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Laparoscopic versus open pyeloplasty: Comparison of two surgical approaches- a single centre experience of three years  [cached]
Bansal Punit,Gupta Aman,Mongha Ritesh,Narayan Srinivas
Journal of Minimal Access Surgery , 2008,
Abstract: Background: Ureteropelvic junction obstruction (UPJO) causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new technique must be compared. We compared laparoscopic (LP) and open pyeloplasty (OP) in a randomized prospective trial. Materials and Methods: A prospective randomized study was done from January 2004 to January 2007 in which a total of 28 laparoscopic and 34 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally. Standard open Anderson Hynes pyeloplasty, spiral flap or VY plasty was done depending on anatomic consideration. Patients were followed with DTPA scan at three months and IVP at six months. Perioperative parameters including operative time, analgesic use, hospital stay, and complication and success rates were compared. Results: Mean total operative time with stent placement in LP group was 244.2 min (188-300 min) compared to 122 min (100-140 min) in OP group. Compared to OP group, the post operative diclofenac requirement was significantly less in LP group (mean 107.14 mg) and OP group required mean of (682.35 mg). The duration of analgesic requirement was also significantly less in LP group. The postoperative hospital stay in LP was mean 3.14 Days (2-7 days) significantly less than the open group mean of 8.29 days (7-11 days). Conclusion: LP has a minimal level of morbidity and short hospital stay compared to open approach. Although, laparoscopic pyeloplasty has the disadvantages of longer operative time and requires significant skill of intracorporeal knotting but it is here to stay and represents an emerging standard of care.
Anderson-Hines Open Pyeloplasty in the Treatment of Pyelo-Ureteral Junction Syndrome: Results from 36 Cases  [PDF]
Anani Wencesl Severin Odzébé, Caryne Mboutol-Mandavo, Aristide Steve Ondziel Opara, Lucie Irene Patricia Ondima, Armel Melvin Ondongo Atipo, Rolland Bertile Banga Mouss, Prosper Alain Bouya
Open Journal of Urology (OJU) , 2019, DOI: 10.4236/oju.2019.99016
Abstract: Goal: To evaluate the results and complications of open pyeloplasty according to Anderson-Hynestechnic. Patients and Methods: We conducted a retrospective study from 2000 to 2014. The study included 36 cases of opening the ureteropyelic junction operated pit syndrome according to Anderson-Hynes technique. Results: Lumbotomy was used in all patients. A pelvic pyelolithotomy for lithiasis was performed in two patients (5.5%) and unwinding of a lower polar pedicle in 3 cases (8.3%). The average duration of response was 119 ± 15 min. The average length of hospital stay was 11.2 ± 3 days. Patients were followed for a mean of 10 months. Thirty-five patients were asymptomatic and in one case lower back pain persisted. IVU to 6 months showed a permeable junction in 97.2% of cases. Seven patients (19.4%) had short-term complications. Ureteropelvic stenosis was the only complication in the medium and long term in one case (2.8%). The success rate of the Pyeloplasty was 97.2%. Conclusion: The open pyeloplasty as Anderson-Hynes remains the treatment of choice in our context SJPU with great results. The indications tend to decrease in favor of laparoscopic pyeloplasty.
Laparoscopic dismembered pyeloplasty in 47 cases
Mitre, Anuar Ibrahim;Brito, Artur Henrique;Srougi, Miguel;
Clinics , 2008, DOI: 10.1590/S1807-59322008000500011
Abstract: purpose: to evaluate the results of a sequence of 47 laparoscopic anderson-hynes pyeloplasties for the treatment of patients with ureteropelvic junction obstruction, independently of the etiology. materials and methods: twenty male and 27 female patients diagnosed with ureteropelvic junction obstruction were treated by anderson-hynes transperitoneal laparoscopic dismembered pyeloplasty from april 2002 to january 2006. the age of the patients ranged from four to 75 years, with a mean age of 32.3 years. the follow-up ranged between six and 30 months, with a mean follow-up time of 24 months. the outcomes were evaluated through the assessment of symptoms and imaging studies. results: in 44 (93.6%) of the 47 patients, resolution of the pain and a reduction in ureteropelvic dilation were observed. the mean operative time was 157 minutes (ranging from 90 to 270 minutes). neither blood transfusion nor conversion to open surgery was required. the mean hospital stay was 2.2 days. the presence of crossing vessels over the ureteropelvic junction was verified in 26 patients (55%), and vessel transposition in relation to the urinary tract was performed in 25 of these cases. in one patient, the crossing vessel was mobilized out of the ureteropelvic junction with a perivascular suture to the renal capsule associated with the pyeloplasty. conclusions: the outcome of transperitoneal anderson-hynes laparoscopic pyeloplasty used for different causes of pyeloureteral obstruction presented a success rate similar to a previously-published open procedure, with the advantage of being less invasive. this procedure may be considered the first option for the treatment of ureteropelvic junction obstruction.
