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Background: There is no agreed protocol on usage of proper and best suturing material in minimally invasive pyeloplasty. The aim of this meta- analysis was to summarize and analyze current evidence on suturing materials for laparoscopic pyeloplasty. Materials and Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. Scientific databases (PubMed, Scopus, Web of Science, and EMBASE) were systematically searched for relevant comparative studies on barbed suture (BS) and non-barbed suture (NBS) in minimally invasive pyeloplasty. Results: Five comparative studies met the inclusion criteria and were included in the meta- analysis. Pooling the data demonstrated a significantly shorter operative duration in patients belonging to the BS group versus the NBS group (95% confidence interval [CI] -81.63 to -10.41, P = .01), with statistically significant estimated heterogeneity among the included studies (P < .0001). Although the incidence of redo- pyeloplasty was higher in the BS group, the pooled risk ratio (RR) for the need for redo-pyeloplasty in subjects belonging to the BS group versus the NBS group was 6.00 (95% CI 0.78-46.14), demonstrating no statistically significant difference (P = .09). A total of 5 patients developed postoperative complications. The pooled RR for the occurrence of these complication showed no significant difference among the patients belonging to both the groups (95% CI 0.22-6.05, P = .88). Conclusions: Minimally invasive pyeloplasty using BS is associated with significantly shorter operative time. The incidence of postoperative complications and requirement of redo-pyeloplasty showed no significant difference among both the treatment groups. Further randomized controlled trials need to be conducted before any definite conclusions are drawn.

Robot-assisted laparoscopic pyeloplasty (RALP) use in children has increased, though many centers still favor open pyeloplasty (OP) in infants. This study aims to compare safety and efficacy of RALP and OP in infants.A single-institution, retrospective cohort study of infants1 year of age who underwent primary RALP or OP between January 2009 and June 2020 was performed. Primary outcomes were intraoperative and 30-day complications, postoperative radiographic improvement at last clinic visit, and operative failure leading to redo pyeloplasty. Multivariable logistic regression was performed for 30-day complications to adjust for demographic variation between groups. Survival analysis was performed to compare time to diagnosis of operative failure leading to redo pyeloplasty.Among 204 patients, 121 underwent OP and 83 underwent RALP (74.5% male). RALP patients were older (median 7.2 vs 2.9 months, p0.001) and larger (median 8.2 vs 5.9 kg, p0.001) than OP patients. Radiographic improvement was seen in 91.1% of RALP patients and 88.8% of OP patients at last visit. Median (interquartile range) followup in months was 24.4 (10.8-50.3) for the full cohort. In adjusted analysis, the odds of a 30-day complication (OR 0.40, 95% CI 0.08-2.00) was lower for RALP compared to OP, though not statistically significantRALP is a safe and effective alternative to OP for infants, with comparable intraoperative and 30-day complications, radiographic improvement at last followup, and risk of pyeloplasty failure.

We aimed to evaluate the safety and efficacy of RALP for UPJO in a heterogeneous pediatric population. The medical records of all patients with UPJO who underwent RALP over the last 6 years and completed at least 6 months of follow-up, were retrospectively reviewed. Data included age, sex, laterality, weight, preoperative and postoperative ultrasound and renal scintigraphy results, operation time, complications, length of hospital stay. We separately examined two groups: low-weight children (

The OBJECTIVE of the study was to analyze the results and to introduce our experience of the laparoscopic pyeloplasty regarding the stricture of the pyeloureteral segment.METHODS and MATERIALS. Our study represents results of treatment of 114 patients who had surgical treatment during the years 2013–2018. In that period, we made 114 primaries and 9 secondaries laparoscopic pyeloplasties with transperitoneal access. In this account, there were 43 men aged from 19 to 64 years, average age was (34.9±3.7), and 71 women aged from 19 to 77 years, average age was (39.2±4.2). All patients underwent ultrasound examination of the kidneys on the day of discharge and 3-5 days after stent extraction. Control examination, which included history taking, examination, clinical and biochemical blood analyses, clinical urine analysis and ultrasound of the kidneys were performed after 3 months. Plain and excretory urography were performed 6 and 18 months after surgical intervention. RESULTS. Operative removal of the stricture of the pyeloureteral segment was successful in 105 (92.2 %) out of 114 cases. 9 patients (7.8 % of the total number of operated patients) underwent repeated laparoscopic pyeloplasty. Duration stay after primary laparoscopic pyeloplasty was from 3 to 5 days, on average (3.9±0.7) days. Postoperative period after secondary pyeloplasty was without complications, the bed-day was from 3 to 6 days, on average (4.3±0.6) days.CONCLUSION. Our opinion is that the optimal method for surgical treatment of patients with primary and secondary strictures of the pyeloureteral segment is laparoscopic pyeloplasty. This kind of surgery has a favorable security profile and optimal postoperative results. Considering the possible causes of relapse of the stricture of the pyeloureteral segment, we came to the conclusion that the frequency of relapse is mainly connected with selected suture material, which determines the severity of scar changes.

