Modified Laparoscopic and Robotic Flap Pyeloplasty for Recurrent Ureteropelvic Junction Obstruction with a Long Proximal Ureteral Stricture: The “Wishbone” Anastomosis and the “Ureteral Plate” Technique
- 10 February 2021
- journal article
- research article
- Published by S. Karger AG in Urologia Internationalis
- Vol. 105 (7-8), 642-649
- https://doi.org/10.1159/000512994
Abstract
Objectives: The aim of the study was to present our modified flap pyeloplasty techniques for recurrent ureteropelvic junction obstruction (UPJO) with a long proximal ureteral stricture and compare outcomes of laparoscopic and robotic procedures. Materials and Methods: Between March 2018 and January 2020, 21 patients underwent modified laparoscopic or robotic flap pyeloplasty for recurrent UPJO with a long proximal ureteral stricture. Our surgical modifications included the “wishbone” anastomosis and “ureteral plate” technique. Demographic, perioperative, and follow-up data were recorded and compared retrospectively between the groups. Success was defined as subjective pain alleviation and hydronephrosis improvement. Results: Thirteen modified laparoscopic flap pyeloplasty (mLFP) and 8 modified robotic flap pyeloplasty (mRFP) were performed successfully without conversion. mRFP tended to have shorter overall operative time (142.4 vs. 179.1 min, p = 0.122) and anastomosis time (43.1 vs. 61.0 min, p = 0.093) than mLFP. No difference was found in estimated blood loss (p = 0.723) and pararenal draining time (p = 0.175) between the groups. The mean postoperative hospital stay of mRFP was significantly shorter than that of mLFP (5.0 vs. 8.2 days, p = 0.015). No major complications occurred. During the mean follow-up of 17.9 months, the overall success rate was 90.5%, and there was no significant difference between 2 groups. Conclusions: The modified flap pyeloplasty could be considered a practical and effective treatment option with a high success rate for recurrent UPJO with a long proximal ureteral stricture, and the robotic procedures showed advantages of higher efficiency and faster recovery.Keywords
This publication has 35 references indexed in Scilit:
- Analysis of Robotic-assisted Laparoscopic Pyleloplasty for Primary Versus Secondary Repair in 119 Consecutive CasesUrology, 2012
- Laparoscopic Pyeloplasty: Our New Gold StandardJournal of Endourology, 2009
- Case Report: Laparoscopic Ureteral Reconstruction with Pelvic Flap in Ureteropelvic Junction Obstruction of Ectopic Left KidneyJournal of Endourology, 2007
- Salvage Laparoscopic Pyeloplasty in the Worst Case Scenario: After Both Failed Open Repair and Endoscopic SalvageJournal of Endourology, 2006
- Open Dismembered Tubularized Flap Pyeloplasty: An Effective and Simple Operation for Treatment of Ureteropelvic Junction ObstructionUrologia Internationalis, 2006
- MANAGEMENT OF THE FAILED PYELOPLASTY: A CONTEMPORARY REVIEWJournal of Urology, 2005
- Laparoscopic Pyeloplasty for Secondary Ureteropelvic Junction ObstructionJournal of Urology, 2003
- LAPAROSCOPIC DISMEMBERED TUBULARIZED FLAP PYELOPLASTY:Journal of Urology, 2002
- ENDOPYELOTOMY AFTER FAILED PYELOPLASTYJournal of Urology, 1998
- VERTICAL FLAP URETEROPELVIOPLASTYSouthern Medical Journal, 1953