Which Patients Should be Administrated Prophylactic Antibacterial Agents? A Study of Bacteriuria or Funguria by Urine Culture Taken From the Renal Pelvis in Children with Ureteropelvic Junction Obstruction  [PDF]
Gao-Yan Deng, Li-Yu Zhang, Zhong-Ming Li, Ying-Quan Wen
Open Journal of Urology (OJU) , 2011, DOI: 10.4236/oju.2011.14016
Abstract: Objective: To detect bacteriuria or funguria by urine culture taken from the renal pelvis directly before Anderson-Hynes pyeloplasty. Methods: 290 patients who underwent Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction (UPJO) were included in a retrospective analysis. Urine was obtained directly before the renal pelvis was opened, and was carried to the laboratory for bacterial culture. Clinical features were analyzed to evaluate risk factors for bacteriuria or funguria by comparing patients whose urine yielded positive cultures to those whose urine cultures were negative for bacteria or yeast. Results: Eighteen patients (6.2%) had positive urine cultures, including six cultures positive for Escherichia coli (E. coli), four for Pseudomonas aeruginosa, three for klebsiella pneumoniae, one for maltophilia monad, one for Enterococcus faecium, one for Candida albicans, one for Candida parapsilosis, and one for yeast not otherwise specified. Bacteriuria or funguria was significantly correlated with four clinical features: fever, urinary urgency, and history of nephrostomy or pyeloplasty. Conclusions: Bacteriuria or funguria was less common in children with UPJO, and the majority of organisms were identified as Escherichia coli, Pseudomonas aeruginosa, or Klebsiella pneumoniae. Prophylactic antibacterial agents were probably necessary in those patients who had signs of urinary tract infection (UTI), or history of nephrostomy or pyeloplasty.
Transperitoneal laparoscopic pyeloplasty: Brazilian initial experience with 55 cases
Lasmar, Marco T. C.;Castro Junior, Hilario A.;Vengjer, Alessandro;Guerra, Francisco A. T.;Souza, Eugenio A. C.;Rocha, Lydston M.;
International braz j urol , 2010, DOI: 10.1590/S1677-55382010000600005
Abstract: purpose: to evaluate prospectively the results obtained in 55 patients undergoing laparoscopic pyeloplasty through transperitoneal access. materials and methods: from january 2005 to july 2009, fifty-five patients between 13 and 64 years old, were treated for ureteropelvic junction (upj) stenosis via a transperitoneal laparoscopy. all patients had clinical symptoms of high urinary obstruction and hydronephrosis confirmed by imaging methods. anderson-hynes dismembered pyeloplasty was performed in 51 patients and fenger technique in the other 4 cases. patients were clinically and imaging evaluated in the postoperative period at 3 and 6 months and then followed-up annually. results: the operative time ranged from 95 to 270 min. the mean hospital stay was 2 days. the average blood loss was 170 ml. the time to return to normal activities ranged from 10 to 28 days. anomalous vessels were identified in 27 patients, intrinsic stenosis in 23 patients and 5 patients had high implantation of the ureter. laparoscopic pyelolithotomy was successfully performed in 6 patients with associated renal stones. that series monitoring ranged from 1 to 55 months. one patient had longer urinary fistula (11 days), 3 patients had portal infection and 6 patients had prolonged ileus. there was one conversion due to technical difficulties. from the later postoperative complications, 2 patients had re-stenosis, one determined by anderson-hynes technique and the other by fenger technique. the success rate was 95.65%. conclusions: laparoscopic pyeloplasty has functional results comparable to conventional open technique. it offers less morbidity, with aesthetic and post-operative convalescence benefits and lower complication rates.
