Minimally Invasive Approaches to Ureteropelvic Junction Obstruction
- VernacularTitle:Тэвш шээлгүүрийн хэсгийн нарийслыг бага хүрцэт мэс заслаар эмчлэх эмчилгээний асуудалд
- Author:
Ganbold G
1
;
Bayan-Undur D
1
;
Nyamsuren D
1
;
Baasanjav N
2
Author Information
1. First Clinical Hospital, Mongolia
2. Ach Medical University
- Publication Type:Review
- Keywords:
Endourological techniques;
open pyeloplasty;
ureteropelvic junction obstruction;
laparoscopic pyeloplasty
- From:Mongolian Medical Sciences
2019;190(4):52-59
- CountryMongolia
- Language:Mongolian
-
Abstract:
There are many treatment options for the management of ureteropelvic junction obstruction (UPJO).
Open pyeloplasty has a high success rate and has been considered as a gold standard. Minimally
invasive surgical techniques are associated with reduced morbidity, improved cosmetic result and
better convalescence than open pyeloplasty. For endopyelotomy, these advantages for minimally
invasive surgery such as laparoscopic pyeloplasty and robot assisted pyeloplasty have superior
success rate than open pyeloplasty. However, the success rate for laparoscopic surgery could
potentially be improved by careful selection of patients, using the criteria of stricture <2 cm, renal
function >25% and the absence of severe hydronephrosis. Laparoscopic pyeloplasty and robot-assisted pyeloplasty have similar success rates to open pyeloplasty (>90%) and the best outcomes
have been reported for robot-assisted pyeloplasty although this treatment option is less readily
available than laparoscopic pyeloplasty. Retrograde endopyelotomy is a simple, safe, and effective
therapeutic option for primary and secondary symptomatic UPJO.
Retrograde endopyelotomy should be considered a viable first-line treatment option for the
management of patients with UPJO. These include balloon dilation, antegrade endopyelotomy,
retrograde endopyelotomy, Acucise endopyelotomy and laparoscopic pyeloplasty. During last decade,
advances in endourological techniques have resulted in significant progress in the development of
minimally invasive surgical procedures to treat UPJO.
Surgeons described their modification of Kusters dismembered procedure that involved anastomosis
of the spatulated ureter to a projection of the lower aspect of the pelvis after a redundant portion
was excised. Laparoscopic pyeloplasty was first reported in 1993 both by Schuessler and others
and by Kavoussi and Peters, who utilized dismembered pyeloplasty technique. During last decade,
advances in endourological techniques have resulted in significant progress in the development
of minimally invasive surgical procedures to treat UPJO. The combination of less postoperative
morbidity, improved cosmesis, shorter convalescence and comparable operative success rates has
lured many patients away from gold standard of open pyeloplasty. Only few retrospective studies have
been conducted regarding laparoscopic versus open pyeloplasty. Success rates are comparable for
laparoscopic pyeloplasty.
The number of minimally invasive surgeries performed by us increased from year to year. Therefore
the characteristics and performance of the surgeries should be studied in detail and based on the
finding the evidence based medicine should be placed in.
- Full text:2019-190(4)-52-59.pdf
