One-Trocar–Assisted Pyeloplasty in Children: An 8-Year Single Institution Experience

Abstract

Introduction Ureteropelvic junction obstruction (UPJO) is the most common pediatric obstructive uropathy. We report our 8-year experience with the use of a retroperitoneal laparoscopic-assisted pyeloplasty (one–trocar–assisted pyeloplasty [OTAP]).

Materials and Methods This is a retrospective analysis of 88 patients treated in 8 years. Surgery was performed on the basis of standard indications and it consisted of 88 OTAP (the ureteropelvic junction is identified through a retroperitoneoscopic inspection and it is exteriorized to perform a traditional dismembered pyeloplasty). Operative time, hospital stay, complication, success of the technique, and aesthetical results are analyzed.

Results In the 8-year period we performed 88 OTAP. Mean age was 19 months. Prenatal diagnosis was the most common presentation (n = 73), followed by occasional identification (n = 8), and symptomatic (n = 7). Mean operating time was 139 minutes (range 60–225 minutes). Conversion was required in seven cases. The success rate was 87.5% (reduction of the severity of hydronephrosis on ultrasound) and 100% among symptomatic patients (symptoms resolution). Aesthetical results were excellent.

Discussion and Conclusions OTAP is safe, feasible, and efficacious. Operative times are similar or even shorter than those of other minimally invasive techniques and complication rate agrees with the findings of literature. OTAP can be considered a reasonable alternative.

Keywords

OTAP - pyeloplasty - hydronephrosis - pyelo-ureteral junction stenosis

• References

• 1 Turner II RM, Fox JA, Tomaszewski JJ, Schneck FX, Docimo SG, Ost MC. Laparoscopic pyeloplasty for ureteropelvic junction obstruction in infants. J Urol 2013; 189 (4) 1503-1507
• 2 Boylu U, Basatac C, Turan T, Onol FF, Gumus E. Comparison of surgical and functional outcomes of minimally invasive and open pyeloplasty. J Laparoendosc Adv Surg Tech A 2012; 22 (10) 968-971
• 3 Hao G, Xiao J, Yang P, Shen H. Laparoscopic retroperitoneal dismembered pyeloplasty: single-center experience in China. J Laparoendosc Adv Surg Tech A 2013; 23 (1) 38-41
• 4 Lima M, Tursini S, Ruggeri G, Gargano T, Libri M, Domini M. One trocar assisted pyeloplasty (OTAP): initial experience and codification of a technique. Pediatr Med Chir 2007; 29 (2) 108-111
• 5 Almodhen F, Jednak R, Capolicchio JP, Eassa W, Brzezinski A, El-Sherbiny M. Is routine renography required after pyeloplasty?. J Urol 2010; 184 (3) 1128-1133
• 6 El-Ghoneimi A. Laparoscopic management of hydronephrosis in children. World J Urol 2004; 22 (6) 415-417
• 7 Gundeti MS, Kojima Y, Haga N, Kiriluk K. Robotic-assisted laparoscopic reconstructive surgery in the lower urinary tract. Curr Urol Rep 2013; 14 (4) 333-341
• 8 El-Ghoneimi A, Farhat W, Bolduc S , et al. Laparoscopic dismembered pyeloplasty by a retroperitoneal approach in children. BJU Int 2003; 92 (1) 104-108 , discussion 108
• 9 Tan HL. Laparoscopic Anderson-Hynes dismembered pyeloplasty in children. J Urol 1999; 162 (3 Pt 2) 1045-1047 , discussion 1048
• 10 Janetschek G, Peschel R, Altarac S, Bartsch G. Laparoscopic and retroperitoneoscopic repair of ureteropelvic junction obstruction. Urology 1996; 47 (3) 311-316
• 11 Wu Y, Dong Q, Han P, Liu L, Wang L, Wei Q. Meta-analysis of transperitoneal versus retroperitoneal approaches of laparoscopic pyeloplasty for ureteropelvic junction obstruction. J Laparoendosc Adv Surg Tech A 2012; 22 (7) 658-662
• 12 El Gohary MA. Laparoscopic assisted pyeloplasty in children. Ped Endosurg Innov Tech 2004; 8: 260-263
• 13 Neheman A, Noh PH, Piaggio L, González R. The role of laparoscopic surgery for urinary tract reconstruction in infants weighing less than 10 kg: a comparison with open surgery. J Pediatr Urol 2008; 4 (3) 192-196
• 14 Szavay PO, Luithle T, Seitz G, Warmann SW, Haber P, Fuchs J. Functional outcome after laparoscopic dismembered pyeloplasty in children. J Pediatr Urol 2010; 6 (4) 359-363
• 15 Bird VG, Leveillee RJ, Eldefrawy A, Bracho J, Aziz MS. Comparison of robot-assisted versus conventional laparoscopic transperitoneal pyeloplasty for patients with ureteropelvic junction obstruction: a single-center study. Urology 2011; 77 (3) 730-734
• 16 Tong Q, Zheng L, Tang S , et al. Comparison of laparoscopic-assisted versus open dismembered pyeloplasty for ureteropelvic junction obstruction in infants: intermediate results. Urology 2009; 74 (4) 889-893
• 17 Caione P, Lais A, Nappo SG. One-port retroperitoneoscopic assisted pyeloplasty versus open dismembered pyeloplasty in young children: preliminary experience. J Urol 2010; 184 (5) 2109-2115
• 18 Scuderi MG, Arena S, Di Benedetto V. One-trocar-assisted pyeloplasty. J Laparoendosc Adv Surg Tech A 2011; 21 (7) 651-654
• 19 Blanc T, Muller C, Abdoul H , et al. Retroperitoneal laparoscopic pyeloplasty in children: long-term outcome and critical analysis of 10-year experience in a teaching center. Eur Urol 2013; 63 (3) 565-572
• 20 Valla JS, Breaud J, Griffin SJ , et al. Retroperitoneoscopic vs open dismembered pyeloplasty for ureteropelvic junction obstruction in children. J Pediatr Urol 2009; 5 (5) 368-373
• 21 Chen Z, Chen X, Qi L , et al. Retroperitoneoscopic dismembered pyeloplasty for pediatric ureteropelvic junction obstruction: a report of 85 cases [in Chinese]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2011; 36 (5) 430-434
• 22 Zhou H, Li H, Zhang X , et al. Retroperitoneoscopic Anderson-Hynes dismembered pyeloplasty in infants and children: a 60-case report. Pediatr Surg Int 2009; 25 (6) 519-523
• 23 Piaggio LA, Franc-Guimond J, Noh PH , et al. Transperitoneal laparoscopic pyeloplasty for primary repair of ureteropelvic junction obstruction in infants and children: comparison with open surgery. J Urol 2007; 178 (4 Pt 2) 1579-1583
• 24 Reddy M, Nerli RB, Bashetty R, Ravish IR. Laparoscopic dismembered pyeloplasty in children. J Urol 2005; 174 (2) 700-702
• 25 Fuchs J, Luithle T, Warmann SW, Haber P, Blumenstock G, Szavay P. Laparoscopic surgery on upper urinary tract in children younger than 1 year: technical aspects and functional outcome. J Urol 2009; 182 (4) 1561-1568