AI Article Synopsis
- * Results showed that EUSSS-MLP significantly reduced the time needed for ureteral preparation and double-J stenting (5.7 minutes vs. 19.2 minutes) and had a lower overall surgery duration compared to the traditional method.
- * There were no notable differences in postoperative complications or success rates between the two groups, indicating that EUSSS is a safe and effective option for pediatric laparoscopic pyeloplasty
Article 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 (< 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.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562585 | PMC |
| http://dx.doi.org/10.1186/s12894-024-01645-y | DOI Listing |
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Article Synopsis
- * Results showed that EUSSS-MLP significantly reduced the time needed for ureteral preparation and double-J stenting (5.7 minutes vs. 19.2 minutes) and had a lower overall surgery duration compared to the traditional method.
- * There were no notable differences in postoperative complications or success rates between the two groups, indicating that EUSSS is a safe and effective option for pediatric laparoscopic pyeloplasty
Background: At our center, surgical modifications to the conventional kidney transplant technique were developed with two goals in mind: to minimize the risk of developing post-transplant urologic/vascular/other surgical complications, and to simultaneously eliminate the need for initial ureteral stent placement and surgical drainage.
Methods: Here, the authors describe these modifications along with (what we believe are) their advantages over the conventional technique: creating an abdominal flap for easier abdominal closure (reflecting the parietal peritoneum from the abdominal wall), mobilizing the bladder before transplant (creating more space for bladder dissection, allowing it to move upward during abdominal wall closure), minimizing the dissection of iliac vessels to only anterior lymphatic tissue (attempting to minimize the incidence of fluid collections), using plastic arterial vascular bulldog clamps (causing less trauma to the iliac artery), performing vascular anastomosis of the renal artery first (making it easier for the surgeon to perform the anastomoses), creating longer ureteral spatulation, and inclusion of bladder mucosa along with some detrusor muscle layer in performing the ureteral anastomosis (attempting to minimize the incidence of urologic complications). Of note, no initial ureteral stent placement or surgical drainage was used.
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Urology
July 2024
Department of Urology, Kantonsspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland; Department of Urology, Kantonsspital Münterlingen, Spital Thurgau AG, Münsterlingen, Switzerland.
Introduction: Benign ureterointestinal anastomotic stricture (UIAS) is a recognized long-term complication following radical cystectomy with urinary diversion (UD). The incidence of UIAS following robotic-assisted radical cystectomy varies, with reported rates ranging from 6.5%-25.
View Article and Find Full Text PDFRobot-Assisted Ureteroplasty with Labial Mucosal Onlay Grafting for Long Left-Sided Proximal Ureteral Stenosis in Children and Adolescents: Technical Tips and Functional Outcomes.
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Department of Pediatric Urology, Senior Department of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China.
To evaluate functional outcomes of robot-assisted ureteroplasty with labial mucosa grafting for long proximal ureteral stenosis (LPUS) in children and adolescents. Included in this study were 15 patients who underwent robot-assisted ureteroplasty with labial mucosal grafting in our center between July 2017 and September 2021. The left affected stenotic ureter was repaired using labial mucosal grafting.
View Article and Find Full Text PDFA Pilot Study to Determine the Role of Spatulating the Ureter During Pyeloplasty in Children for Ureteropelvic Junction Obstruction in the Robotic Era.
J Laparoendosc Adv Surg Tech A
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Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Spatulation during ureteropelvic junction obstruction repair was evaluated in children treated by robot-assisted retroperitoneal pyeloplasty anastomosis (RRPA). Intraoperative video recordings (IVRs) of RRPA ( = 22 ureters) performed at a single institute between 2018 and 2022 were reviewed blindly by 5 independent surgeons for perceived difficulty of suturing (DOS; 5 = impossible; 4 = difficult; 3 = tedious; 2 = slow; 1 = easy) and spatulation ranking as superior (+1), inferior (-1), or unnecessary (0). The retroperitoneal space was accessed in the lateral decubitus position using a closed technique under direct vision to avoid air leakage and subcutaneous emphysema.
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