LAPAROSCOPIC PYELOPLASTY IN RECURRENT URETEROPELVIC JUNCTION OBSTRUCTION


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Abstract

Performed more commonly and in case of its failure a repeated pyeloplasty can be done. The aim of the study was to assess the results of laparoscopic pyeloplasty in these recurrent cases. Materials and methods. A total of 178 laparoscopic pyeloplasty was performed in urologic clinic from February 2010 to March 2018. In 18 patients (10.1%), including 11 men and 7 women, recurrent UPJ obstruction was diagnosed. Mean age was 36.5±8.0 years. There were 12 left UPJ obstruction and 6 right UPJ obstruction. Previously, 10 and 8 patients undergone open and laparoscopic pyeloplasty, respectively. Retrograde pyelothomy was done in 12 cases (75.0%). All patients had clinical symptoms and obstructive curve pattern on dynamic scintigraphy. Intra- and postoperative complications were graded using Clavien classification. The results of laparoscopic pyeloplasty were evaluated by excretory urography and dynamic scintigraphy. Results. There was no conversion. Mean duration of laparoscopic pyeloplasty was 105.5±28 min. The surgery was more prolonged in patients who previously undergone transperitoneal laparoscopic pyeloplasty. Conversely, laparoscopic pyeloplasty after failed open retroperitoneal pyeloplasty was less complicated. Mean blood loss was 60.0±20.5 ml. There was no intraoperative complications and postoperative complications developed in 3 patients (16.7%), including fever in 2 cases (grade II on Clavien) and urinary leakage in 1 patient (grade I on Clavien). Laparoscopic pyeloplasty was ineffective in 1 case (5.4%), according to dynamic scintigraphy. Conclusion. Laparoscopic pyeloplasty is feasible method in case of recurrent UPJ obstruction despite scar tissue in the area of intervention.

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About the authors

B. G Guliev

FGBOU VO North-Western State Medical University named after I.I. Mechnikov; City Mariinsky hospital

Email: gulievbg@mail.ru
MD, professor at the department of urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Head of Center of Urology with robot-assisted surgery of City Mariinsky hospital Saint Petersburg, Russia

References

  1. Jarrett T.W., Chan D.Y., Charambura T.C., Fugita O., Kavoussi L.R. Laparoscopic pyeloplasty: the first 100 cases. J Urol. 2002;167:1253-1256.
  2. Komyakov B.K., Guliev B.G., Aliev R.V. Laparoscopic pyeloplasty in primary ureteropelvic junction obstruction. Urologiia. 2013;6:81-84.
  3. Oberlin D.T., McGuire B.B., Pilecki M., et al. Contemporary national surgical outcomes in the treatment of ureteropelvic junction obstruction. Urology. 2015;85(2):363-367.
  4. Madi R., Roberts W.W., Wolf J.S. Late failures after laparoscopic pyeloplasty. Urology. 2008;71:677-680.
  5. Tan H.J., Ye Z., Roberts W.W., Wolf J.S. Failure after laparoscopic pyeloplasty: prevention and management. J. Endourol. 2011;25(9): 1457-1462.
  6. Fedelini P., Verze P., Meccariello C., Arcaniolo D., Taglialatela D., Mirone V.G. Intraoperative and postoperative complications of laparoscopic pyeloplasty: a single surgical team experience with 236 cases. J Endourol. 2013; 27:1224-1229.
  7. Guliev B.G., Aliev R.V. Complications of laparoscopic pyeloplasty according to Clavien classification. Eksperimental’naya i klinicheskaya urologiya. 2016;2:47-51.
  8. Jacobs B.L., Lai J.C., Seelam R., Hanley J.M. et al. The comparative effectiveness of treatments for ureteropelvic junction obstruction. Urology. 2018;111:72-77.
  9. Doo C.K., Hong B., Park T., Park H.K. Long-term outcome of endopyelotomy for the treatment of ureteropelvic junction obstruction: how long should patients be followed up? J. Endourol. 2011;21(2):158-161.
  10. Patel T., Kellner Ch. P., Ktasumi H., Gupta M. Efficacy of endopyelotomy in patients with secondary ureteropelvic junction obstruction. J. Endourol. 2011;25(4):587-591.
  11. Martov A.G., Ergakov D.V., Andronov A.S., Dutov S.V. Minimally-invasive treatment of upper urinary tract strictures. Khirurgiya. 2014; 12:46-55.
  12. Alyaev Yu.G., Glybochko P.V., Rapoport L.M., Gazimiev M.A., Akopyan G.N. Radioendoscopic surgery of primary and secondary strictures of the upper urinary tract. Voprosy urologii i andrologii. 2017;5 4):5-12.
  13. Swearingen R., Ambani S., Faerber G.J., Bloom D.A., Wolf J.S. Definitive management of failure after pyeloplasty. J Endourol. 2016; 30(Suppl. 1):23-27.
  14. Sundaram C.P., Grubb R.L., Rehman J., Yan Y., Chen C., Landman J. et al. Laparoscopic pyeloplasty for secondary ureteropelvic junction obstruction. J Urol. 2003;169:2037-2040.
  15. Piaggio L.A., Noh P.H., Gonzalez R. Reoperative laparoscopic pyeloplasty in children: comparison with open surgery. J Urol. 2007;177:1878-1882.
  16. Chiancone F., Fedelini M., Pucci L., Meccariello C., Fedelini P. Laparoscopic management of recurrent ueteropelvic junction obstruction following pyeloplasty: a single surgical team experience with 38 cases. Inter. Braz. J. Urol. 2017;43(3):512-517.
  17. Thomas J.C., DeMarco R.T., Donohoe J.M., Adams M.C, Pope J.C., Brock J.W. Management of the failed pyeloplasty: a contemporary review. J Urol. 2005;174:2363-2366.
  18. Braga L.H., Lorenzo A.J., Skeldon S., Dave S., Bagli D.J., Khoury A.E. et al. Failed pyeloplasty in children: comparative analysis of retrograde endopyelotomy versus redo pyeloplasty. J Urol. 2007;178:2571-2575.
  19. Osman T., Eltahawy I., Fawas K. et al. Ureterocalicostomy for treatment of complex cases of ureteropelvic junction obstruction in adults. Urology. 2011;78(1):202-207.
  20. Arap M.A., Andrade H., Torricelli F.C., Denes F.T., Mitre A.I. et al. Laparoscopic ureterocalicostomy for complicated up- per urinary tract obstruction: mid-term follow-up. Int. Urol. Nephrol. 2014;46(5): 865-869.
  21. Kamat N., Khandelwal P. Laparoscopy-assisted ileal ureter creation for multiple tuberculous strictures: report of two cases. J Endourol. 2006;20(6):388-393.
  22. Komyakov B.K., Guliev B.G., Al-Attar T.Kh. Laparoscopic ureterocaliceal anastomosis in long recurrent stricture of right ureteropelvic junction. Vestnik urologii. 2017;5(3):87-94.
  23. Rehman J., Landman J., Sundaram C., Clayman R.V. Missed anterior crossing vessels during open retroperitoneal pyeloplasty: laparoscopic transperitoneal discovery and repair. J Urol. 2001;166:593596.
  24. Persky L., McDougal W.S., Kedia K. Management of initial pyeloplasty failure. J Urol. 1981;125:695-697.

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