 1.1 [CI 1.03–1.2], p = 0.003). For every 0.1unit increase in MPTR the odds of hypofunction decrease by 40%(aOR 0.6 [CI 0.4–0.9], p = 0.019); and the odds of high-risk drainage decrease by 30%(aOR 0.7 [CI 0.5–0.9], p = 0.011). Optimal statistical cut-points of APRPD >16 mm and/or MPTR <0.36 identified patients at risk for obstructive parameters on DR. Of the sonographic hydronephrosis measurement variables analyzed, only APRPD and MPTR were independently associated with objective definitions of obstruction based on renal function and drainage categories. Patients who maintain APRPD <16 mm and/or MPTR >0.36 can potentially be monitored with renal sonograms as there is >90% chance that they will not have DRF<40% or T1/2 > 40 min. Summary Table Receiver operator curve analysis of the ability of the test variables Minimal Parenchymal Thickness Ratio and APRPD to predict the outcomes of renal hypofunction and high-risk renal drainage. Summary table Cut-point value ROC AUC Sensitivity (%) Specificity (%) Positive Predictive Value (%) Negative Predictive Value (%) Renal Hypofunction (RDF <40%) APRPD >16.9 mm 0.853 90 71 26 98 MPTR <0.36 0.803 85 63 21 97 High-Risk drainage (T1/2 > 40 min) APRPD >18.1 mm 0.787 77 80 48 93 MPTR <0.36 0.820 82 68 39 94 [ABSTRACT FROM AUTHOR]

Objectives: To explore surgical, functional, and symptomatic outcomes in a series of patients who underwent robot-assisted laparoscopic Anderson–Hynes pyeloplasty (RALP) for ureteropelvic junction obstruction using the DaVinci Si surgical robotic system. Methods: Retrospective study including patients aged 16 years or older who underwent RALP from June 2016 to December2021. The following outcomes were recorded: operative outcome and complications [classified according to the Clavien–Dindo Classification (CD)] within 30 days of the procedure as well as 1 year success rate and restenosis during follow-up. Results: In total, 194 patients were available for analyses with a median follow-up of 4.5 (IQR 3.0-6.0) years. The primary indications were loss of kidney function (45%), pain (36%), infection (11%), kidney stone (6%), and others (2%). The median operation time was 134 min (IQR 112-159), the median length of stay was 2 days (IQR 2-2), and the median time with double-j stent postoperatively was 24 days (IQR 22-27). Overall, 65 out of 194 patients (33%) experienced a postoperative complication (12% CD I, 13% CD II, 8% CD IIIa or IIIb). The 1 year success rate was 92% for patients treated because of deteriorating renal function, 78% for patients treated because of symptoms, 82% for patients treated because of infections, and 78% for patients treated because of kidney stones. Seven percent of the patients presented a recurrent ureteropelvic junction stricture during follow-up. Conclusions: In our experience, robot-assisted laparoscopic Anderson–Hynes pyeloplasty performed with the DaVinci Si system is a safe with a few major complications and acceptable success rate. [ABSTRACT FROM AUTHOR]

Background: Modified Anderson-Hynes pyeloplasty is currently preferred for ureteropelvic junction obstruction (UPJO). Extravasation of urine and anastomotic stenosis are the most common complications after Anderson-Hynes pyeloplasty, which are closely linked with the technique for anastomosis. However, there are currently no clear guidelines for the suture bite depth in suturing the anastomosis during pyeloplasty. Objective: To analyze the optimal suture bite depth in laparoscopic Anderson-Hynes pyeloplasty. Study Design: A total of 90 children aged 4–14 years with UPJO-induced hydronephrosis who were surgically treated in the First People's Hospital of Lianyungang from July 2019 to July 2022 were prospectively recruited. All received laparoscopic Anderson-Hynes pyeloplasty using 5-0 Vicryl continuous sutures. According to the suture bite depth, the patients were divided into group A (depth 1 mm, n = 46) and group B (depth 0.5 mm, n = 44). Operation time, postoperative drainage volume, time of ureteral stent removal, incidence of postoperative complications, and time to hydronephrosis resolution were compared between groups. Results: Group A showed significantly less postoperative drainage volume, and shorter time of ureteral stent removal and hydronephrosis resolution (all P < .05). Four cases in group B received replacement of a double-J stent. Except for 1 patient receiving reoperation for anastomotic stenosis caused by massive extravasation of urine, the replaced double-J stent was successfully removed from the remaining 3 patients at 3 months, and the symptoms of anastomotic stenosis disappeared. No significant difference was detected in the operation time between groups (P > .05). Conclusion: An appropriate deeper suture bite depth for anastomosis may reduce postoperative urine extravasation and related complications in children who received laparoscopic pyeloplasty for UPJO-induced hydronephrosis. [ABSTRACT FROM AUTHOR]

To analyze the clinical characteristics of ureteropelvic junction obstruction (UPJO) caused by crossing vessels (CV) in infants and young children. A retrospective analysis was performed on children with UPJO who underwent primary surgery. Patients were classified into laparoscopic pyeloplasty (LP) and open pyeloplasty (OP) groups and classified as ≤3 or >3 (years old) groups. Children with CV-caused UPJO were identified. A total of 747 patients were included. Ninety cases of CV were identified. The CV discovery rate was higher in the LP group (78/457, 17.1%) than in the OP group (12/290, 4.1%) (P < 0.001). In the ≤3 group, the CV discovery rate in the LP group (27/144, 18.8%) was higher than that in the OP group (11/274, 4.0%) (P < 0.001). In the LP group, there was no significant difference between ≤3 (27/144, 18.8%) and >3 (51/313, 16.3%) groups in the CV discovery rate. The rate in children with UPJO was not significantly different at any age (P > 0.05). Progressive aggravation of hydronephrosis (21/27, 77.8%) and symptomatic hydronephrosis (44/51, 86.3%) were the main surgical indications in the ≤3 and > 3 groups, respectively. There were no preoperatively confirmed cases of CV in the ≤3 group. In the OP group, five patients underwent reoperation, three of whom were due to failure to detect CV during the initial operation. The CV distribution is similar in children with UPJO across all ages; CV in infants and young children are not rare. LP should be considered as CV are prone to being missed during OP. III. • What is currently known about this topic? Crossing vessels-caused UPJO was reported to be more common in older children. There are few studies on crossing vessels-caused UPJO in infants and young children and on the age distribution of crossing vessels in children with UPJO. • What new information is contained in this article? The distribution of crossing vessels is similar in children of all ages with UPJO, and crossing vessels are not rare in infants and young children. [ABSTRACT FROM AUTHOR]