Background Since its first description, multiple reports proved efficacy and safety of the robotic platform. Further progress has been made allowing for the application of robotic surgery to smaller patients, including infants. Despite the early favorable results, the use of robot surgery in infants is still controversial and more studies are needed to confirm its benefits. Objective To our knowledge, we present the largest single-institution case series of robot-assisted laparoscopic pyeloplasty (RAL-P) in infants, aiming to contribute to the current literature with a guide for key technical steps and safety tips for infant RAL-P. Design, setting, and participants We performed a retrospective review of a prospectively maintained database. The study protocol was approved by the institutional review board. Surgical procedure Only infants (≤12 mo of age) with a diagnosis of congenital ureteropelvic junction obstruction (UPJO) undergoing primary robotic dismembered pyeloplasty were included in the study. Measurements We critically reviewed the clinical outcomes, described the main steps of the operation, and shared tips for a safe approach. Results and limitations From January 2012 to August 2019, 44 infants underwent RAL-P for UPJO––33 (75%) males and 11 (25%) females. All robotic cases were completed successfully, with no laparotomic conversions. The median age and weight were 4 (1–12) mo and 6.8 (3.8–10.5) kg, respectively. The mean operative time was 142 (±25) min. The mean estimated blood loss was 7 (±3.6) ml, and no intraoperative complications occurred. The mean length of hospital stay (LOS) was 1.4 (±0.7) d. Seven (15.6%) patients had postoperative complications—one (2%) ileus (Clavien-Dindo grade [CDG] I), four (9%) urinary tract infections (CDG II), and two (4.5%) port-site hernias (CDG III). At a median follow-up of 19 mo, the success rate was 100%. Conclusions Given the successful outcomes, benefits of decreased LOS, and improved cosmesis, RAL-P is an appealing management option for UPJO in infants. Market release of new systems, further miniaturization of instruments, and more affordable costs will hopefully be shedding light on more complex applications. Patient summary Infants (≤12 mo of age) diagnosed with ureteropelvic junction obstruction undergoing primary robotic dismembered pyeloplasty were selected and included in this study. No intraoperative complications or conversion to an open approach occurred. Seven patients (16%) developed postoperative complications—one (2%) postoperative ileus, four (9%) urinary tract infections, and two (4.5%) port-site hernias. At a median follow-up of 19 (7–66) mo, the success rate was 100%.

Summary Objective While there are several reports confirming the safety and efficacy of laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP) in children there have been none comparing LP and RALP specifically in infants. In this meta-analysis, we have compared the outcomes of LP and RALP in infants. Methods Pubmed (Medline), Publon, Index Medicus and Embase were searched using the search terms: pyeloplasty (laparoscopic OR robot-assisted) AND (infant), to identify all papers pertaining to LP and RALP. Systematic review was performed to identify information regarding number of patients/renal units, age, body weight, operating time, hospital stay, success and complications. Meta-analysis of heterogeneity was reported with I2statistics. Once heterogeneity was found low, the pooled outcomes were compared with student's t test and Fishers exact test, wherever appropriate. Results After screening a total of 267 articles, 18 articles were included (10 articles on LP, 7 on RALP, 1 reporting both), comprising 323 renal units for LP and 173 renal units for RALP. With low heterogeneity (I2: 0%) both groups were considered to have been conducted under similar conditions for fixed effect model. There was no significant difference between the success rates of LP or RALP (97.5% vs 94.8%; p = 0.21). The mean age at operation was significantly lower for LP (5.6 ± 1.8 months) than RALP (7.2 ± 1.2 months, P = 0.0001). The duration of surgery was 137 ± 45 min for LP while significantly higher at 179 ± 49 min for RALP (p = 0.0001). The mean (s.d) time to discharge was 2.0 (1.9) days for LP while 1.3 (0.4) days for RALP. The overall complication rate was significantly higher (summary table) for RALP than LP (p = 0.03), mainly due to more port-site hernias in RALP. Discussion In the present study, we found that the success of LP and RALP in infants was similar. RALP in infants had longer duration of surgery, similar hospital stay and higher Clavien-3 complications than LP. While several studies have reported favorable outcomes for RALP over LP in children, this was not the case in infants. The smaller workspace, in an infant, can significantly limit the mobility of robotic instruments and increase the chance of port-site conflicts or trocar collisions. The use of larger robotic ports and instruments in the small space of infant abdomen might have been responsible for higher complications in RALP, including significantly larger number of port-site hernias. This meta-analysis represents the early experience of most RALP in infants, and it is possible that with experience RALP outcomes in infants also will catch up with LP. Miniaturization of robotic instruments might render RALP the future standard of care for pyeloplasty in infants. Summary table . Meta-analysis comparing pooled outcomes of infant LP & RALP Summary LP (n = 323) RALP (n = 173) Difference (p value) Age in months Mean (s.d) 5.6 (1.8) 7.2 (1.1) 0.0001 Surgery duration (min) Mean (s.d) 137 (45) 179 (49) 0.0001 Time to discharge (days) Mean (s.d) 2.0 (1.9) 1.3 (0.4) 0.0001 Success rate 315 (97.5%) 164 (94.8%) 0.12 Complication rate Clavien 1–2 25 (7.6%) 18 (10.2%) 0.32 Complication rate Clavien 3–4 5 (1.5%), 1 port site hernia 10 (5.7%), 4 port site hernias 0.01 All complications 30 (9%) 28 (16%) 0.03

Introduction: Success rate of laparoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO) in children is comparable with open pyeloplasty. Prolonged ileus and injury to adjacent viscera ...

To understand the viability, safety and efficacy of the K-wire technique for externalised nephrostent placement in laparoscopic pyeloplasty. The technique has been previously described by the senior author in 2018. Retrospective analysis of consecutive laparoscopic pyeloplasties between June 2016 and November 2019 employing this technique. Pre-operative ultrasound (US) and MAG3 scans, procedure-related complications, hospital stay, further interventions and follow-up imaging were analysed. Stents are knotted in 48 h and removed on day 7 on return to the ward without the need for a second anaesthetic. 38 patients had 38 pyeloplasties. Median age at surgery was 30.3 months (3.7–208.3 months), 28 were male and 20 patients had antenatal hydronephrosis. Pre-operative US median antero-posterior diameter (APD) was 28 mm (14–56 mm), median MAG3 was 42.5% (10–55%) of which 16 were under 40%. No procedure-related complications were noted. Median hospital stay was 2 days (2–4 days). In a couple, vesico-ureteric junction obstruction (VUJO) came to light needing a redo pyeloplasty with VUJO correction in one, and only a VUJO correction in the other. In one, stent removal was difficult as a suture had passed through it. Median follow-up was 19.4 months (range 7–38.3 months). Post-operative median APD on ultrasound was 8.5 mm (range 3–52 mm) and median MAG3 was 46% (range 12–53%). The study shows that the K-wire technique is a viable option which is safe and effective to provide stenting in laparoscopic pyeloplasty without the need for a subsequent procedure.

