Horizontal pyeloureteral anastomosis in patients with UPJ obstruction has anatomical and functional advantages over vertical anastomosis

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Abstract

Introduction. The standard approach to the treatment of short ureteropelvic junction (UPJ) obstruction is the Anderson-Hynes procedure. Despite its high efficiency and low complication rate, there are ongoing studies which study the modification of the procedure using open, laparoscopic, and robotic approaches.

Aim. To describe a modified pyeloplasty technique with an assessment of the anatomical and functional results in comparison with the Anderson-Hynes procedure.

Materials and methods. The results of 1,768 procedures for short UPJ obstruction and hydronephrosis performed using open (804), laparoscopic (888), and robotic (76) approaches in children and adults from 2000 to 2023 are presented in the article. A technique for horizontal ureteropyeloanastomosis after UPJ resection was developed by V.V. Sizonov and M.I. Kogan. A comparative analysis of the anatomical and functional results of vertical (standard) and horizontal anastomoses of the ureteral pelvis was performed using mathematical methods of the theory of hydrodynamics, and imaging studies after 12 months of follow-up.

Results. Horizontal anastomosis of the renal pelvis and ureter increases the passage of urine by 19.75% compared to vertical anastomosis. Horizontal anastomosis is less tense after resection of the ureteral pelvis. Postoperative dynamics of the anteroposterior size of the renal pelvis after horizontal anastomosis reliably demonstrates accelerated reduction compared to standard technique. Horizontal anastomosis is associated with a significantly higher increase in GFR compared to vertical anastomosis.

Conclusion. The author's technique of horizontal anastomosis between the ureter and pelvis has reliable anatomical and functional advantages over the Anderson-Hynes technique when performing open, laparoscopic and robotic pyeloplasty.

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About the authors

M. I. Kogan

Rostov State Medical University

Author for correspondence.
Email: dept_kogan@mail.ru
ORCID iD: 0000-0002-1710-0169

PhD, MD, Professor, Honored Scientist of Russian Federation, Head of the Department of Urology and Human Reproductive Health with the Course of Pediatric Urology and Andrology

Russian Federation, Rostov-on-Don

V. V. Sizonov

Rostov State Medical University

Email: vsizonov@mail.ru
ORCID iD: 0000-0001-9145-8671

PhD, MD, Professor at the Department of Urology and Human Reproductive Health with the Course of Pediatric Urology and Andrology

Russian Federation, Rostov-on-Don

V. L. Medvedev

Kuban State Medical University

Email: medvedev_vl@mail.ru
ORCID iD: 0000-0001-8335-2578

PhD, MD, Professor, Head of the Department of Urology

Russian Federation, Krasnodar

G. A. Palaguta

Scientific and Research Institute of Regional Clinical Hospital №1 named after Prof. S.V. Ochapovsky

Email: palaguta83@gmail.com
ORCID iD: 0000-0002-3462-8766

urologist at the Urologic Department No. 1

Russian Federation, Krasnodar

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Supplementary files

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1. JATS XML
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2. Fig. 1. Anderson-Hynes technique for LMS plasty

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3. Fig. 2. Stages of surgery with horizontal ureteropieloanastomosis technique

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4. Fig. 3. Schemes of anastomoses and fluid flow through the LMS (A - horizontal anastomosis, B - vertical anastomosis)

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5. Fig. 4. Schematics of vertical and horizontal anastomosis (A and C, B and D - connection points at anastomosis)

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6. Fig. 5. Mean values of pelvic RPE in children of groups 1 and 2

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