肾造瘘后Ⅱ期与Ⅰ期肾盂成形术治疗小婴儿重度肾积水的效果比较
Comparison of clinical efficacy between one-stage pyeloplasty and second-stage pyeloplasty after nephrostomy for the treatment of severe hydronephrosis in infants
 [PDF]

姜大朋 赵骁 耿红全 徐卯升 金龙虎 徐国锋 林厚维 方晓亮 贺雷
JIANG Da-peng
, ZHAO Xiao, GENG Hong-quan, XU Mao-sheng, JIN Long-hu, XU Guo-feng, LIN Hou-wei, FANG Xiao-liang, HE Lei

- , 2016, DOI: 10.3969/j.issn.1674-8115.2016.08.018
Abstract: 目的·探讨分期肾盂成形术(先期肾造瘘)与不分期肾盂成形术治疗小于3个月重度肾积水患儿的临床效果。方法·回顾性分析上海交通大学医学院附属新华医院2012年1月—2015年7月接受手术治疗的小于3个月重度肾积水患儿的临床资料。25例行分期肾盂成形术(A组),39例行不分期肾盂成形术(B组)。比较2组手术时间、术中出血量、并发症发生率、总住院时间及术后肾积水恢复情况等。结果·共有64例小于3个月重度肾积水患儿纳入研究。A组手术时间、总住院时间、术后尿路感染发生率明显高于B组,分别为(81±20) min与(53±18) min、(11.6±2.6) d与(6.2±1.5) d、36.0%与17.9%。术后6个月,2组患儿肾积水程度和肾脏功能均得到显著改善,组间差异无统计学意义。结论·分期肾盂成形术对于小于3月龄重度积水患儿肾脏的最终形态、功能恢复没有明显优势;不分期肾盂成形术安全、有效,应作为小婴儿重度肾积水的首选治疗方式。
: Objective · To investigate the clinical efficacy of one-stage pyeloplasty and second-stage pyeloplasty after nephrostomy for the treatment of severe hydronephrosis in infants younger than 3 months. Methods · Clinical data of severe hydronephrosis infants younger than 3 months who underwent pyeloplasty at Xinhua Hospital affiliated to the Shanghai Jiao Tong University School of Medicine from Jan. 2012 to Jul. 2015 were retrospectively analyzed. Twenty-five patients received second-stage pyeloplasty after nephrostomy (the A group) and 39 patients received one-stage pyeloplasty (the B group). The operative time, intraoperative blood loss, incidence rate of complications, hospital stay, and postoperative recovery were compared between two groups. Results · Sixty-four severe hydronephrosis infants younger than 3 months were enrolled. The A group has longer operative time and hospital stay and higher incidence rate of postoperative urinary tract infection as compared with the B group [(81 ± 20) min vs (53 ± 18) min, (11.6 ± 2.6) dvs (6.2 ± 1.5) d, and 36.0% vs 17.9%), respectively]. The hydronephrosis and renal function in two groups were significantly improved 6 months after surgery and the difference between two groups was not statistically significant. Conclusion · Second-stage pyeloplasty after nephrostomy has no obvious advantage for the treatment of severe hydronephrosis in infants younger than 3 months with respect to the final morphology and function recovery of involved kidneys. One-stage pyeloplasty is safe and effective and should be served as the preferred method for the treatment of severe hydronephrosis in infants
Round-Traction-Assisted Pyeloplasty (Ro.T.A.P.): A Minimal Approach Using Alexis Autostatic Retractor  [PDF]
Vincenzo Domenichelli, Maria Domenica Sabatino, Simona Straziuso, Francesco Italiano, Silvana Federici
Open Journal of Urology (OJU) , 2015, DOI: 10.4236/oju.2015.510031
Abstract: Anderson-Hynes dismembered ureteropyeloplasty has been the gold standard surgical treatment for ureteropelvic junction obstruction (UPJO) caused either by crossing renal vessel or by a stenotic junction in children. Nowadays it is still discussed which could be the best surgical approach. All the techniques actually used have the goal to improve functional outcome and to reach better results in terms of reducing traumatic damage, postoperative pain and therefore reduction of hospitalization. We are presenting our experience in the treatment of UPJO by open dismembered pyeloplasty with a minimal invasive approach using the Alexis® (Applied Medical, Rancho Santa Margherita, CA) autostatic wound retractor.