Introduction: Anderson-Hynes pyeloplasty has been gold standard in the management of pelviureteric junction obstruction (PUJO). It has evolved from open to laparoscopic and now robotic surgery. Open surgery has its drawback of long incision and scar mark, significant post-operative pain and long hospital stay. The main limitation of laparoscopic surgery had been the difficulty in endosuturing. Robotic surgery has incorporated the minimal access method of laparoscopy and endowrist movement of open surgery to overcome the challenge of intracorporeal suturing. Here, we present our initial experience of robotic pyeloplasty. Patients and Methods: A total of 30 patients underwent robot-assisted laparoscopic pyeloplasty (RALP) over 19 months. Diagnosis of PUJO was made by computed tomography urography, diuretic renogram and retrograde pyelogram in selected patients. All patients underwent RALP by colon reflecting approach. Post-operative evaluation was done by DTPA scan at 3- and 6-month follow-up. Data were analysed after a mean follow-up of 11 months. Results: The mean operative time was 148 min and the mean hospital stay was 3.5 days. While 93% of the patients showed objective improvement in their drainage pattern on DTPA renogram, 90% of the patients were symptom-free at the end of 6 months. Conclusions: Robotic pyeloplasty is a safe and easily conquerable technique with comparable outcomes in the hands of surgeons who are beginners in this technique.

Background: Open pyeloplasty is considered as the gold standard for the treatment of pelvi-ureteric junction obstruction. Laparoscopic pyeloplasty has added advantages with equivalent success rate and low complication rate. Objectives: The aim is to study our experiences in laparoscopic retroperitoneal and transperitoneal pyeloplasty. Methodology: Sixty-five patients with pelvi-ureteric junction obstruction were included in the study. The study was conducted between October 2016 and May 2019 at Kathmandu Medical College Teaching Hospital. Pelvi-ureteric junction obstruction was evaluated by ultrasound and intravenous or computed tomography urography. Clinical history, hospital stay, complications, success rate and functional outcome were analyzed. Statistical analysis was done using the Statistical Package for the Social Sciences,version 20.0 (SPSS Inc., Chicago, IL, USA). A p-value < 0.05 was taken as significant. Followup of the patients was carried out for six to twelve months clinically and radiologically. Results: Laparoscopic transperitoneal pyeloplasty was performed in 27 males and 8 females. Retroperitoneal pyeloplasty was performed in 30 cases (20 males and 10 females). The mean age was 20.26 ± 3.92 years for all cases. Operative time was longer in retroperitoneal group. There were four conversions in retroperitoneal group. Mean hospital stay was longer in retroperitoneal group with significant p-value

The aim of this study was to investigate the safety and clinical efficacy of mini-laparoscopic pyeloplasty in treating ureteropelvic junction obstruction (UPJO) in infants.We retrospectively analysed the clinical data of 66 infants with UPJO from January 2013 to August 2018 at our hospital. They were divided into the laparoscopic surgery group (group A) and the open surgery group (group B), depending on the surgical method.The bleeding volume, analgesia duration, postoperative hospitalization duration, and incision length in group A were significantly less than those in group B (Mini-laparoscopic pyeloplasty to treat UPJO in infants has the same early clinical efficacy and safety as open surgery, and this procedure has the advantages of fewer incisions, less pain, quicker recovery, and better cosmetic outcomes.

Introduction. This study describes authors’ experience in performing laparoscopic pyeloplasty in infants whose age does not exceed 3 months of life, and compares pre- and postoperative results of these surgeries in order to answer the question - does the laparoscopic technology for the treatment of hydronephrosis in newborns and infants provide acceptable results based on improving kidney morphology and function? Material and methods. 105 children, aged 3 months, were enrolled into this retrospective study who for 8 years, since 2012, have been laparoscopically operated on for congenital hydronephrosis. Because of bilateral renal damage, a total of 110 surgeries were performed, including simultaneous pyeloplasty in 5 patients. All patients had dismembered pyeloplasty with the Anderson-Hynes technique via transparietal laparoscopic access. Indications for surgery were: decreased renal function with obstruction signs of urine outflow from the pelvis confirmed by radioisotope renography; a combination of reduction of parenchyma thickness and increase of pelvis diameter at serial ultrasound studies; or a combination of these pathologies with urinary tract infection. During the trial, the following parameters were recorded: demographic data, findings of perioperative diagnostic examinations, surgical details, recovery process after surgery and long-term consequences. Results. The average age of patients was 50.24 days. Of 105 patients, 60 (57.14%) were less than 1 month old, and the remaining 45 (42.86%) were 1-3 months old. Gender distribution in groups was as follows: m / f = 73:32. Unilateral operations on the left kidney were in 61.82% patients, on the right kidney - in 33.64% patients. 4.54% patients had bilateral pyeloplasty. Average duration of surgery was 73.07 minutes (40-120 minutes). The average length of hospital stay was 4.19 days (2-9 days). At the early postoperative period, 4 (3.6%) patients developed postoperative complications - urinoma formation. A comparison of pre- and postoperative renal morphometry findings by ultrasound and Doppler ultrasound examination showed a significant decrease of renal pelvis dimensions and improved renal blood flow. The pelvis size decreased in average from 23.5 to 5.5 mm (p = 0.001), and RI from 0.72 to 0.64 (p = 0.001). Functioning of the operated kidney, as showed by the radioisotope renography, improved from 34 to 45.27 (p = 0.001). Long-term follow-up observation revealed one relapse of the disease (0.9%) - stenosis of pyeloureteral anastomosis which required a repeated laparoscopic pyeloplasty. One patient (0.9%)/ who was under follow-up observation for 36 months, had deterioration and loss of kidney function without signs of renal obstruction at the level of pyeloureteral segment which required laparoscopic nephrectomy. Thus, taking into account one relapse and loss of kidney function in one patient, we can state that the effectiveness of laparoscopic pyeloplasty in our study was 98.2%. Conclusion. Summarizing results of the applied laparoscopic pyeloplasty in the youngest group of patients whose age does not exceed 3 months of life, it can be stated that the minimally invasive approach contributes to normalizing morphological and functional parameters of kidney.

