Patch grafting the renal pelvis and ureteropelvic junction

Summary Lyophilized dura mater (Lyodura) and autogenous free peritoneum were compared in the replacement of the partially resected renal pelvis and ureteropelvic junction (UPJ) in the pig. The Lyodura and peritoneum grafts were both progressively resorbed, and replaced by fibroblasts which formed a mature scar lined by transitional epithelium, but without smooth muscle regeneration. Lyodura was found to be superior to free peritoneum with a longer time before resorption of the graft, less intense inflammatory reaction, absence of metaplastic bone formation, less risk of urine leak and greater ease of surgical manipulation.Supported by the University Urological Research Foundation     

Decompensated ureteropelvic junction obstruction in renal allograft

We report a case of complete obstruction at the ureteropelvic junction in a renal allograft 6 months after related kidney transplantation. Surgical treatment consisted of a Foley nondismembered Y-V pyeloplasty. Although the donor harbored undetected bilateral, mild, ureteropelvic junction stenosis, as established by review of the excretory urogram that was performed before nephrectomy, the remaining kidney functioned well, as confirmed by renal function and morphological appearance on a repeat excretory urogram. The possible mechanisms of ureteropelvic junction decompensation, the most crucial of which appears to be autonomic denervation of the allograft, are discussed.     

Thickness of the renal pelvis smooth muscle indicates the postoperative course of ureteropelvic junction obstruction treatment

ObjetiveTo investigate the relationship between the histopathologic findings and the postoperative course of children surgically treated for ureteropelvic junction (UPJ) obstruction.Material and methodsTwenty-eight patients operated for unilateral UPJ obstruction from 1998 to 2005 with adequate histopathologic specimens and postoperative follow up were retrospectively reviewed. Specimens were stained using elastic van Geisson to differentiate smooth muscle from collagen and elastin. Postoperative follow up included renal ultrasound (U/S) and diuretic renogram studies.ResultsTwelve patients with mean renal pelvis smooth muscle thickness (mRPSMT) of 136.97 ± 34.17 improved on the 6^th postoperative month. Nine patients that improved after 9 months postoperatively had mRPSMT=173.61 ± 33.91. The rest 7 patients that improved on the 12^th postoperative month had mRPSMT=258.78 ± 96.09. Correlation between renal pelvis smooth muscle and time of postoperative improvement was extremely significant (r = 0.7928, p < 0.0001).ConclusionThe thickness of the renal pelvis smooth muscle is significantly correlated to the postoperative course of patients with UPJ obstruction and can be used as a prognostic tool for the onset of their improvement.     

Innocent aberrant renal vessels producing ureteropelvic junction obstruction

Hydronephrosis caused by a triad of weight loss, renal ptosis, and the presence of lower pole aberrant renal vessels in two adults, with review of literature and surgical approach to this problem, is discussed.     

Trifid pelvis and controlateral bifid ureter with bilateral ureteropelvic junction obstruction

A 20-month-old boy with a trifid pelvis and ureteropelvic junction obstruction on one side and incomplete duplication of the ureter with ureteropelvic junction obstruction on the lower pole of the other kidney is described.     

肾盂输尿管连接部梗阻的微创外科治疗进展

肾盂输尿管连接部梗阻(ureteropeivic junetion obstruction.UPJO)是导致肾积水的主要原因之一.以Anderson-Hynes肾盂成形术为代表的离断性肾盂成形术由于切除了病变的UPJ,同时尽量修剪扩大的肾盂,克服了连续性术式的缺点,成为了治疗UPJO的"金标准",近20多年来随着腔内技术和腹腔镜技术的发展,UPJO有以开放手术为主的传统治疗转向微创技术为主的趋势,特别是泌尿外科领域腹腔镜技术及其器械的成熟与改进,经验操作技巧的不断提高,腹腔镜肾盂成形术手术的成功率和远期效率与开放手术相当,而手术创伤明显小于开放手术,患者痛苦少,住院时间短,恢复体力劳动快.已被人们所接受.腹腔镜肾盂成形术,将逐渐代替传统的开放肾盂成形术.     

肾盂输尿管连接部梗阻的微创外科治疗进展

肾盂输尿管连接部梗阻(ureteropeivic junetion obstruction.UPJO)是导致肾积水的主要原因之一.以Anderson-Hynes肾盂成形术为代表的离断性肾盂成形术由于切除了病变的UPJ,同时尽量修剪扩大的肾盂,克服了连续性术式的缺点,成为了治疗UPJO的"金标准",近20多年来随着腔内技术和腹腔镜技术的发展,UPJO有以开放手术为主的传统治疗转向微创技术为主的趋势,特别是泌尿外科领域腹腔镜技术及其器械的成熟与改进,经验操作技巧的不断提高,腹腔镜肾盂成形术手术的成功率和远期效率与开放手术相当,而手术创伤明显小于开放手术,患者痛苦少,住院时间短,恢复体力劳动快.已被人们所接受.腹腔镜肾盂成形术,将逐渐代替传统的开放肾盂成形术.     