ObjectiveTo explore the causes and surgical managements of restenosis after pyeloplasty for ureteropelvic junction obstruction (UPJO) in children and examine the potential risk factors for restenosis. MethodsFrom January 2013 to February 2023, the relevant clinical data were retrospectively reviewed for 326 UPJO children (332 sides) undergoing primary and redo pyeloplasties. The causes, diagnoses, surgical procedures and outcomes of restenosis after primary pyeloplasty were summarized. They were assigned into two groups of restenosis and non-restenosis according to follow-up results. The relevant clinical data of two groups were compared for examining the risk factors of recurrence. ResultsThere were 11 sides in restenosis group and 321 sides in non-restenosis group. Postoperative restenosis was confirmed by ultrasonography, computed tomography (CT) and retrograde pyelography. Laparoscopic redo pyeloplasty ( n=10) and open surgery ( n=1) were performed. Interval between two operations was (9. 68±2. 71) month. The intraoperative findings included local stenosis of ureteropelvic junction ( n=4, 36. 36%), adhesion & compression around ureteropelvic junction ( n=5, 45. 45%) and compression of anterior crossing vessel ( n=2, 18. 18%). During a follow-up period after redo pyeloplasty of (46. 90±43. 75) month, hydronephrosis improved in all cases. In the restenosis group, 27. 27%(3/11)cases underwent the percutoneaus nephrostomies before pyeloplasty and 45. 45%(5/11)underwent miniature pyeloplasty via a dorsal paravertebral transverse incision. which were significant more than those in non-restenosis group(6. 85%(22/321)and 17. 76%(57/321). Multivariate Logistic regression analysis revealed that preoperative percutaneous nephrostomy ( P=0. 009, OR=7. 226, 95% CI: 1. 628-32. 082) and dorsal mini-incision ( P=0. 015, OR=5. 038, 95% CI: 1. 376-18. 440) were independent risk factors for recurrent UPJO. ConclusionsThe common causes of restenosis include local stricture of anastomosis, adhesion and compression around ureteropelvic junction and anterior crossing vessels. Laparoscopic redo pyeloplasty is both safe and effective for recurrent UPJO. Preoperative percutaneous nephrostomy should be adopted cautiously with definite indications. Surgeons should be vigilant for handling anterior crossing vessels within a confined dorsal field. [ABSTRACT FROM AUTHOR]

Introduction: Ureteropelvic junction obstruction (UPJO) is a commonly encountered abnormality and it can lead to serious consequences such as renal dysplasia eventually resulting in loss of kidney. Hence, early diagnosis and timely management remains the cornerstone of the treatment. The most anticipated technique amongst modern day urologist is the robot-assisted laparoscopic pyeloplasty (RALP). The study aims to determine early post-operative outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedure in patients presenting with unilateral ureteropelvic junction obstruction to establish the local perspective. Methodology: This is a descriptive study involving patients with ureteropelvic junction obstruction in a tertiary care facility in Karachi; Sindh Institute of Urology and Transplant (SIUT). A total of 46 participants were recruited. Robot-assisted laparoscopic transperitoneal dismembered Hynes–Anderson pyeloplasty was performed by a single surgeon with over 3 years of experience in the presence of the researcher. Early postoperative outcome total operative time, length of hospital stay, console time and blood loss were noted by the researcher as per operational definition. Data were analyzed on SPSS Version 22. Results: Mean age in our study was 46.51 years with the standard deviation of ± 10.87. Whereas, mean length of hospital stay, total operative time, total blood loss, console time, pre-hemoglobin, posthemoglobin, height, weight and BMI in our study was 1.19 ± 0.40 days, 64.58 ± 17.59 min, 9.56 ± 6.13 ml, 30.17 ± 4.99 min, 12.66 ± 1.47 ml, 11.79 ± 1.93 ml, 165.62 ± 8.23 cm, 68.34 ± 8.23 kg and 24.85 ± 3.34 kg/m2, respectively. Conclusion: Recent advancements in technology have yielded the latest RALP technique which has been proven significantly better than existing approaches and similar results are reported by this study demonstrating improvement in peri-operative and post-operative outcomes ultimately ameliorating the quality of life of patients with UPJO. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate the urinary caspase-3 and cytochrome c levels in patients with unilateral antenatal hydronephrosis and to determine whether changes in urinary biomarker levels could be useful for both predicting the need for surgical intervention due to ureteropelvic junction obstruction (UPJO) and postoperative surgical success. Methods: Sixty-five children with a history of unilateral antenatal hydronephrosis and postnatal anteroposterior diameter ≥ 10 mm were included in this prospective case–control study between January 2013 and December 2021. The obstruction group consisted of 33 patients (28 boys, 84.8%) who underwent open dismembered pyeloplasty due to UPJO. The non-obstructive dilatation (NOD) group consisted of 32 patients (27 boys, 84.4%) with stable or improving hydronephrosis and no significant reduction in ipsilateral split renal function during follow-up, whereas 34 healthy children were enrolled in the study as a control group. Urinary urinary caspase-3 and cytochrome c levels using ELISA were measured. Results: The median preoperative urinary caspase-3 level was significantly higher in the obstruction group when compared to the NOD group (4.82 ng/mgCr vs. 2.61 ng/mgCr, p = 0.013) as well as the control group (4.82 ng/mgCr vs. 1.72 ng/mgCr, p = 0.002). In the postoperative period, urinary caspase-3 levels significantly decreased compared to preoperative measurements (4.82 ng/mgCr vs. 2.51 ng/mgCr, p = 0.006) and became similar to the control group (2.51 ng/mgCr vs. 1.72 ng/mgCr, p = 0.422). On the other hand, no significant differences were observed in urinary cytochrome c levels between the groups. All patients who underwent pyeloplasty achieved postoperative resolution in hydronephrosis and improved drainage on MAG-3, so none of the patients required re-do pyeloplasty. Postoperative decrease in caspase-3 level was found to be compatible with adequate urine drainage on MAG-3 scan. The cut-off value of urinary caspase-3 to predict patients requiring pyeloplasty was found to be 3.31 ng/mg creatinine with 63.6% sensitivity, 62.5% specificity (AUC = 0.679). In the multivariable analysis, urinary caspase-3 level (OR: 1.653, p = 0.019), anteroposterior pelvic diameter (OR: 1.401, p = 0.001), and split renal function on MAG-3 (OR: 1.277, p = 0.011) were found to be independent factors in determining patients who require surgery. Conclusion: Based on our preliminary findings, urinary caspase-3 levels could be a useful biomarker not only for predicting the need for surgical intervention but also for determining the postoperative surgical success in children with UPJO. [ABSTRACT FROM AUTHOR]

