Abstract
Introduction
Anderson–Hynes pyeloplasty is the technique of choice for the treatment of pyeloureteral junction obstruction (PUJO) with an excellent success rate. Minimally invasive surgery has become the standard of care for the management of PUJO in children. Although it has been comparable to the open approach at all levels, its diffusion or employment in younger children has not been widely adopted. Our aim is to evaluate laparoscopic pyeloplasty outcomes from international academic centers in children under 1 year of age, focusing on feasibility and outcomes including possible complications.
Materials and methods
This is review of consecutive infants under 1 year of age who underwent laparoscopic pyeloplasty between 2009 and 2018 with more than 12 months of follow-up. Seven different training centers with different backgrounds participated in this study. Evaluation was carried out with ultrasound and renogram before and after surgery. Demographic data, perioperative characteristics, complications, and results are described and analyzed.
Results
Over 9 years, 124 transperitoneal laparoscopic Anderson–Hynes pyeloplasties were performed on 123 children under 1 year of age; 88 males and 35 females, with 1 case of bilateral PUJO. Of the 124 renal units, 86 were left-sided. Mean age at surgery was 6.6 months (1 week–12 months), with 56% (n = 70) done before 6 months of age. Mean weight at surgery was 6.8 kg (3–12 kg), with 59% (n = 73) weighing less than 8 kg. Mean operative time (skin-to-skin) was 150 min (75–330 min). After a mean follow-up of 46 months (12–84 months), 12 (9%) patients developed complications, with only 1 needing a redo pyeloplasty also done laparoscopically. One child, with deterioration in renal function, underwent nephrectomy.
Conclusion
Laparoscopic pyeloplasty under 1 year of age and/or less than 12 kilos is feasible with lower complication rate. Furthermore, age younger than 6 months and weight less than 8 kg are no longer limiting factors for a successful pyeloplasty as shown by this multicentre study.
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References
Tubre R, Gatti J (2015) Surgical approaches to pediatric ureteropelvic junction obstruction. Curr Urol Rep 16:72
Peters C, Schlussel R, Retik A (1995) Pediatric laparoscopic dis-membered pyeloplasty. J Urol 153:1962
Piaggio LA, Franc-Guimond J, Noh PH, Wehry M, Figueroa TE, Barthold J et al (2007) Transperitoneal laparoscopic pyeloplasty for primary repair of ureteropelvic junction obstruction in infants and children: comparison with open surgery. J Urol 178(4 Pt 2):1579–1583
Kutikov A, Resnick M, Casale P (2006) Laparoscopic pyeloplasty in the infant younger than 6 months—is it technically possible? J Urol 175:1477
Cascio S, Tien A, Chee W, Tan HL (2007) Laparoscopic dismembered pyeloplasty in children younger than 2 years. J Urol 177:335–338. https://doi.org/10.1016/j.juro.2006.08.145
Nguyen HT, Hendron CD, Cooper C, Gatti J, Kirsch A, Kokorowski P et al (2010) “The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 6:212–231
Nguyen HT, Benson C, Bromley B, Campbell J, Chow J, Coleman B, Cooper C, Crino J, Darge K, Hendro CD, Odibo A, Somers M, Stein D (2014) Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol 10:982–999
Taylor A, Ziffer J (1995) Urinary tract. In: Early P, Sodee B (eds) Principles and practice of nuclear medicine, 2nd edn. Year Book, Inc., Mosby, pp 579–616 (Chapter 23)
Reed F and López PJ (2014) Laparoscopic Pyeloplasty. Pediatric Endourology Techniques, Second Edition. Chapter 7:67–75
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Li P, Zhou H et al (2021) Early robotic-assisted laparoscopic pyeloplasty for infants under 3 months with severe ureteropelvic junction obstruction. Front Pediatr 9:590865. https://doi.org/10.3389/fped.2021.590865
Tan HL (1999) Laparoscopic Anderson-Hynes dismembered pyeloplasty in children. J Urol 162:1045–1047. https://doi.org/10.1016/S0022-534768060-1
Chou CM, Yeh CM, Huang SY, Chen HC (2016) Perioperative parameter analysis of neonates and infants receiving laparoscopic surgery. J Chin Med Assoc 79:559–564. https://doi.org/10.1016/j.jcma.2016.05.005
Passoni N, Peters C (2020) Managing Ureteropelvic Junction Obstruction in the young infant. Front Pediatr 8:242. https://doi.org/10.3389/fped.2020.00242
Silay MS, Spinoit AF, Undre S, Fiala V, Tandogdu Z, Garmanova T et al (2016) Global minimally invasive pyeloplasty study in children: results from the pediatric urology expert group of the european association of urology young academic urologists working party. J Pediatr Urol 12(229):e1-7. https://doi.org/10.1016/j.jpurol.2016.04.007
Sukumar S, Djahangirian O, Sood A, Sammon JD, Varda B, Janosek-Albright K et al (2014) Minimally invasive vs. open pyeloplasty in children: the differential effect of procedure volume on operative outcomes. Urology 84:180–184. https://doi.org/10.1016/j.urology.2014.02.002
Garcia-Aparicio L, Blazquez-Gomez E, Martin O, Manzanares A, Garcia-Smith N, Bejarano M et al (2014) Anderson-hynes pyeloplasty in patients less than 12 months old. Is the laparoscopic approach safe and feasible? J Endourol 28:906–908. https://doi.org/10.1089/end.2013.0704
Rague JT et al (2021) Robot-assisted laparoscopic urologic surgery in infants weighing ≤10 kg: a weight stratified analysis. J Pediatr Urol 17(6):857.e1-857.e7
Zamfir Snykers C et al (2019) Is de laparoscopic Pyeloplasty fou UPJ obstruction in infants under 1 year of age a good option? Front Pediatr 7:352. https://doi.org/10.3389/fped.2019.00352
Mei H et al (2011) Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and meta-analysis. J Endourol 25(5):727–736
Andolfi C, Lombardo AM, Aizen J et al (2022) Laparoscopic and robotic pyeloplasty as minimally invasive alternatives to the open approach for the treatment of uretero-pelvic junction obstruction in infants: a multi-institutional comparison of outcomes and learning curves. World J Urol 40:1049–1056. https://doi.org/10.1007/s00345-022-03929-0
Gatti JM, Amstutz SP, Bowlin PR, Stephany HA, Murphy JP (2017) Laparoscopic vs open pyeloplasty in children: results of a randomized, prospective. Controlled Trial J Urol 197(3 Pt 1):792–797
Rickard M, Braga LH, Oliveria JP, Romao R, Demaria J, Lorenzo AJ (2016) Percent improvement in renal pelvis antero-posterior diameter (PI-APD): prospective validation and further exploration of cut-off values that predict success after pediatric pyeloplasty supporting safe monitoring with ultrasound alone. J Pediatr Urol 12(4):228. https://doi.org/10.1016/j.jpurol.2016.04.003
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Reed, F., Recabal, X., Echeverría, P. et al. Are weight or age limits for pediatric laparoscopic pyeloplasty? Results of a multicentric study. World J Urol 41, 1675–1679 (2023). https://doi.org/10.1007/s00345-023-04359-2
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DOI: https://doi.org/10.1007/s00345-023-04359-2