Background: Laparoscopy-assisted pyeloplasty [LAP] has been introduced to shorten the operative time and make the traditional transperitoneal laparoscopic pyeloplasty [LP] much easier while maintaining comparable functional and cosmetic results to the LP. Purpose: Comparing the outcomes of LP to LAP in terms of operative time and cosmetic appearance. Patients and Methods: This is a randomized controlled study where twenty patients presented with ureteropelvic junction obstruction [UPJO] were divided into two equal groups. The first was subjected to LP while the second was subjected to LAP. The outcome measurements included the operative time, the hospital stay, intraoperative complications, and the success rates. Postoperative data were collected with special emphasis on pain and analgesia requirements. Results: The mean age of the patients was 4.95 ±3.7 years [range=9 months to 12 years], the preoperative SFU grade was 3.7 and the renal relative function was 25.5%. The mean operative time was 154±21 minutes [range =126 to 185 minutes] for LP compared to just 114±12 minutes [range =98 to 130 minutes] in LAP (p < 0.001). The success rate was 90% in both groups and the postoperative split function rose to around 40%. Although the leakage was slightly higher in the LP, the wound complications were higher in the LAP group. The cosmetic results and patients’ satisfaction were in favor of LP. Conclusion: The success and recurrence rates are almost equal in both techniques. The main advantages of LAP over LP are the marked operative time reduction and its reproducibility by the less experienced laparoscopic surgeons.

Aim: Our primary aim was to report the prevalence of recurrent stricture following primary pyeloplasty and the secondary treatment performed. The secondary aim was to identify the clinical or surgical factors related to recurrent ureteropelvic junction obstruction (UPJO). Materials and methods: A retrospective study was conducted on patients diagnosed with UPJO at the Hospital General de Mexico “Dr. Eduardo Liceaga”, between 2011-2019. Patients that underwent primary pyeloplasty, and developed recurrent UPJO, underwent secondary treatment, and had follow-up ³6 months were included in the study. A descriptive analysis was carried out. Results: A total of 52 patients underwent open or laparoscopic pyeloplasty as primary treatment and 6 of them (11.5%) presented with recurrent UPJO at 44 months (median). Two of those patients presented with a non-functioning kidney and underwent simple laparoscopic nephrectomy and the remaining 4 patients underwent transperitoneal laparoscopic redo pyeloplasty as secondary treatment. The mean age of the patients with recurrence was 46 years, their mean BMI was 32.57±5 kg/m2, and two of them had urinary diversion prior to the primary pyeloplasty. Surgery duration was longer for laparoscopic redo pyeloplasty versus primary pyeloplasty (192 minutes versus 113 minutes) and intraoperative bleeding was similar (52cc versus 52.9cc). The surgical and histologic finding in laparoscopic redo pyeloplasty was peri-ureteral fibrosis. No aberrant vessels were found. Stricture was longer than 15 mm in the patients that underwent laparoscopic redo pyeloplasty (n=4). Obesity, lithiasis, and stricture length >15mm were more frequent in the patients with recurrence. Conclusions: The prevalence of UPJO in our study population was 11.5%, which concurs with international parameters. Laparoscopic redo pyeloplasty is a useful tool in cases of UPJO.

Introduction. The use of minimally invasive surgery of urteropelvic junction obstruction was started in the in the mid-90s of the last century. Replacement rates of open surgery and methods of the minimally invasive surgery are different in various countries. We analyzed the spread of minimally invasive technologies in some regions of the Russian Federation.Purpose of the study. To study the dynamics of replacement of open pyeloplasty with laparoscopic pyeloplasty in certain regions of the Russian FederationMaterial and methods. Available data included the annual number of laparoscopic and open pyeloplasties, patient age, complications, and medium-term results. Our analysis screened 1581 pyeloplasties, which were performed during 2004‒2018 in eight regions of the Russian Federation. The patients were separated into two groups according to age. There were 566 infants and 1015 older children. A total 908 (57.4%) laparoscopic pyeloplasty (LP) and 673 (42,6%) open pyeloplasty (OP) were performed. Of those patients who underwent laparoscopic pyeloplasty, 274 (48.4%) were infants, while 624 (61.5%) were older children. The rates of LP and OP use were then assessed according to year of surgery. A binary logistic regression model was used to evaluate the statistical significance of the rate of LP use over time, to predict postoperative complications and to compare the effectiveness of LP in comparison with OP.Results. The use of LP increased remarkably during the study period. In regions with 5 years of LP experience, LP utilization rate was significantly higher. The rate of LP in infants has been associated with increasing experience in the LP. A total, 70% of older children and 59% of infants were operated with LP in 8 regions in 2018.Conclusion. In some regions of the Russian Federation, the rate of LP is markedly increased and almost replaces open surgery. In regions where LP has been introduced over the past 5 years, the replacement rate is higher than in regions where LP was introduced before.