Reports of hydronephrosis-induced hypertension in pediatric patients are rare. A 7-year-old girl with hypertension was referred to our hospital with left hydronephrosis caused by ureteropelvic junction obstruction of the lower moiety in a partial duplex system. Because the lower moiety was almost nonfunctional, a laparoscopic heminephrectomy was performed. Antihypertensive drugs were unnecessary on the day after surgery. This is the first report of a Page kidney in a patient with ureteropelvic junction obstruction of the lower moiety. The cause of hypertension was evaluated based on the plasma renin activity and pathological findings of the lower moiety.

Objective·To explore the predictive value of diuretic renal scintigraphy parameters such as 20-minute residual rate (R20) for pyeloplasty in children with congenital unilateral ureteropelvic junction obstruction (UPJO).Methods·The clinical data and diuretic renal scintigraphy results of 110 children with congenital unilateral UPJO who were first treated at the Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from August 2018 to August 2023 were retrospectively analyzed. The imaging results and the progress of hydronephrosis were followed up after the first diuretic renal scintigraphy. According to the outcome event of pyeloplasty due to the progression of hydronephrosis, the children were divided into operation group and non-operation group. Age, gender, side of hydronephrosis, and baseline diuretic renal scintigraphy parameters including blood perfusion rate (BPR), differential renal function (DRF), time to peak (Tmax), time to half (T1/2) and R20 were compared between the two groups. Logistic regression was used to analyze the effect of various parameters on the progression of hydronephrosis. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of diuretic renal scintigraphy parameters for surgical intervention. Wilcoxon test was used to compare the examination parameters of two diuretic renal dynamic imaging.Results·During the follow-up, 60 children underwent pyeloplasty after progression, and the other 50 children did not progress. The differences in DRF, Tmax, T1/2 and R20 between the two groups of children at baseline were statistically significant (all P0.05).Conclusion·R20 plays an important role in the prediction of pyeloplasty in children with congenital unilateral UPJO. For children with R20≥90.08%, pyeloplasty should be performed as soon as possible to prevent further deterioration of renal function.

Mintesnot Yitagesu Kidane, Adugna Getachew Mideksa, Mubarek Bargicho Adem, Fitsum Gebreegziabher Gebrehiwot, Ramzi Yessuf Adem, Mensur Mohammed Ahmed, Abebe Ketema Aderu, Mintesnot Tadesse Berta Department of Surgery, Urology Division at St. Paul Hospital and Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Mintesnot Yitagesu Kidane; Adugna Getachew Mideksa, Email minteyit01@gmail.com; adulense@gmail.comAbstract: We report rare case of concomitant left nutcracker syndrome and right ureteropelvic junction obstruction (UPJO) on adult female patient diagnosed by CT urogram after she presented with intermittent bilateral flank pain. For this we did Anderson-Hynes pyeloplasty for right ureteropelvic obstruction, it was laparoscopic initially but due to difficulty of stenting it is changed to open. She had smooth post-op course then discharged on 3rd post-op day. Symptoms of nutcracker syndrome are not that much bothersome for the patient so we planned to follow her conservatively.Keywords: nutcracker syndrome, ureteropelvic junction obstruction, pyeloplasty, UPJO

Abstract Background Ureteropelvic junction obstruction (UPJO) is the most common cause of pediatric congenital hydronephrosis, and continuous kidney function monitoring plays a role in guiding the treatment of UPJO. In this study, we aimed to explore the differentially expressed proteins (DEPs) in the urinary extracellular vesicles(uEVs) of children with UPJO and determine potential biomarkers of uEVs proteins that reflect kidney function changes. Methods Preoperative urine samples from 6 unilateral UPJO patients were collected and divided into two groups: differential renal function (DRF) ≥ 40% and DRF

Objective: To investigate whether the panoramic view offered by robot-assisted laparoscopic pyeloplasty (RALP) reduces the likelihood of missing a crossing vessel compared to open pyeloplasty in cases where initial pyeloplasty fails. Methods: A single institution redo-pyeloplasty database was reviewed for children treated between January 2012 to July 2023. Clinical history, imaging and operative details were reviewed to identify the etiology for the redo procedure. Results: Cohort consisted of 45 patients undergoing a redo RALP during the study period. 29 of 45 patients had an initial open surgical approach, whereas 16 had an initial RALP. 10 patients were noted to have a missed crossing vessel on redo pyeloplasty – 9 had an initial open approach whereas 1 had an initial RALP (p<0.0001). Conclusions: RALP may reduce the risk of missing a crossing vessel due to the panoramic view of the surgical field intrinsic to an intraperitoneal RALP approach. [ABSTRACT FROM AUTHOR]