Results of surgical reconstruction in patients with renal failure owing to ureteropelvic junction obstruction

During the last 6 years we managed 20 patients with renal failure owing to bilateral ureteropelvic junction obstruction (12) or ipsilateral ureteropelvic junction obstruction with contralateral renal agenesis, hypoplasia or dysplasia (8). Of the patients 11 underwent emergency dialysis for hyperkalemia, fluid overload or metabolic acidosis. Mean serum creatinine at presentation was 6.5 mg. per cent. Preliminary decompression of the obstructed kidney was done in 14 patients (20 renal units) with a serum creatinine of more than 3 mg. per cent at presentation. Reconstruction was done in all patients (31 of 36 renal units) after decompression and control of infection. Pyeloplasty was done in 24 renal units, vesicopyelostomy in 3 pelvic kidneys and calicoureteroplasty in 2 renal units with an intrarenal pelvis. Two renal units were removed. All patients showed improvement in renal function and the mean postoperative serum creatinine value was 2.05 mg. per cent. The postoperative serum creatinine value showed a significant positive correlation with the initial value as well as with the initial blood urea levels. However, the postoperative serum creatinine value showed no correlation with patient age, duration of symptoms, serum creatinine level after preliminary nephrostomy and presence or absence of urinary infection. Postoperative recovery (on the basis of postoperative serum creatinine levels) in patients who had bilateral ureteropelvic junction obstruction was not different from those with a solitary functioning kidney and ureteropelvic junction obstruction.     

肾盂输尿管连接部梗阻的微创外科治疗进展

肾盂输尿管连接部梗阻(ureteropeivic junetion obstruction.UPJO)是导致肾积水的主要原因之一.以Anderson-Hynes肾盂成形术为代表的离断性肾盂成形术由于切除了病变的UPJ,同时尽量修剪扩大的肾盂,克服了连续性术式的缺点,成为了治疗UPJO的"金标准",近20多年来随着腔内技术和腹腔镜技术的发展,UPJO有以开放手术为主的传统治疗转向微创技术为主的趋势,特别是泌尿外科领域腹腔镜技术及其器械的成熟与改进,经验操作技巧的不断提高,腹腔镜肾盂成形术手术的成功率和远期效率与开放手术相当,而手术创伤明显小于开放手术,患者痛苦少,住院时间短,恢复体力劳动快.已被人们所接受.腹腔镜肾盂成形术,将逐渐代替传统的开放肾盂成形术.     

Radiologic evaluations affecting surgical technique in ureteropelvic junction obstruction

Ureteropelvic junction obstructions can be explored by radiographic methods including ultrasonography, intravenous pyelography, radionuclide scanning, magnetic resonance imaging and computerized tomography. The decision to operate on an ureteropelvic stricture is best given by the results of a radionuclide scan, which can demonstrate the obstruction. The operative technique is influenced by the presence of a polar artery, as this presence represents a danger when endopyelotomy is performed. The presence of a polar artery may be demonstrated by computerized tomography using helicoidal reconstruction. Magnetic resonance imaging with injection of gadolinium is also useful when available. The outcome and the results of the surgical procedure are also evaluated by radionuclide scanning.     

Lower pole ureteropelvic junction obstruction and incomplete renal duplication

The rare finding of lower pole ureteropelvic junction obstruction and incomplete renal duplication is discussed in 5 children. The children were divided into 2 groups, with short (less than 0.5 cm.) and long (greater than 4 cm.) lower ureteral segments. Short ureteral segment obstruction was managed by total excision of the narrow ureteral segment and end-to-side pyeloureterostomy. Obstructions associated with long lower ureteral segments were treated by excising the ureteropelvic junction and performing a standard Anderson-Hynes pyeloplasty. A thorough preoperative evaluation is helpful for successful management.     

Percutaneous endopyelopyelotomy: endourological management of a bifid pelvis with ureteropelvic junction obstruction

A patient with a bifid renal pelvis and a severely stenotic ureteropelvic junction was managed successfully by creating a fistula between the 2 renal pelves with a direct vision urethrotome, and intubating the fistula with a circle tube and a universal stent for 6 weeks. This endourological procedure spared this obese diabetic patient from an open operation.     