Introduction Laparoscopic preparation of the ureter is a challenging part of upper urinary tract reconstruction, due to limited depth perception provided by the camera and lack of wristed motion of most laparoscopic instruments needed for adequate spatulation and scar tissue removal. One solution has been to perform the more difficult portions of the surgery in an extracorporeal manner. A hybrid intracorporeal-extracorporeal approach to upper tract ureteral reconstruction facilitates ureteral preparation at the stage of mastering the technique. Material and methods This retrospective study included 100 patients with primary ureteropelvic junction obstruction, who underwent laparoscopic pyeloplasty from 2014 to 2017. The patients were stratified into 2 groups: those who underwent conventional laparoscopic surgery and those who were managed with the hybrid approach. For the hybrid approach, externalizing the ureter to skin level required additional mobilization of the upper urinary tract. Results A total of 47 patients underwent conventional laparoscopic pyeloplasty and 53 - hybrid surgery. The maximum body mass index was 32. The hybrid approach was 8.5 minutes shorter compared to the conventional approach (p

Introduction Laparoscopic ureterocalicostomy is a useful alternative to laparoscopic pyeloplasty for treating ureteropelvic junction obstruction under certain conditions. One concern regarding this technique is the inevitability of amputation of the renal lower pole to expose the lower renal calyx. Case presentation A 43-year-old man who presented ureteropelvic junction obstruction and multiple renal cysts underwent laparoscopic pyeloplasty, which could not be performed because of the intrarenal ureteropelvic junction. We switched the surgical technique to modified laparoscopic ureterocalicostomy, wherein amputation of the lower renal pole was substituted with fenestration of a renal cyst under the guidance of ureteroscopic light. Computed tomography performed 2 months postoperatively showed good patency of the anastomosis. Conclusion Light-guided laparoscopic renal cyst fenestration followed by ureterocalicostomy is feasible in patients with ureteropelvic junction obstruction and lower pole renal cysts adjacent to the lower renal calyx.

For ureteropelvic junction obstruction (UPJO), the standard of surgical care is dismembered pyeloplasty. This applies both for intrinsic but also for extrinsic etiology of the UPJO. When in 1995, Peters described for the first time laparoscopic pyeloplasty in children, the era of laparoscopic pediatric urological surgery began. Nowadays, laparoscopic dismembered pyeloplasty in children has evolved to become the gold standard. In this article, we report a standardized technique of laparoscopic transperitoneal dismembered pyeloplasty for infants and children. The described single steps of the procedure are reproducible regardless of age and weight and thus offer a high surgical success rate.

Aim A systematic review was conducted to evaluate the current evidence for prophylactic antibiotic use in paediatric robotic-assisted laparoscopic pyeloplasty (RALP). As pyeloplasties are ‘clean contaminated’ procedures, prophylactic antibiotics are recommended, however, recent evidence suggests that antibiotics may be unnecessary. Prophylactic antibiotics are often either under or over prescribed in paediatric surgery, which increases the risk of developing antibiotic resistance. In general, minimally invasive surgery is associated with less postoperative infections, however, it is not yet clear how RALP compares with other approaches. Recent reviews have indicated prophylactic antibiotics may not decrease postoperative infections, however, there are no clear guidelines. Methods A systematic review was conducted of the following electronic databases: Pubmed, Medline Ovid, The Cochrane Library, TRIP Database, NICE Evidence Search, and EMBASE. The search terms used were: paediatric, pyeloplasty, robotic, antibiotic and were used as keywords as well as in combination as MeSH terms. Results Forty-one articles were retrieved, and after screening for relevance and redundancy, 2 articles remained including a total of 315 pyeloplasties. Prophylactic antibiotics did not reduce the incidence of postoperative UTIs in RALP. Conclusion Prophylactic antibiotics for RALP is not associated with lower rates of UTIs and therefore, may be reserved for patients with risk factors. However, due to the limited data and confounding factors, further research is required to optimise antibiotic stewardship and infection prevention.

INTRODUCTION AND OBJECTIVE:In this study we set out to compare perioperative and follow-up outcomes between single port robot-assisted laparoscopic pyeloplasty (SP-LRP) and multiport robot-assisted...

INTRODUCTION AND OBJECTIVE:Horseshoe kidneys are uncommon with an estimated incidence of approximately 1 in 500 persons. Horseshoe kidneys are characterized by arrested developmental ascent and are...

INTRODUCTION AND OBJECTIVE:Pelvic kidneys are uncommon with an estimated incidence of approximately 1 in 3,000 persons. Pelvic kidneys are characterized by arrested renal developmental ascent in th...

Objective: This study aimed to evaluate the clinical efficacy of laparoscopic pyeloplasty (LP) for ureteropelvic junction obstruction (UPJO) via retroperitoneal and transperitoneal approaches.Method: A systematic literature search on keywords was undertaken using PubMed, Cochrane Library, Embase, China Nation Knowledge (CNKI), and Wanfang. The eligible literature was screened according to inclusion and exclusion criteria. Meta-analysis was performed by using RevMan 5.0 software.Results: According to the inclusion and exclusion criteria, 12 studies were identified with a total of 777 patients. Four hundred eight patients were treated with retroperitoneal laparoscopic pyeloplasty (RLP), and 368 patients were treated with transperitoneal laparoscopic pyeloplasty (TLP). The meta-analysis results showed that the two approaches were similar in terms of presence of postoperative hospital stay, postoperative complication, the rate of conversion, and recurrence (p > 0.05). The operative time in the TLP group was significantly shorter than the RLP group (MD = 16.6; 95% CI, 3.40–29.80; p = 0.01). The duration of drainage was significantly shorter (MD = −1.06; 95% CI, −1.92 to −0.19; p = 0.02), and the score of postoperative visual analog score (VAS) was significantly lower in the RLP group than in the TLP group (MD = −0.52; 95% CI, −0.96 to −0.08; p = 0.02).Conclusion: Both approaches have good success rates and low postoperative complication rates. RLP provides a shorter duration of drainage and lower VAS score, but it takes more operative time than TLP.

Background We retrospectively analyzed the initial results of laparoscopic pyeloplasty, among pediatric patients undergoing the procedure by transperitoneal access. Methods We retrospectively reviewed the medical records of patients who were operated with transperitoneal laparoscopy-assisted pyeloplasty at our institution between 2015 and 2020. Results The mean age of the 51 patients (M/F = 36/15) was 59 ± 49.8 months. The mean preoperative renal pelvis anterior–posterior diameter was 32.9 ± 13.4 mm, and the relative renal function was 42 ± 12.1% on the operation side. Forty-three (84.3%) patients had no excretion on MAG3 examination preop. The number of patients with no excretion decreased to 10 (19.7%) after surgery. One of them underwent a successful endopyelotomy; eight of them underwent a successful laparoscopic re-pyeloplasty. There was nothing to do in only one patient whose DRF decreased to 11%. The mean anterior posterior diameter decreased significantly to 16.7 ± 11.2 mm after surgery (p Conclusion Preoperative increased renal pelvis anterior–posterior diameter detected in our study was found to be a risk factor in the failure of transperitoneal laparoscopy-assisted pyeloplasty procedure.