Interventional Radiology Procedures after Pediatric Pyeloplasty and Ureteral Reimplantation in Patients with Postoperative Obstruction  [PDF]
Brent W. Snow, M. Chad Wallis, G. Peter Feola, John W. Rampton, Teisha Shiozaki
Open Journal of Urology (OJU) , 2014, DOI: 10.4236/oju.2014.46015
Abstract:

Introduction: Obstructive complication after pyeloplasty or ureteral reimplant surgery is a rare though worrisome problem in pediatric urology. These are often complex patients with complicated post-operative courses that at times require interventional radiology procedures. The current literature is lacking in guiding principles to manage these complications. In this study we have reviewed these difficult to manage patients at our children’s hospital over the past 15 years. Methods: A list of patients who underwent interventional radiology procedures to place nephrostomy tubes or internal double-J ureteral stents was compared a list of patients undergoing pyeloplasty or reimplant procedures. These lists were cross-referenced to a list of patients undergoing cystoscopic removal of double-J stents. This small patient group does not represent all complications but those with radiology intervention. Results: At our institution, during the years 1998-2011 we performed 458 pyeloplasties and 3003 open ureteral reimplant procedures. 14 (0.4%) met all of the inclusion criteria. The long term outcome of these problems showed 11 of these patients went on to stability or improvement with either percutaneous drainage or JJ stent placement alone, and three of the reimplant patients ultimately required redo surgery. Of our pyeloplasty patients only three required percutaneous nephrostomy tube, and one went on to JJ stent placement (0.66% of pyeloplasties). No patients in the pyeloplasty group needed surgical revision. Of patients how had undergone ureteral reimplantation, with or without tapering, seven of them underwent interventional radiology procedures (0.23% of reimplant patients). Conclusion: Pediatric urology patients with persistent obstruction after pyeloplasties and ureteral reimplantation surgery with or without tapering who needed interventional radiology rescue procedure resolved or stabilized in 11 of 14 patients. Surgical revision was performed in only 3 of our 14 patients after months of conservative trial after interventional radiologic procedures.

Die roboterassistierte laparoskopische Pyeloplastik analog Anderson-Hynes  [PDF]
Schmid DM,John H,Sulser T
Journal für Urologie und Urogyn?kologie , 2006,
Abstract: Wir berichten über unsere prospektive Studie der roboterassistierten laparoskopischen Pyeloplastik analog Anderson-Hynes bei 14 Patienten mit symptomatischer pyeloureteraler Abgangsstenose. Die ersten Ergebnisse sind zumindest mittelfristig ausgezeichnet und lassen die Vorteile gegenüber konventionellen offenen und laparoskopischen Techniken erkennen.
Navigating the Difficult Robotic Assisted Pyeloplasty  [PDF]
David D. Thiel
ISRN Urology , 2012, DOI: 10.5402/2012/291235
Abstract: Pyeloplasty is the gold standard therapy for ureteropelvic junction obstruction. Robotic assisted pyeloplasty has been widely adopted by urologists with and without prior laparoscopic pyeloplasty experience. However, difficult situations encountered during robotic assisted pyeloplasty can significantly add to the difficulty of the operation. This paper provides tips for patient positioning, port placement, robot docking, and intraoperative dissection and repair in patients with the difficult situations of obesity, large floppy liver, difficult to reflect colon (transmesenteric pyeloplasty), crossing vessels, large calculi, and previous attempts at ureteropelvic junction repair. Techniques presented in this paper may aid in the successful completion of robotic assisted pyeloplasty in the face of the difficult situations noted above. 1. Introduction Pyeloplasty is the gold standard therapy for ureteropelvic junction obstruction (UPJO), with reported success rates approaching 90% [1]. Urology has embraced the da Vinci surgical system (Intuitive Surgical, Inc., Sunnyvale, CA, USA) for complex reconstructions of the urinary tract, including pyeloplasty. Success rates of robotic assisted pyeloplasty (RAP) appear to be equivalent to open pyeloplasty while conferring the well-published advantages of minimally invasive surgery (decreased postoperative pain, shorter hospital stay, quicker return to normal activities, etc.) [1–3]. Situations encountered during RAP can significantly alter surgical difficulty and possibly contribute to surgical morbidity. Obesity, large floppy liver, unretractable colon, crossing vessels, large calculi, and previous attempts at UPJO repair can all present a significant intraoperative difficulty. This paper describes techniques to aid in the successful completion of RAP if these situations are encountered. 2. Standard Technique The standard patient positioning, port placement, colon mobilization, UPJO dissection, repair, and stent placement as well as postoperative management of RAP have been well described [4]. The patient is placed in a 70-degree flank position with the ipsilateral arm secured above the head on an arm board. A cystoscopically placed stent-wire complex is anchored to a urethral catheter and prepared in the sterile operative field. Standard port placement is demonstrated in Figure 1. The colon and its mesentery are reflected medially to reveal the underlying kidney, renal pelvis, and ureter. The renal pelvis and proximal ureter are freed of their surrounding attachments with care taken to avoid excessive manipulation
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