Purpose: Retroperitoneal robotic-assisted pyeloplasty (ret-RAP) for ureteropelvic junction obstruction (UPJO) requires a larger retroperitoneal space (RS) to maintain specified distances between robotic (da Vinci) trocars and between trocars and the region of interest. A modified closed technique (MOT) and conventional closed technique (COT) were compared for creating an adequate RS with optical trocars. Methods: RS access in children with UPJO who underwent ret-RAP (n = 30) was MOT (n = 15) and COT (n = 15). All patients were positioned laterally. For MOT, a 5 mm optical trocar was inserted at the angle formed between the 12th rib and the erector spinae muscles. As the trocar was advanced under direct vision, it pierced the superficial subcutaneous layer, Scarpa's fascia, lumbar fascia, internal/external oblique and transversus abdominalis muscles, and the posterior renal fascia. Once in the RS, the tip of the scope was used for blunt dissection of perirenal fat, the tip was withdrawn until it was outside the perirenal fascia, and used to dissect toward the anterior abdomen in the pararenal fat layer. Results: Ages and weights at ret-RAP were similar (MOT: 5.6 ± 1.8 years versus COT: 7.8 ± 4.6 years; MOT: 20.6 ± 10.1 kg versus COT: 27.6 ± 13.9 kg). Times for RS access were similar (MOT: 1.6 ± 0.5 minutes versus COT: 1.9 ± 0.7 minutes), but RS expansion was significantly quicker in MOT (32.3 ± 8.7 minutes versus 52.0 ± 15.1 minutes; P < .001). Peritoneal injury caused carbon dioxide leakage in 4 of 15 COT cases and 0 of 15 MOT cases. Conclusion: RS expansion with MOT was safer because there were no peritoneal injuries and MOT was quicker than COT. [ABSTRACT FROM AUTHOR]

Patients with high grade hydronephrosis (HN) and non-obstructive drainage on mercaptoacetyltriglycine (MAG-3) diuretic renography (renal scans) can pose a dilemma for clinicians. Some patients may progress and require pyeloplasty; however, more clarity is needed on outcomes among these patients. Our primary objective was to predict which patients with high-grade HN and non-obstructive renal scan, (defined as T ½ time <20 min) would experience resolution of HN. Our secondary objective was to determine predictors for surgical intervention. Patients with prenatally detected HN were prospectively enrolled from 7 centers from 2007 to 2022. Included patients had a renal scan with T ½<20 min and Society for Fetal Urology (SFU) grade 3 or 4 at last ultrasound (RBUS) prior to renal scan. Primary outcome was resolution of HN defined as SFU grade 1 and anterior posterior diameter of the renal pelvis (APD) < 10 mm on follow-up RBUS. Secondary outcome was pyeloplasty, comparing patients undergoing pyeloplasty with patients followed with serial imaging without resolution. Multivariable logistic regression was used for analysis. Of the total 2228 patients, 1311 had isolated HN, 338 patients had a renal scan and 129 met inclusion criteria. Median age at renal scan was 3.1 months, 77% were male and median follow-up was 35 months (IQR 20–49). We found that 22% (29/129) resolved, 42% of patients had pyeloplasty (54/129) and 36% had persistent HN that required follow-up (46/129). Univariate predictors of resolution were age≥3 months at time of renal scan (p = 0.05), T ½ time≤5 min (p = 0.09), SFU grade 3 (p = 0.0009), and APD<20 mm (p = 0.005). Upon multivariable analysis, SFU grade 3 (OR = 4.14, 95% CI: 1.30–13.4, p = 0.02) and APD<20 mm (OR = 6.62, 95% CI: 1.41–31.0, p = 0.02) were significant predictors of resolution. In the analysis of decision for pyeloplasty, SFU grade 4 (OR = 2.40, 95% CI: 1.01–5.71, p = 0.04) and T ½ time on subsequent renal scan of ≥20 min (OR = 5.14, 95% CI: 1.54–17.1, p = 0.008) were the significant predictors. Patients with high grade HN and reassuring renal scan can pose a significant challenge to clinical management. Our results help identify a specific candidate for observation with little risk for progression: the patient with SFU grade 3, APD under 20 mm, T ½ of 5 min or less who was 3 months or older at the time of renal scan. However, many patients may progress to surgery or do not fully resolve and require continued follow-up. [ABSTRACT FROM AUTHOR]

Standard protocol for post-pyeloplasty monitoring in children and natural course of hydronephrosis resolution have not been well defined. We aimed to analyze critical time intervals and risk factors in the long-term clinical outcomes of children who were operated for ureteropelvic junction obstruction. Files of patients who underwent open dismembered pyeloplasty between January 2000 and December 2012 and had a ≥10 years follow-up were retrospectively reviewed. Changes in SFU hydronephrosis grade, pelvis anteroposterior diameter (APD), renal parenchymal thickness, split renal functions (SRF) on MAG-3 scan as well as development of hypertension and proteinuria were noted. Complete resolution was defined as SFU grade 0–1 or APD≤10 mm or ≥50 % APD decrease. Overall, 223 patients (161 boys, 72.1 %) with a median age of 9 (range 1–185) months underwent unilateral pyeloplasty, whereas 14 patients (13 boys, 92.8 %) with a median age of 4 (range 2–39) months underwent bilateral pyeloplasty. Median follow-up was 13 (range 10–22) years. Complete resolution was observed in 190 patients (85.2 %). None of the cases required re-do pyeloplasty. Regarding unilateral cases, postoperative changes in hydronephrosis reached a plateau at the 60th month. Also, there was no significant difference regarding SRF between the 12th month and the 60th month (p > 0.05). Hypertension developed after a median period of 12 years in 13 (5.4 %) of the patients, while proteinuria developed in four (1.6 %) patients. Bilateral disease (HR: 2.518, p = 0.034) was found to be a significant determinant for development of hypertension and/or proteinuria. Our results indicated that ultrasonographic findings stabilized after the 60th month postoperatively, and SRF remained stable between the postoperative 12th and the 60th months. The risk of developing hypertension and/or proteinuria was 2.5 times greater in bilateral cases. Level II. What is currently known about this topic? • Dismembered pyeloplasty is the most common surgical procedure performed in ureteropelvic junction obstruction with high success rates of up to 90–98 %. • A standard protocol for post-pyeloplasty monitoring in children as well as proper definition and the natural course of hydronephrosis resolution have not been well defined. What new information is contained in this article? • Ultrasonographic findings regarding hydronephrosis stabilized after the 60th month postoperatively. • Split renal functions remained stable between the postoperative 12th and the 60th months. • The risk of developing hypertension and/or proteinuria was 2.5 times greater in bilateral cases. [ABSTRACT FROM AUTHOR]