肾盂输尿管交界部功能性梗阻

自１９８５～１９９１年间共收治先天性肾盂输尿管交界部（ＵＰＪ）功能性梗阻患者３７例，病理检查而确诊，均经手术治疗。其中近期７例手术标本作了电镜检查，结果证实本病的病因为ＵＰＪ处平滑肌细胞之间有大量胶原纤维组织堆积，平滑肌细胞本身发育不良所致传导功能障碍。治疗应尽量切除病变的ＵＰＪ组织。     

Contemporary trends in surgical correction of pediatric ureteropelvic junction obstruction: data from the nationwide inpatient sample

PURPOSE: The presentation and diagnosis of ureteropelvic junction obstruction have changed in the last 20 years. We describe trends in pediatric surgical correction of ureteropelvic junction obstruction between 1988 and 2000. MATERIALS AND METHODS: The Nationwide Inpatient Sample contains data on approximately 5 million to 7 million hospital inpatient stays per year, approximating a 20% sample of United States hospitals. We used International Classification of Disease-9 codes to identify pediatric pyeloplasty cases, and analyzed the data for practice patterns. RESULTS: A total of 5,858 pediatric patients (mean age 62.8 months) underwent pyeloplasty. Males comprised 70.7% of the sample, and tended to undergo surgery at a younger age (60.1 vs 69.4 months, p <0.0001). The proportion of procedures done during the first 6 months of life decreased from 34.2% (1988 to 1991) to 25.2% (1997 to 2000, p <0.0001). Nonwhites underwent surgery in the first 6 months more often than whites (38.9% vs 25.0%, p <0.0001) and had a lower mean age at surgery (44.4 vs 70.7 months, p <0.0001). The percentage of procedures done at urban teaching hospitals increased from 48.9% (1988 to 1991) to 61.3% (1997 to 2000, p <0.0001). Length of stay decreased significantly from 6.7 days (1988 to 1991) to 3.7 days (1997 to 2000, p <0.0001). CONCLUSIONS: Practice patterns in pediatric pyeloplasty evolved between 1988 and 2000. Fewer procedures are being performed in newborns, suggesting that patients with prenatal hydronephrosis are increasingly being observed instead of undergoing early surgery. There was a substantial difference in timing of surgery between whites and nonwhites. To our knowledge this observation has not previously been reported. More procedures are being performed at teaching hospitals, and length of stay has decreased significantly.     

经皮肾镜内切开术联合碎石术治疗UPJO并肾结石25例报告

目的:观察经皮肾镜内切开术联合碎石取石术治疗UPJO并肾结石的可行性、疗效及临床应用价值。方法:对25例UPJO并肾结石的患者采用经皮肾镜肾盂内切开术加碎石取石术进行治疗。结果:平均手术时间80min,术中出血量100～500ml,平均住院11.2d。23例患者一次完成手术,2例行Ⅱ期手术处理残石。其中单通道治疗19例,双通道治疗6例,清石率为88%。无大出血等严重并发症发生。随访6个月～3年,UPJO有效率为92%,2例患者术后出现再狭窄,两次内切开无效后改为开放性离断肾盂成形术。结论:经皮肾镜肾盂内切开术联合碎石取石术创伤小,恢复快,疗效确切,是一种治疗UPJO并肾结石的有效方法。     

腹腔镜手术治疗肾盂输尿管连接部狭窄19例

目的 评价腹腔镜手术治疗肾盂输尿管连接部狭窄（ureteropelvic junctiono bstruction，UPJO）的疗效。方法 采用经腹路径对19例UPJO行离断式。肾盂输尿管成形术。打开侧腹膜，以。肾下极为标志游离出。肾盂输尿管连接部，切除狭窄部分，端端吻合肾盂输尿管并留置双J管。结果 19例手术全部成功，手术时间110～240min，平均150min。术中出血量50～100ml，平均80ml，无严重并发症发生。术后住院6～10d，平均7．8d。19例随访3～15个月，平均6个月，14例静脉尿路造影（intrarenous urography，IVU）无吻合口狭窄。结论 腹腔镜下离断式肾盂输尿管成形术治疗UPJO有效、可行，可以替代开放手术。     

Non-invasive markers of ureteropelvic junction obstruction

Non-invasive prognosis of the clinical progression of disease is of high interest, especially in newborn and children. Neonatal ureteropelvic (UPJ) junction obstruction needs close and invasive surveillance to determine the necessity of pyeloplasty. A number of groups have initiated research with the aim to find non-invasive biomarkers for UPJ obstruction. Two different strategies have been followed. One strategy, based on the knowledge obtained in animal models of UPJ obstruction, has identified a number of individual urinary markers of severe UPJ obstruction. Combining these markers might allow prediction of which patients will require surgery and in which patients UPJ obstruction will spontaneously resolve. The other strategy is based on urinary proteomics. In this strategy the entire urinary proteome is probed for a set of biomarkers that correlates with the degree of UPJ obstruction. In subsequent steps, these sets of urinary biomarkers are used for prediction of the clinical evolution of UPJ obstruction patients. This proteomic-based strategy allowed prediction, several months in advance, of the clinical evolution of neonates with UPJ-obstruction. Both strategies will be complementary and will hopefully replace in the near future the invasive follow-up of newborns with UPJ obstruction.