Background: Comparative outcome studies investigating internal Double-J (DJ) and externalized stents have primarily been performed for open and laparoscopic pyeloplasty, with a paucity of literatur...

Objective: To investigate the outcomes of minimally invasive approach to infants with ureteropelvic junction (UPJ) obstruction by comparing the two surgical modalities of robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP).Methods: We conducted a retrospective review of all consecutive infants aged ≤12 months who underwent either LP or RALP in a single institution over the period of 2008–Jul 2020. We included primary pyeloplasty cases that were performed by or under the supervision of the same surgeon.Results: Forty-six infants (LP = 22; RALP = 24) were included with medians of age and body weight at 6 months (2–12months) and 8.0 kg (5.4–10 kg), respectively. There was no difference between the two groups in the patients' demographics and pre-operative characteristics. All infants underwent LP or RALP successfully without conversion to open surgery. None had intraoperative complications. Operative time (OT) was 242 min (SD = 59) in LP, compared with 225 min (SD = 39) of RALP (p = 0.25). Linear regression analysis showed a significant trend of decrease in OT with increasing case experience of RALP(p = 0.005). No difference was noted in the post-operative analgesic requirement. RALP was associated with a shorter hospital length of stay than LP (3 vs. 3.8 days; p = 0.009). 4/22(18%) LP and 3/24(13%) RALP developed post-operative complications (p = 0.59), mostly minor and stent-related. The success rates were 20/22 (91%) in LP and 23/24 (96%) in RALP (p = 0.49).Conclusions: Pyeloplasty by minimally invasive approach is safe and effective in the infant population. RALP may have superiority over LP in infants with its faster recovery and a more manageable learning curve to acquire the skills.

Introduction: Minimally invasive pyeloplasty (MIP) for correction of ureteropelvic junction (UPJ) obstruction in children has significantly improved the postoperative management of these patients. In this study, we sought to examine the factors associated with early discharge (≤24 hours) in children that underwent robotic-assisted laparoscopic pyeloplasty (RALP). Methods: We performed a retrospective chart review of all children who underwent RALP from 2012 to 2018 in our center. Descriptive statistics and a non-adjusted risk analysis were performed to evaluate the factors associated with early discharge (≤24h), readmission, and complications within the first 30 days after the procedure. Results: Eighty-nine patients out of 124 total pyeloplasties (72%) stayed ≤24 hours post-surgery. Of the variables analyzed, later cases were statistically associated with length of stay (LOS); the first 55 patients had a lower probability of being hospitalized for ≤24 hours (odds ratio [OR] 0.24, 95% confidence interval [CI] 0.09–0.64, p=0.004). Conclusions: Robotic-assisted pyeloplasty for children is associated with a high rate of early recovery, short hospital stay, low re-admission, and complication rate. Although not statistically significant, patients with shorter operative room time also had a shorter LOS. An increased LOS was observed in the initial patients of our series, and this is most likely explained because of the initial learning curve of all the team for the procedure itself and the more conservative postoperative management.

V clanku prezentujeme kazuistiku 55leteho pacienta se stenozou pyeloureteralniho přechodu a vicecetnou kalikolitiazou, který nejdřiv podstoupil akutni zavedeni stentu pro pravostrannou dilataci kalichopanvickoveho systemu s naslednou laparoskopickou pyeloplastikou s extrakci kalikolitiazy. Cilem tohoto clanku je ozřejmit nase rozhodovani a volbu terapeutickeho postupu u komplikovaneho pacienta.

Introduction: The process of improving one's skills over time is called a “learning curve”. This term has attracted great attention during the last decades, especially in relation to laparoscopic techniques. Aim: To assess the outcome of paediatric laparoscopic pyeloplasty (LP). Material and methods: Retrospective analysis of the consecutive LPs. The inclusion criteria: (1) children aged < 18 years, (2) transperitoneal approach, and (3) the same operating paediatric urologist (RC). Patients with a history of any procedure on the upper urinary tract were excluded. Any surgical reintervention during follow-up was defined as a failure. The outcomes of LPs performed before 2012 (G1) were compared to those conducted between 2012 and 2016 (G2). Fisher's exact test was used for statistical analysis. Results: Ninety patients met the inclusion criteria, and a total of 95 LPs were performed. The mean operation time was 155 min, and the mean hospitalisation period was 2.4 days. In G1, 19 patients underwent Anderson-Hynes LP, 16 had Fenger non-dismembered LP and two underwent vascular hitch. In G2, 54, 2 and 2 patients underwent these procedures, respectively. The overall success rate was 91.5%. There were six failures in G1 and three in G2 (p = 0.147). Of the Anderson-Hynes LPs, 1/19 in G1 and 3/58 in G2 required reintervention (p = 1). For Fenger LPs, this was 4/16 and 0/2, respectively (p = 1). Only one patient required reoperation after vascular hitch. Conclusions: The surgeons' learning curve reflects their experience with regard to the entire therapeutic process, but not exclusively their manual skills.

Introduction Pyeloplasty represents main treatment method of patients with primary ureteropelvic obstruction (UPJ). In recurrent UPJ obstruction endopyelothomy is 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.