Upper ureteral stricture is a relatively rare but increasingly encountered condition in clinical practice. While simple stricture can often be addressed through endoluminal treatment or surgical reconstruction, complex upper ureteral stricture poses challenges, particularly in patients with ureteropelvic junction obstruction (UPJO) or perirenal pelvic fibrosis and scarring resulting from previous surgeries. These cases present difficulties for traditional endoluminal and ureteral reconstruction treatments, posing a significant problem for many clinical surgeons. Our study involved a thorough search and comprehensive analysis of the existing literature on Ureterocalicostomy (UC). The literature indicates that UC is a safe and effective treatment for ureteral stenosis. By resecting the renal lower pole parenchyma, it is possible to achieve mucosal anastomosis between the calyceal and ureteral mucosa, leading to the restoration of normal urinary excretion. This technique has emerged as an alternative for treating complex upper ureteral strictures. However, there is a lack of direct comparative studies between open surgery and minimally invasive surgery. Our findings revealed a scarcity of relevant review documents, with most being case reports or retrospective studies conducted in single centers with small sample sizes. Therefore, it is crucial to conduct large-scale, multicenter prospective studies and long-term follow-up to validate the long-term efficacy of UC. This article reviews the development history of UC and focuses on a comprehensive discussion of its indications, surgical techniques, and complications. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic ureteroplasty is an effective method for managing ureteropelvic junction obstruction. Despite its high success rate, there remains a subset of patients who do not experience improvement in the hydrops. Methods: The study retrospectively analyzed the data of 143 patients with ureteropelvic junction obstruction (UPJO) who underwent laparoscopic pyeloplasty (LP) in our hospital from January 2015 to May 2022. Logistic regression was used to analyze the risk factors of recurrence stenosis after UPJO. Results: Out of these patients, 119 had complete clinical data and follow-up records. Among these patients, restenosis occurred in nine cases after the operation. There was a significant statistical difference in blood loss (P < 0.05). Univariate and multivariate logistic regression analysis revealed that the preoperative separation degree of the renal pelvis, cystatin C, and intraoperative blood loss were potential risk factors for recurrent stenosis after primary LP. When divided by split renal function (SRF), the odds ratio (OR) was 7.850 (P = 0.044), indicating that it was an independent risk factor for postoperative restenosis. Similarly, the OR for stenotic segment length was 0.025 (P = 0.011), also indicating it as an independent risk factor for restenosis. The areas under the receiver operating characteristic curve for stenotic segment length and SRF were 0.9056 and 0.7697, respectively. Conclusion: In our study, we identified that preoperative renal pelvis separation, cystatin C, and intraoperative blood loss were potential risk factors for postoperative restenosis. SRF and stenosis segment length were independent risk factors for postoperative restenosis. [ABSTRACT FROM AUTHOR]

Background: Ureteropelvic junction obstruction (UPJO) is the most common cause of pediatric congenital hydronephrosis, and continuous kidney function monitoring plays a role in guiding the treatment of UPJO. In this study, we aimed to explore the differentially expressed proteins (DEPs) in the urinary extracellular vesicles(uEVs) of children with UPJO and determine potential biomarkers of uEVs proteins that reflect kidney function changes. Methods: Preoperative urine samples from 6 unilateral UPJO patients were collected and divided into two groups: differential renal function (DRF) ≥ 40% and DRF < 40%.We subsequently used data-independent acquisition (DIA) to identify and quantify uEVs proteins in urine, screened for DEPs between the two groups, and analyzed biofunctional enrichment information. The proteomic data were evaluated by Western blotting and enzyme-linked immunosorbent assay (ELISA) in a new UPJO testing cohort. Results: After one-way ANOVA, a P adj value < 0.05 (P-value corrected by Benjamin–Hochberg) was taken, and the absolute value of the difference multiple was more than 1.5 as the screening basis for obtaining 334 DEPs. After analyzing the enrichment of the DEPs according to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment combined with the protein–protein interaction (PPI) network results, we selected nicotinamide adenine dinucleotide-ubiquinone oxidoreductase core subunit S1 (NDUFS1) for further detection. The expression of NDUFS1 in uEVs was significantly lower in patients with DRF < 40% (1.182 ± 0.437 vs. 1.818 ± 0.489, P < 0.05), and the expression level of NDUFS1 was correlated with the DRF in the affected kidney (r = 0.78, P < 0.05). However, the NDUFS1 concentration in intravesical urine was not necessarily related to the change in DRF (r = 0.28, P = 0.24). Conclusions: Reduced expression of NDUFS1 in uEVs might indicate the decline of DRF in children with UPJO. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the effects of the antioxidant thymoquinone on treated and untreated kidneys on histological and oxidative parameters as well as Kidney Injury Molecule (KIM-1) levels in an experimental unilateral ureteropelvic junction obstruction (UPJO) with resultant hydronephrosis (HN) model. In adherence to the Animal research: reporting of in vivo exepriments guidelines, 34 male Wistar rats were randomly divided into four groups which were named accordingly: "CO" (corn oil), "TQ" (thymoquinone and corn oil), "HNCO" (UPJO-HN and corn oil), "HNTQ" (UPJO-HN, thymoquinone and corn oil). Histologically, pelvic epithelial damage, glomerular shrinkage and sclerosis, tubular damage, interstitial edema-inflammation-fibrosis (IEIF), and vascular congestion were assessed. Biochemically, malondialdehyde (MDA), superoxide dismutase (SOD), glutathione reductase (GR) and KIM-1 levels were assessed. Macroscopic HN developed in all obstructed kidneys. Ipsilateral obstructed kidneys deteriorated in all histological parameters. Thymoquinone attenuated glomerular shrinkage and sclerosis alterations but increased vascular congestion. Contralateral non-obstructed kidneys also showed histological deterioration. Thymoquinone had beneficial effects in terms of IEIF presence in contralateral kidneys but it increased vascular congestion. MDA and SOD results were inconclusive. UPJO caused decreased GR levels in the ipsilateral kidneys but not in the contralateral ones. This effect was not ameliorated by thymoquinone treatment. KIM-1 levels were increased in ipsilateral obstructed kidneys with a lower level in HNTQ group than in HNCO. KIM-1 level of the ipsilateral HNTQ group was higher than in both non-obstructed ipsilateral kidney groups. The effect of thymoquinone in ameliorating bilaterally observed histological alterations was limited and controversial. Oxidative damage detected by GR measurements was not prevented by thymoquinone. Thymoquinone partially decreased the damage as evidenced by reduced KIM-1 levels in thymoquinone-treated obstructed kidneys. [ABSTRACT FROM AUTHOR]

