Download PDF
Eur J Pediatr Surg 2019; 29(01): 033-038
DOI: 10.1055/s-0038-1668149
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Surgery for Pediatric Ureteropelvic Junction Obstruction—Comparison of Outcomes in Relation to Surgical Technique and Operating Discipline in Germany

G. Goetz   *
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
,
M. Klora   *
2   Center for Health Economics Research Hannover, Leibniz University Hannover, Hannover, Germany
,
J. Zeidler
2   Center for Health Economics Research Hannover, Leibniz University Hannover, Hannover, Germany
,
S. Eberhard
3   AOK Niedersachsen, Statutory Health Insurance of Lower Saxony, Hannover, Germany
,
S. Bassler
4   AOK PLUS, The Health Insurance Company for Saxony and Thuringia, Dresden, Germany
,
S. Mayer
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
,
J.-H. Gosemann
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
,
M. Lacher
1   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
› Author Affiliations
Further Information

Publication History

15 May 2018

27 June 2018

Publication Date:
15 August 2018 (online)

    Permissions and Reprints

Abstract

Introduction Surgery for ureteropelvic junction obstruction (UPJO) is performed by both pediatric surgeons (PS) and urologists (URO). The aim of this study was to analyze treatment modalities for UPJO and results in relation to the surgical technique and the operating discipline in Germany.

Materials and Methods Data of patients aged 0 to 18 years were extracted from a major public health insurance (covering ∼5.7 million clients) during 2009 to 2016 and were analyzed for sociodemographic variables, surgical technique, and treating discipline. Logistic regression analysis was performed for the risk of a complication within the first postoperative year.

Results A total of 229 children (31.0% female) were included. Laparoscopic pyeloplasty (LP) was performed in 58 (25.3%) patients (8.6 ± 6.4 years), and open pyeloplasty (OP) was applied in 171 (74.7%; 4.6 ± 5.9 years). LP was the dominant technique in females (p < 0.02); males preferentially underwent OP (p < 0.02). Length of hospital stay was 4.3 days (p = 0.0005) shorter in LP compared with that in OP, especially in children ≤ 2 years (6.7 days, p = 0.007). PS operated on 162 children (70.7%), and URO performed surgery on 67 patients (29.3%). The mean age of children operated by PS (3.5 ± 4.7 years) was significantly younger compared with that operated by URO (10.8 ± 6.5 years, p < 0.0001). Complication rates were independent of surgical technique or treating specialty.

Conclusion In Germany, UPJO was treated by LP in 25.3% of patients, which was associated with a shorter length of stay, especially in children ≤ 2 years. Complication rates were independent of the operating specialty and surgical technique. Therefore, LP should be further promoted for the treatment of UPJO in small children.

Keywords

pyeloplasty - laparoscopy - children - open surgery - ureteropelvic junction obstruction

* G. Goetz and M. Klora contributed equally to the study.


Supplementary Material

 