Background To describe a simple, novel stone extraction technique using the transvaginal route for large renal calculi encountered during laparoscopic/robotic pyelolithotomy. Methods After a standard approach laparoscopic pyelolithotomy in a patient with a large (42 × 36 mm) pelvic calculus, Anderson-Hynes pyeloplasty was performed. A transverse posterior colpotomy was performed laparoscopically with the assistance of the Colpassist Vaginal Positioning Device (Boston Scientific) and the calculus was extracted, intact, through the vagina with the aid of an endoscopic retrieval bag. The vaginal incision was then closed intra-corporeally. A systematic review on the topic was also performed. Results The stone was removed in its entirety through an occult vaginal incision. There were no complications reported and the patient was stone free at follow-ups. Conclusions This simple, novel technique is an easily reproducible method, for the removal of large urinary calculi during either traditional laparoscopic or robotic-assisted laparoscopic stone surgery in the appropriate female patient. It avoids the need for additional abdominal incisions or complex techniques involving lithotripsy which may be more complicated and time consuming. All previously published stone extraction techniques for large calculi (greater than 20 mm) within this systematic review are also critically appraised.

Amaç: Laparoskpik cerrahisinin üroloji alanından yaygınlaşması ile üreteropelvik bileşke darlığı (ÜPBD) ve böbrek taşlarının tedavisinde laparoskopik pyeloplasti ve laparoskopik pyelolitotomi yaygın olarak kullanılmaktadır. İlave kaliks taşlarının çıkarılmasında bu yöntemlerle eş zamanlı olarak fleksible sistoskop kullanılabilmektedir. Biz çalışmamızda bu cerrahi prosedürlerin kullanılabilirliğini değerlendirdik.Gereç ve Yöntemler: Şubat 2016-Ekim 2017 tarihleri arasında 7 hastaya laparoskopik pyeloplasti ve laparoskopik pyelolitotomi esnasında fleksible sistoskop ile taş çıkarılması işlemi uygulandı. Hastaların operasyon süresi, kan kaybı, hastanede kalış süresi, peroperatif ve postoperatif komplikasyonlar ve takip süreleri değerlendirildi.Bulgular: 7 hastanın 5’inde UPBD ile birlikte böbrek taşları mevcuttu. 2 hastada ise renal pelvis taşına eşlik eden alt kaliks taşları mevcuttu. Hastaların ortalama yaşları 36.8 (18-73) idi. Taşsızlık oranı % 85,7 olarak hesaplandı. Ortalama operasyon süresi 153,5 (105-230) dakika olup, hastanede kalış süresi 4,4(3-7) gün idi. İntraopratif ve postoperatif herhangi bir komplikasyon gelişmedi.Sonuç: UPBD’na böbrek taşı eşlik eden hastalarda ve multipl böbrek taşı olan hastalarda laparoskopik pyeloplasti ve pyelolitotomi ile eş zamanlı fleksible sistoskop kullanımı yüksek başarı oranı ile kullanılabilir bir tedavi seçeneğidir., Objective: Laparoscopic pyeloplasty and laparoscopic pyelolithotomy are widely used in the treatment of ureteropelvic junction (UPJ) obstructions and renal stones in the urology field. Flexible cystoscopy can be used simultaneously with these methods for removal of calyceal stones in patients with UPJ obstructions. The present study assessed the usefulness of these surgical procedures .Material and Methods: Between February 2016 and October 2017, 7 patients underwent stone removal with a flexible cystoscope during laparoscopic pyelolithotomy and laparoscopic pyeloplasty. The durations of the operations and hospital stays, blood loss, preoperative and post- operative complications, and follow-up times were evaluated.Results: Five of seven patients had renal stones with UPJ obstruction. Two patients had calyceal stones in the lower calyx , in addition to renal pelvic stones. The mean age of the patients was 36.8 (18–73) years. The stone-free rate was 85.7%. The mean duration of the operation was 153.5 (105–230) min, and the duration of the hospital stay was 4.4 (3–7) days. There were no intraoperative or postoperative complications.Conclusion: Laparoscopic pyeloplasty and pyelolithotomy, with simultaneous use of flexible cystoscopy in UPJ obstruction patients with kidney stones and patients with multiple renal stones is a feasible treatment option, with a high success rate.

Objective: To describe and analyze our experience with secondary robot-assisted laparoscopic pyeloplasty (RALP) and conventional laparoscopic pyeloplasty (LP) in treating recurrent ureteropelvic junction obstruction (UPJO) after primary pyeloplasty. Methods: Patients who underwent secondary RALP or LP for recurrent UPJO were retrospectively analyzed. Baseline characteristics, detailed history of previous pyeloplasty, operative profile and follow-up data were collected and analyzed. Results: Among 29 patients presented with recurrent UPJO, 15 patients underwent secondary RALP. Both groups (RALP or LP) were comparable in baseline characteristics and detailed history of previous pyeloplasty. The mean operative time, suturing time, and hospitalization time of patients in RALP group were significantly less than those in LP group. The mean operative time of RALP group was 2.1 h, while the mean operative time of LP group was 3.23 h. The average suturing time of LP (62.43 min) is about 3 times that of RALP (21.47 min). The overall mean follow-up data was 23 months. The success rate of the RALP group and LP group was 87.7 and 85.7% respectively. Conclusion: Compared to LP, RALP may be a better choice for the treatment of recurrent UPJO. Further high-quality clinical studies are needed to confirm the superior nature of RALP.

Open Anderson-Hynes dismembered pyeloplasty was the criterion standard for ureteropelvic junction obstruction. Laparoscopic pyeloplasty was comparable to open pyeloplasty in success rates while laparoscopic pyeloplasty offered the advantages of decreased morbidity, shorter hospital stay, and quicker recovery. While laparoscopic pyeloplasty was accompanied with the slow learning curve due to technically demanding and time-consuming intracorporal suturing, which has limited its widespread use. Robotic pyeloplasty and laparoscopic pyeloplasty were comparable regarding complication rate, success rate and operative time.