BackgroundLaparoscopic pyeloplasty is a minimally invasive approach for the therapy of infant ureteropelvic junction obstruction (UPJO), reliant on CO2 pneumoperitoneum insufflation. While the impact of CO2 insufflation on adult and older pediatric populations has been studied, its effects on infants remain less explored.MethodsThis prospective randomized controlled trial included infants with UPJO undergoing laparoscopic pyeloplasty. Patients were allocated to low pneumoperitoneum pressure (LPP, 5 mmHg) or high pneumoperitoneum pressure (HPP, 8 mmHg) groups. Surgical parameters, postoperative complications, acid-base balance, stress markers, inflammatory cytokines, and oxidative stress markers were evaluated and compared.ResultsA total of 116 infants were analyzed. Preoperative characteristics were comparable between LPP and HPP groups. No significant differences in blood loss, operation time, or hospitalization time were observed. Postoperative complications were similar between groups. Acid-base balance analysis revealed a decrease in pH after pneumoperitoneum in both groups, with greater reductions in actual base excess and standard base excess in the HPP group. Stress markers, cytokines, and oxidative stress markers increased postoperatively in both groups, with higher levels in the HPP group.ConclusionHPP leads to more pronounced physiological responses, including acid-base alterations, stress reactions, and inflammatory cytokine elevations.

Abstract Background Ureteropelvic junction obstruction (UPJO) is a common obstructive disease of the urinary tract. UPJO patients commonly exhibit coexistent renal calculi. The main aim of therapy is to relieve the obstruction and remove the stones at the same time. Methods This retrospective study included 110 patients diagnosed with UPJO coexisting with multiple renal calculi at Shanxi Bethune Hospital and the First Hospital of Shanxi Medical University between March 2016 and January 2022. Patients were divided according to the methods used for dealing with UPJO and renal calculi. In Group A, patients underwent traditional open pyeloplasty and pyelolithotomy. In Group B, patients underwent percutaneous nephrolithotomy first and then laparoscopic pyeloplasty. In Group C, patients underwent flexible cystoscopy to remove stones and then laparoscopic pyeloplasty. In Group D, patients underwent flexible vacuum-assisted ureteral access sheath (FV-UAS)assisted flexible ureteroscopy (f-URS) and underwent laparoscopic pyeloplasty. The stones were broken up using a holmium laser. The pyeloplasty success rate, stone clearance rate, operation time, bleeding amount, complication occurrence rate, postsurgical pain, length of stay, and hospitalization cost were compared between the groups. The follow-up period was at least 2 years. Results The use of f-URS and the FV-UAS, significantly increased the renal stone clearance rate and significantly reduced the complication incidence and operation time in UPJO patients with multiple coexisting renal calculi. Conclusions Laparoscopic pyeloplasty combined with f-URS and FV-UAS is safe and effective for treating UPJO in patients complicated by renal caliceal stones. Trial registration Retrospectively registered.

Ureteropelvic junction obstruction (UPJO) can be treated by various pyeloplasty techniques. We present a hybrid technique incorporating elements of laparoendoscopic single-site surgery and open pyeloplasty through a single umbilical incision. As a result, seven infants with UPJO underwent the hybrid pyeloplasty smoothly. The mean operative time was 131.9 min. At a follow-up of 11.8–50.0 months, all infants showed significant improvement and no symptoms except for one febrile urinary tract infection. The cosmetic results were very satisfactory without obvious visible scars. Therefore, the hybrid pyeloplasty appears to be a simple and effective minimally invasive surgery for treating infant UPJO. [ABSTRACT FROM AUTHOR]

Urinary tract dilations (UTDs) are the most frequent prenatal renal anomaly. The spectrum of etiologies causing UTD ranges from mild spontaneously resolving obstruction to severe upper and lower urinary tract obstruction or reflux. The early recognition and management of these anomalies allows for improved renal endowment prenatally and ultimately better outcome for the child. The role of the general obstetrician and pediatrician is to recognize potential prenatal and postnatal cases addressed to their practice and to refer patients to specialized pediatric nephrology and urology centers with a sense of the urgency of such a referral. The aim of this paper is to offer clinical recommendations to clinicians regarding the management of neonates and children born with prenatally detected UTD, based on a consensus between Swiss pediatric nephrology centers. The aim is to give suggestions and recommendations based on the currently available literature regarding classifications and definitions of prenatal and postnatal UTD, etiologies, prenatal and postnatal renal function evaluation, investigations, antibiotic prophylaxis, and the need for referral to a pediatric nephrologist and/or urologist. The overarching goal of a systematic approach to UTD is to ultimately optimize kidney health during childhood and improve long-term renal function prognosis.

