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Stentless laparoscopic pyeloplasty: A single center experience.

Khawaja AR, Dar TI, Bashir F, Sharma A, Tyagi V, Bazaz MS - Urol Ann (2014)

Bottom Line: Average post operative DRF was significantly higher than preoperative DRF in both the groups.However bothersome irritative lower urinary tract symptoms (LUTS) and hematuria were significantly more in group B patients (P < 0.0001 and <0.013 respectively).It is cost effective, avoids stent-related morbidity, and could be performed without compromising the success rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Sir Ganga Ram Hospital, New Delhi, India.

ABSTRACT

Aim: To assess the effectiveness of laparoscopic stentless pyeloplasty for congenital ureteropelvic junction obstruction.

Materials and methods: This was a prospective comparative study conducted over a period of 5 years. The study included 35 cases of primary ureteropelvic junction obstruction (UPJO) with mean age of 29.5 years, divided in two groups- Group A (stent-less, 18 patients) and Group B (stented, 17 patients). Follow up ranged from one to 4years (mean 2 years). Transperitoneal laparoscopic Anderson- Hyene's pyeloplasty was standard for both the groups. Perioperative and postoperative complications were prospectively collected and analyzed by Statistical Package for Social Sciences (SPSS) 17 version using Pearson chi square test.

Results: Both the groups were comparable with respect to preoperative differential renal function (DRF) and time required for maximum activity in minutes (tmax.min). Average post operative DRF was significantly higher than preoperative DRF in both the groups. Average tmax was significantly lower after pyeloplasty than pre operative tmax. Mean operative time, mean duration of urethral catheter, and mean duration of drain removal were comparable in both the groups. However bothersome irritative lower urinary tract symptoms (LUTS) and hematuria were significantly more in group B patients (P < 0.0001 and <0.013 respectively).

Conclusion: In experienced hands, laparoscopic stentless pyeloplasty is as effective method for treating UPJO as its stented counterpart. It is cost effective, avoids stent-related morbidity, and could be performed without compromising the success rate. However, more randomized studies are needed to evaluate the safety of stentless pyeloplasty.

No MeSH data available.


Related in: MedlinePlus

Bar diagram showing comparison of complications between the two groups
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Figure 2: Bar diagram showing comparison of complications between the two groups

Mentions: Likewise, average tmax was significantly lower than tmax pre operatively in both the groups. In all patients diuretic renogram at 3 month interval after surgery showed significantly improved function as compared to preoperative function (P value < 0.0001) [Table 4, Figure 1], similar to that of stented pyeloplasty. However there was no significant difference in tmax and DRF between the two groups after pyeloplasty [Table 5, Figure 2]. There was no statistically significant difference between the two groups post operatively with respect to renal function improvement, complications like urinoma formation, urinary tract infection (UTI), prolonged drainage, fever and flank pain. However bothersome irritative LUTS and hematuria were significantly more in group B patients (P < 0.0001 and <0.013 respectively [Table 3, Figure 1].


Stentless laparoscopic pyeloplasty: A single center experience.

Khawaja AR, Dar TI, Bashir F, Sharma A, Tyagi V, Bazaz MS - Urol Ann (2014)

Bar diagram showing comparison of complications between the two groups
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127855&req=5

Figure 2: Bar diagram showing comparison of complications between the two groups
Mentions: Likewise, average tmax was significantly lower than tmax pre operatively in both the groups. In all patients diuretic renogram at 3 month interval after surgery showed significantly improved function as compared to preoperative function (P value < 0.0001) [Table 4, Figure 1], similar to that of stented pyeloplasty. However there was no significant difference in tmax and DRF between the two groups after pyeloplasty [Table 5, Figure 2]. There was no statistically significant difference between the two groups post operatively with respect to renal function improvement, complications like urinoma formation, urinary tract infection (UTI), prolonged drainage, fever and flank pain. However bothersome irritative LUTS and hematuria were significantly more in group B patients (P < 0.0001 and <0.013 respectively [Table 3, Figure 1].

Bottom Line: Average post operative DRF was significantly higher than preoperative DRF in both the groups.However bothersome irritative lower urinary tract symptoms (LUTS) and hematuria were significantly more in group B patients (P < 0.0001 and <0.013 respectively).It is cost effective, avoids stent-related morbidity, and could be performed without compromising the success rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Sir Ganga Ram Hospital, New Delhi, India.

ABSTRACT

Aim: To assess the effectiveness of laparoscopic stentless pyeloplasty for congenital ureteropelvic junction obstruction.

Materials and methods: This was a prospective comparative study conducted over a period of 5 years. The study included 35 cases of primary ureteropelvic junction obstruction (UPJO) with mean age of 29.5 years, divided in two groups- Group A (stent-less, 18 patients) and Group B (stented, 17 patients). Follow up ranged from one to 4years (mean 2 years). Transperitoneal laparoscopic Anderson- Hyene's pyeloplasty was standard for both the groups. Perioperative and postoperative complications were prospectively collected and analyzed by Statistical Package for Social Sciences (SPSS) 17 version using Pearson chi square test.

Results: Both the groups were comparable with respect to preoperative differential renal function (DRF) and time required for maximum activity in minutes (tmax.min). Average post operative DRF was significantly higher than preoperative DRF in both the groups. Average tmax was significantly lower after pyeloplasty than pre operative tmax. Mean operative time, mean duration of urethral catheter, and mean duration of drain removal were comparable in both the groups. However bothersome irritative lower urinary tract symptoms (LUTS) and hematuria were significantly more in group B patients (P < 0.0001 and <0.013 respectively).

Conclusion: In experienced hands, laparoscopic stentless pyeloplasty is as effective method for treating UPJO as its stented counterpart. It is cost effective, avoids stent-related morbidity, and could be performed without compromising the success rate. However, more randomized studies are needed to evaluate the safety of stentless pyeloplasty.

No MeSH data available.


Related in: MedlinePlus