  • References

  • 1 van der Toorn F, van den Hoek J, Wolffenbuttel KP, Scheepe JR. Laparoscopic transperitoneal pyeloplasty in children from age of 3 years: our clinical outcomes compared with open surgery. J Pediatr Urol 2013; 9 (02) 161-168
    CrossrefPubMedGoogle Scholar
  • 2 Anderson JC, Hynes W. Retrocaval ureter; a case diagnosed pre-operatively and treated successfully by a plastic operation. Br J Urol 1949; 21 (03) 209-214
    CrossrefPubMedGoogle Scholar
  • 3 Peters CA, Schlussel RN, Retik AB. Pediatric laparoscopic dismembered pyeloplasty. J Urol 1995; 153 (06) 1962-1965
    CrossrefPubMedGoogle Scholar
  • 4 Huang Y, Wu Y, Shan W, Zeng L, Huang L. An updated meta-analysis of laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children. Int J Clin Exp Med 2015; 8 (04) 4922-4931
    PubMedGoogle Scholar
  • 5 Dingemann J, Ure BM. Systematic review of level 1 evidence for laparoscopic pediatric surgery: do our procedures comply with the requirements of evidence-based medicine?. Eur J Pediatr Surg 2013; 23 (06) 474-479
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Thomas DF, Fraser M. The role of the adult urologist in the care of children: findings of a UK survey. BJU Int 2001; 88 (01) 80-83
    CrossrefPubMedGoogle Scholar
  • 7 Silay MS, Spinoit AF, Undre S. , et al. Global minimally invasive pyeloplasty study in children: Results from the Pediatric Urology Expert Group of the European Association of Urology Young Academic Urologists working party. J Pediatr Urol 2016; 12 (04) 229.e1-229.e7
    CrossrefPubMedGoogle Scholar
  • 8 Vemulakonda VM, Cowan CA, Lendvay TS, Joyner BD, Grady RW. Surgical management of congenital ureteropelvic junction obstruction: a Pediatric Health Information System database study. J Urol 2008; 180 (4, Suppl): 1689-1692
    CrossrefPubMedGoogle Scholar
  • 9 Diamond DA, Chan IHY, Holland AJA. , et al. Advances in paediatric urology. Lancet 2017; 390 (10099): 1061-1071
    CrossrefPubMedGoogle Scholar
  • 10 Hidas G, Watts B, Khoury AE. The evolving role of laparoscopic surgery in paediatric urology. Arab J Urol 2012; 10 (01) 74-80
    CrossrefPubMedGoogle Scholar
  • 11 Jackson HT, Kane TD. Advances in minimally invasive surgery in pediatric patients. Adv Pediatr 2014; 61 (01) 149-195
    CrossrefPubMedGoogle Scholar
  • 12 Knoedler J, Han L, Granberg C. , et al. Population-based comparison of laparoscopic and open pyeloplasty in paediatric pelvi-ureteric junction obstruction. BJU Int 2013; 111 (07) 1141-1147
    CrossrefPubMedGoogle Scholar
  • 13 Schmedding A, Rolle U. Decentralized rather than centralized pediatric surgery care in Germany. Eur J Pediatr Surg 2017; 27 (05) 399-406
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Tubre RW, Gatti JM. Surgical approaches to pediatric ureteropelvic junction obstruction. Curr Urol Rep 2015; 16 (10) 72
    CrossrefPubMedGoogle Scholar
  • 15 Mei H, Pu J, Yang C, Zhang H, Zheng L, Tong Q. Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and meta-analysis. J Endourol 2011; 25 (05) 727-736
    CrossrefPubMedGoogle Scholar
  • 16 Varda BK, Wang Y, Chung BI. , et al. Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015. J Pediatr Urol 2018; ;(Feb): 22
    PubMedGoogle Scholar
  • 17 Boysen WR, Gundeti MS. Robot-assisted laparoscopic pyeloplasty in the pediatric population: a review of technique, outcomes, complications, and special considerations in infants. Pediatr Surg Int 2017; 33 (09) 925-935
    CrossrefPubMedGoogle Scholar
  • 18 Paradise HJ, Huang GO, Elizondo Sáenz RA, Baek M, Koh CJ. Robot-assisted laparoscopic pyeloplasty in infants using 5-mm instruments. J Pediatr Urol 2017; 13 (02) 221-222