Introduction: Etiopathogenesis and the symptomatology of ureteropelvic junction obstruction (UPJO) in the pediatric population has not yet been definitely clarified, suggesting a multifactorial nature of the condition. The aim was to analyze the association between the number of Interstitial Cells of Cajal (ICCs), as well as P2X3 receptors in ureteropelvic junction (UPJ) and the pain response in pediatric patients with hydronephrosis. Methods: 50 patients with congenital hydronephrosis underwent open or laparoscopic pyeloplasty at one of two departments of pediatric surgery and urology in Poland. Patients were divided into two groups according to the pain symptoms before surgery. A total of 50 samples of UPJ were obtained intraoperatively and underwent histopathological and immunohistochemical (IHC) analysis. Quantitative assessment of ICCs was based on the number of CD117(+) cells of adequate morphology in the subepithelial layer and the muscularis propria. Expression of P2X3 receptors was evaluated as the intensity of IHC staining. Results: Patients with hydronephrosis and accompanying pain were on average 60 months older (77 vs. 17 months) than children with asymptomatic hydronephrosis (p = 0.017). Symptomatic children revealed higher numbers of ICCs in both the subepithelial layer and in the lamina muscularis propria. In particular, symptomatic patients aged 2 years or more exhibited significantly higher numbers of ICCs in the subepithelial layer. Significant differences in the distribution of ICCs between the subepithelial layer and the lamina muscularis propria were observed in both groups. Expression of P2X3 receptors was limited to the urothelium and the muscle layer and correlated between these structures. There was no relationship between pain response and the expression of P2X3 receptors. Conclusions: ICCs and P2X3 receptors may participate in the pathogenesis of UPJO and in the modulation of pain response to a dilatation of the pyelocaliceal system. Explanation of the role of ICCs and P2X3 receptors in propagation of ureteral peristaltic wave and the modulation of pain stimuli requires further studies. [ABSTRACT FROM AUTHOR]

Objective To compare the perioperative complications and explore the potential factors contributing to the differences in complications between laparoscopic and open dismembered pyeloplasty for congenital ureteropelvic junction obstructive hydronephrosis in children. Methods Between July 2016 and December 2018, retrospective review was conducted for all children with ureteropelvic junction obstruction (UPJO) undergoing primary transperitoneal laparoscopic pyeloplasty (LP) and retroperitoneal open pyeloplasty (OP) Perioperative complications were compared between LP and OP. Complication rate, Clavien-Dindo grade and types were compared. Complications were also compared between different postoperative drainage modes and groups with or without intraoperative complications. Also the differences in postoperative complications were explored among groups with varying age, weight, anterioposterior pelvic diameter (APD) and surgeon expertise. Results For 583 UPJO kidneys, LP was performed for 355 kidneys and OP for 228 kidneys. The median age of the open group was 16.37 months (9.73 months, 61.37 months) and the median weight was 11.00 kg (9.30 kg, 20.00 kg), which were significantly lower than the median age of the laparoscopic group, which was 46.87 months (19.08 months, 90.49 months), and the median weight of 16.50 kg (12.00 kg, 25.00 kg). The median preoperative renal pelvis anteroposterior diameter in the open group was 39.00 mm (27.00 mm, 52.00 mm), significantly larger than that of the laparoscopic group, which was 28.00 mm (22.00 mm, 36.00 mm). These differences were statistically significant ( P<0.05). The inter-group incidence of intraoperative complications showed no significant difference (LP: 7.61% vs OP: 4.39%). Also no significant inter-group difference existed in restenosis of anastomotic rate (LP: 2.62% vs.OP: 1.33%). Although no significant inter-group difference in the incidence or frequency of postoperative complications, types of complications differed. Urinary tract infections (UTIs) dominated in both groups. Kidneys with intraoperative complications were more prone to higher grades of postoperative complications (χ²=5.600, P=0.018) and UTIs (χ²=8.891, P=0.003). As compared with OP group, LP group showed a higher propensity for high-grade postoperative complications (Clavien Ⅲb) (χ²=6.595, P=0.010) and other complications (χ²=10.289, P=0.001), except for UTIs. Conclusions LP and OP are both safe and effective in UPJO children. However, types of complications differ. As compared with OP, LP requires a higher alert for the occurrence of complications and high-grade postoperative complications, except for UTIs. [ABSTRACT FROM AUTHOR]

Objective To explore the risk factors of unplanned reoperation (UR) after laparoscopic pyeloplasty (LP) in children with ureteropelvic junction obstruction (UPJO) and examine the clinical characteristics of UR children. Methods From March 2010 to December 2023, the relevant clinical data were retrospectively reviewed for 678 children of unilateral UPJO undergoing LP. Children undergoing UR after LP were selected as study group and those without UR as control group. Gender, age, history of nephrostomy, Society of Fetal Urology (SFU) grade, surgical proficiency and postoperative hospitalization stay of two groups were collected for univariate and multivariate Logistic regression analyses. Statistical analysis was performed with SPSS version 26.0 software package. Results Among them, 19(2.8%) cases underwent UR. According to the timing of reoperation, it was assigned into short-term and long-term URs. Four children (4/678, 0.6%) underwent short-term UR for uroabdomen and allantois due to anastomotic leakage, varying degrees of intestinal obstruction and abdominal infection. Long-term UR was performed in 15 children (15/678, 2.2%) for recurrent UPJO, aggravation of hydronephrosis, recurrent abdominal pain, urinary tract infection and hematuria. According to univariate analysis, anteroposterior diameter (APD), postoperative hospitalization stay, surgical proficiency, preoperative severity of hydronephrosis and presence of percutaneous nephrostomy were associated with UR ( P<0.05). Based upon multivariable analysis, APD ( OR=1.278, 95% CI: 1.069-1.528), postoperative hospitalization stay ( OR=1.165, 95% CI: 1.094-1.239), surgical proficiency ( OR=1.165, 95% CI: 1.094-1.239) and presence of percutaneous nephrostomy ( OR=17.817, 95% CI: 3.291-96.446) were the strongest predictors of UR ( P<0.05). Conclusions APD, postoperative hospitalization stay, surgical proficiency and presence of percutaneous nephrostomy are correlated with UR. Timely renal ultrasonography, evaluation of renal function, accurate intraoperative handling and a lowered risk of complications are vital for preventing and minimizing UR. [ABSTRACT FROM AUTHOR]