Introduction: The widespread use of robotic surgery has provided surgeons a high-quality and alternative method to perform pyeloplasty. Indeed, robot-assisted technology has made it a lot easier to obtain the advanced technical skills required to perform this procedure. The learning curve (LC) reflects the increase in learning as a function of experience. Robot-assisted laparoscopic pyeloplasty (RALP) represents a well-standardized and reproducible procedure with an LC that allows reliable results to readily be obtained. The aim of our study was to compare the RALP LC of senior versus junior surgeons. Materials and Methods: We reviewed all of the RALP procedures performed at three pediatric surgery centers between November 2007 and November 2018. Three senior surgeons and 4 junior surgeons performed the robotic procedures. Neither the senior nor the junior surgeons had previous experience with robotic surgery; they had experience with conventional laparoscopic procedures but not with laparoscopic pyeloplasty. The primary metric that we selected to evaluate competence acquisition was a composite outcome defined by a combination of operative time (OT), complications, and surgical success. The complications were rated according to the Clavien-Dindo classification expressed by a complication factor; surgical success was expressed as a success factor, and we used a cumulative sum (CUSUM) analysis to determine the LC. The CUSUM method, through its multioutcome approach, is a very effective way to evaluate LCs. Results: Between November 2007 and November 2018, 3 senior surgeons and 4 junior surgeons performed 88 RALP procedures. The included patients had a median age of 6.1 years (range 7 months-16 years). The median duration of follow-up was 6.4 years (range 14 months-12 years). The median OT was 198.86 minutes (range 106-335 minutes). By CUSUM analysis of the composite outcome, we found that despite the junior surgeons having performed fewer procedures than the senior surgeons, their LCs exhibited an earlier inflection point (Fig. 1) followed by a constant rate of improvement in proficiency, thus indicating a more rapid learning process. The median composite scores for the senior surgeons and the junior surgeons were 299 (range 210-370) and 193 (range 131-255), respectively, after seven procedures. Conclusion: Assuming proper exposure to robotics and an adequate case volume, we demonstrated that junior surgeons can readily achieve comparable levels of expertise compared with senior practitioners in the field of pediatric RALP. It can be assumed that the LC in robotic pyeloplasty is not only directly influenced by the individual surgical experience but also by the experience of the surgical team.

Background：A drainage tube is generally retained after an abdominal surgery, especially in cases of postoperative bleeding or exudation. In recent years, negative pressure drainage or vacuum sealing drainage (VSD) has been extensively applied. However, the use of VSD in laparoscopic surgery is still challenging and has been rarely reported. Purpose: To introduce a novel Blake drain applied with negative pressure in laparoscopic surgeries. Materials/Methods: Two bar-shaped cuts were made at the end of the drainage tube, with one deeper than the other, and there were no other side holes retained. Thirty patients aged 4-8 years in novel drainage tube (NDT) group received the novel VSD after laparoscopic appendectomy or laparoscopic pyeloplasty, while those in the control traditional drainage tube (TDT) group received traditional drainage using the tube bearing side holes. Results：Tissue plugging and other complications were not observed in patients of NDT group. Significant differences were found in volume of drainage and cases of tissue plugging between NDT and TDT groups (PConclusions: The novel technique is simple, safe and effective for VSD following laparoscopic surgery. It can prevent plugging of soft tissues into the tube and improve drainage effect.

Objective: To present our primary experience of robotic-assisted laparoscopic pyeloplasty (RALP) for severe ureteropelvis junction obstruction (UPJO) infants under 3 months.Methods: We performed a retrospective study of 9 infants under 3 months who underwent RALP for severe UPJO between April 2017 and March 2019 in our center. The severe UPJO was defined as infants with severe hydronephrosis (Society of Fetal Urology grades III or IV, anteroposterior diameter >3 cm or split renal function 20 min) involving bilateral, solitary kidney, or contralateral renal hypoplasia UPJO at the same time. All clinical, perioperative, and postoperative information was collected.Results: There were four bilateral UPJO cases, two solitary kidney UPJO cases and three unilateral UPJO with contralateral renal hypoplasia cases included. One single surgeon performed RALP on all of the infants. The mean age of the infants was 1.62 ± 0.54 months. The mean operative time was 109.55 ± 10.47 min. The mean estimated blood loss was 19.29 ± 3.19 ml, and the mean length of hospital stay was 5.57 ± 0.73 days. According to the ultrasonography results, all patients had a significant recovery of renal function at 12 months after the operation.Conclusions: To maximize the protection of renal function, early RALP is a safe and feasible option for the treatment of severe UPJO in infants under 3 months.

Background The aim of this study was to evaluate the effectiveness and safety of real-time surgical navigation by three-dimensional (3D) virtual reconstruction models in robot-assisted laparoscopic pyeloplasty (RALP). Methods Between November 2018 and January 2020, 38 patients with ureteropelvic junction obstruction (UPJO) who underwent RALP were retrospectively enrolled. The operations were assisted in real time by 3D models in 16 patients, while 22 patients underwent surgery without navigation. Based on whether patients had a prior intervention history, crossing vessels or congenital deformities, we further divided them into the "complicated UPJO" cohort and the "regular UPJO" cohort for subgroup analysis. The demographic characteristics, intraoperative parameters, perioperative data and follow-up data were recorded and compared between the groups. Results All of the procedures were successfully performed without open or laparoscopic conversion. The mean dissection time to the UPJ was shorter in the navigation group than in the non-navigation group, both in the whole cohort (15.3 vs. 24.8 min, P=0.011) and in the complicated cohort (15.4 vs. 27.5 min, P=0.004), while there was no significant difference in the regular cohort. The overall operative time and estimated blood loss in the navigation group tended to be less, although the difference was not statistically significant. No difference in anastomosis time, postoperative hospital stay or complications was noted between the two groups in either cohort. At a mean follow-up of 11.2 months, the overall success rate was 94.7% (36/38), and there was no significant difference between the two groups. Conclusions Real-time navigation by 3D virtual reconstruction models might be helpful to improve surgical efficiency and safety of RALP by facilitating the dissection around the UPJ, especially for cases of complicated UPJO. However, the prospective study with larger sample size is further needed to confirm the results.