    PubMedGoogle Scholar
  • 19 Liu DB, Ellimoottil C, Flum AS, Casey JT, Gong EM. Contemporary national comparison of open, laparoscopic, and robotic-assisted laparoscopic pediatric pyeloplasty. J Pediatr Urol 2014; 10 (04) 610-615
    CrossrefPubMedGoogle Scholar
  • 20 Monn MF, Bahler CD, Schneider EB. , et al. Trends in robot-assisted laparoscopic pyeloplasty in pediatric patients. Urology 2013; 81 (06) 1336-1341
    CrossrefPubMedGoogle Scholar
  • 21 Liang CC, Cheng PJ, Lin CJ, Chen HW, Chao AS, Chang SD. Outcome of prenatally diagnosed fetal hydronephrosis. J Reprod Med 2002; 47 (01) 27-32
    PubMedGoogle Scholar
  • 22 Vemulakonda VM, Wilcox DT, Crombleholme TM, Bronsert M, Kempe A. Factors associated with age at pyeloplasty in children with ureteropelvic junction obstruction. Pediatr Surg Int 2015; 31 (09) 871-877
    CrossrefPubMedGoogle Scholar
  • 23 Freilich DA, Penna FJ, Nelson CP, Retik AB, Nguyen HT. Parental satisfaction after open versus robot assisted laparoscopic pyeloplasty: results from modified Glasgow Children's Benefit Inventory Survey. J Urol 2010; 183 (02) 704-708
    CrossrefPubMedGoogle Scholar
  • 24 Tanaka ST, Grantham JA, Thomas JC, Adams MC, Brock III JW, Pope IV JC. A comparison of open vs laparoscopic pediatric pyeloplasty using the pediatric health information system database--do benefits of laparoscopic approach recede at younger ages?. J Urol 2008; 180 (04) 1479-1485
    CrossrefPubMedGoogle Scholar
  • 25 Lacher M, Kuebler JF, Dingemann J, Ure BM. Minimal invasive surgery in the newborn: current status and evidence. Semin Pediatr Surg 2014; 23 (05) 249-256
    CrossrefPubMedGoogle Scholar
  • 26 Gatti JM, Amstutz SP, Bowlin PR, Stephany HA, Murphy JP. Laparoscopic vs open pyeloplasty in children: results of a randomized, prospective, controlled trial. J Urol 2017; 197 (3 Pt 1): 792-797
    CrossrefPubMedGoogle Scholar
  • 27 Chan YY, Durbin-Johnson B, Sturm RM, Kurzrock EA. Outcomes after pediatric open, laparoscopic, and robotic pyeloplasty at academic institutions. J Pediatr Urol 2017; 13 (01) 49.e1-49.e6
    CrossrefPubMedGoogle Scholar
  • 28 Nelson CP, Park JM, Dunn RL, Wei JT. Contemporary trends in surgical correction of pediatric ureteropelvic junction obstruction: data from the nationwide inpatient sample. J Urol 2005; 173 (01) 232-236
    PubMedGoogle Scholar
  • 29 Gosemann JH, Lange A, Zeidler J. , et al. Appendectomy in the pediatric population-a German nationwide cohort analysis. Langenbecks Arch Surg 2016; 401 (05) 651-659
    CrossrefPubMedGoogle Scholar
  • 30 Dingemann J, Kuebler JF, Wolters M. , et al. Perioperative analgesia strategies in fast-track pediatric surgery of the kidney and renal pelvis: lessons learned. World J Urol 2010; 28 (02) 215-219
    CrossrefPubMedGoogle Scholar
  • 31 Piaggio LA, Corbetta JP, Weller S. , et al. Comparative, prospective, case-control study of open versus laparoscopic pyeloplasty in children with ureteropelvic junction obstruction: long-term results. Front Pediatr 2017; 5: 10
    PubMedGoogle Scholar
  • 32 Dy GW, Hsi RS, Holt SK, Lendvay TS, Gore JL, Harper JD. National trends in secondary procedures following pediatric pyeloplasty. J Urol 2016; 195 (4 Pt 2): 1209-1214
    CrossrefPubMedGoogle Scholar
  • 33 Mut T, Acar Ö, Oktar T. , et al. Intraoperative inspection of the ureteropelvic junction during pyeloplasty is not sufficient to distinguish between extrinsic and intrinsic causes of obstruction: correlation with histological analysis. J Pediatr Urol 2016; 12 (04) 223.e1-223.e6
    CrossrefPubMedGoogle Scholar