Ureteropelvic junction obstruction (UPJO) is the most common cause of pathological hydronephrosis in children. Laparoscopic pyeloplasty (LP) has gradually become a preferred surgical option for UPJO.As one of the common early complications of LP, urinary tract infection (UTI) prolongs the course of the disease and even induce lethal urogenic sepsis, in severe cases. At the same time, it may lead to postoperative restenosis of the anastomosis and affect the success rate of the operation. This reviews summarized the risk factors for UTI after LP in children with UPJO, in order to improve the understanding of urdogists. Corresponding interventions may prevent the occurrence of UTI, shorten the course of UTI, and thus improve the success rate of operation. [ABSTRACT FROM AUTHOR]

Ureteropelvic junction obstruction (UPJO) has been the most common congenital cause of upper urinary tract obstruction. And dismembered pyeloplasty continues to be a gold standard with an overall success rate of 90%. However, a proper management of surgical complications remains rather challenging. As surgical techniques continue innovating, surgeons should be more precise about the indications for surgery and more comprehensively understand and correctly manage surgical complications to maximize patient benefits. This review summarized the complications of pyeloplasty from the perspectives of types, causes, preventions and risk factors. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical features and outcomes of massive urinary extravasation after pyeloplasty in children. Methods From January 2016 to December 2023, the relevant clinical data were retrospectively reviewed for 18 children with massive urinary extravasation after pyeloplasty. Demographic profiles, medical history, perioperative images, urinary extravasation during hospitalization, and treatment outcomes were recorded. Results There were 16 boys and 2 girls with an operative age of (6.03±4.79) year. Obstruction was located at left ( n=16) and right ( n=2). Length of hospitalization stay was 20 (13-24) day and median duration of massive postoperative urinary extravasation 2(1-20) day. In 17/18 children, abdominal drainage tube was retained for a median duration of 11(8-15) day. The highest volume of abdominal drainage fluid withinin a single day was 485(298-786) ml. Clavien-Dindo grade of postoperative complications was Ⅰ ( n=8), Ⅱ ( n=4) and Ⅲb ( n=6).The frequency of reoperation during hospitalization was 33.33%(6/18). The perioperative APD were (4.11±1.83) and 2.40(1.58, 4.53) cm with statistically significant difference ( Z=-2.628, P=0.009). Perioperative PTmin was 0.6(0.2, 0.8) and (0.93±0.32) cm with statistically significant difference ( Z=-2.580, P=0.011). Perioperative ratio of APD/PT was 6.05(2.85-13.44) and 2.64(1.95-5.73) with statistically significant difference ( Z=-2.940, P=0.002). Postoperative values of APD, PTmin, and APD/PT significantly improved as compared preoperatively. PI-APD was 20.95%(-0.45%, 60.91%). There were two cases of postoperative re-obstruction. Overall success rate of operation was 88.89%(16/18). Conclusions Severe urinary extravasation after pyeloplasty may result in an extended duration of hospitalization and an elevated probability of reoperation. However, the occurrence of re-obstruction after pyeloplasty with massive urine extravasation remains low. [ABSTRACT FROM AUTHOR]

Ureteropelvic junction obstruction (UPJO) is a common urinary malformation in children. And dismembered pyeloplasty has been a "gold standard" for surgery due to its extensive indications, convenient handling and low complication rate. Although overall successful operative rate has surpassed 90%, pediatric urologists are striving to lower the incidence of postoperative complications, prevent the occurrences of high-grade complications, enable a rapid recovery and achieve optimal outcomes. Assessing the severity of renal injury remains a daunting challenge. This review focused upon the causes and managements of surgical complications of UPJO in children. [ABSTRACT FROM AUTHOR]

Purpose: To determine if children with UPJO demonstrate a clinically significant change in somatic growth following pyeloplasty. Methods: We retrospectively evaluated the growth chart data of infants with SFU grade 3 or 4 congenital hydronephrosis at our institution from 2015 to 2022. Of those, 35 patients underwent pyeloplasty and 66 had no surgical intervention. Patients met criteria if they had SFU 3 or 4 hydronephrosis and MAG3 renal scan. If patients underwent surgery, height and weight percentiles were recorded from the pre-op and 6–16-month follow-up visits. In non-surgery patients, measurements were taken near the median age of surgery in the intervention group and 6–16 months later. Interval changes in group height and weight percentiles are compared for significant changes. Results: The surgery and non-surgery groups did not differ in terms of gender (71% vs 74% Male), starting age (296 vs 244 days), starting weight (58th vs 52nd percentile), or time between measurements (255 vs 260 days), though the surgery group had significantly less height in the pre-operative period (43rd vs 55th percentile, p = 0.050) and were more likely to have delayed drainage on renal scan (83% w/delay vs 35%). The surgery group showed a significant increase in height (18.9 percentiles; 95% CI 11–27) and weight (6.0 percentiles; 95% CI 0.50–12) after intervention. Conclusions: Patients with congenital hydronephrosis due to UPJO that underwent pyeloplasty showed a significant increase in weight and height at 6–16 months postoperatively compared to those that were managed with close observation. This suggests UPJO might lead to growth delay in infants. [ABSTRACT FROM AUTHOR]