Uretero-Pelvic Junction Obstruction (UPJO) Treatment Using: One-Trocar-Assisted Pyeloplasty (OTAP)

Abstract

Since its ideation in 1949, the Anderson–Hynes dismembered pyeloplasty has remained the most adopted technique for the correction of uretero-pelvic junction obstruction in children. During the past decades, many successful attempts have been made to complete such procedure in a minimally invasive way, at first with a transperitoneal approach, and then with a retroperitoneoscopic one.

Due to our increasing experience in one-trocar video-assisted procedures, in 2005, we attempted a new technique, the One-Trocar-Assisted Pyeloplasty (OTAP). Since then, OTAP has become the mainstay surgical treatment for UPJO at our Centre, and has also been adopted by several paediatric surgical units in Italy.

This procedure consists of isolating the UPJ thanks to a retroperitoneoscopic one-trocar approach and exteriorizing the UPJ through the lumbar incision in order to perform an open dismembered pyeloplasty. The main complications are stenosis of the anastomosis, urinary leakage and opening of the peritoneum, which may require the conversion to an open standard approach. The patients are then followed-up by ultrasound at 3, 6, 12 months and then yearly.

At our Centre, we have treated very young patients affected by severe forms of hydronephrosis, for which an early surgical correction can be advantageous. As a matter of fact, we demonstrated feasibility, in terms of efficacy and safety, of OTAP in the first 90 days of life in a case series of 23 patients.