How successful is the conservative management of pelvi‐ureteric junction obstruction in adults?

OBJECTIVE

To assess the conservative management of pelvi‐ureteric junction obstruction (PUJO), according to severity, accepted in paediatric urology but rarely reported in adults.

PATIENTS AND METHODS

A series of 23 patients (median age 58 years, 17 men and six women) with asymptomatic or minimally symptomatic PUJO were managed conservatively. The patients’ age, preference and comorbidities were considered. The diagnosis of PUJO was based on intravenous urography and isotopic renography. After stringently reviewing the renograms based on relative renal function (RRF) and output efficiency (OE), 15 patients had an OE consistent with definitive PUJO. One patient had no further imaging due to associated comorbidities. Ten patients had right PUJO, three left and one with bilateral PUJO, with unilateral conservative management. The follow‐up included annual renography and clinical consultation. Laparoscopic pyeloplasty was considered for patients with a >10% loss of RRF and/or <40% RRF during the follow‐up.

RESULTS

Overall, 14 of 15 patients had renograms during the follow‐up. The mean RRF of the affected kidney at diagnosis was 48.6% which marginally decreased to 46.7% after a median (range) follow‐up of 44 (23–75) months. The RRF of 11 patients remained stable and in three decreased significantly (median 11% RRF), requiring pyeloplasty. None of the patients became symptomatic throughout the follow‐up.

CONCLUSION

In asymptomatic adults the conservative management of PUJO appears to be safe during a short‐ to medium‐term follow‐up. We recommend that patients are regularly followed with renography and seen promptly should they become symptomatic. A longer follow‐up is needed in a larger group to confirm these findings.     

Critical analysis of pyeloplasty role in adults with late diagnosis of ureteropelvic junction obstruction—a comparative study

International Urology and Nephrology - Due to the data paucity about the&nbsp;functional outcomes post pyeloplasty for patients diagnosed with ureteropelvic junction obstruction (UPJO) with...     

Being born in China:the Chinese experience of management of labor

Being born in China nowadays is muchmore fortunate than fifty years ago, or eventen years ago. Quality and correct management of labor directly affects the lives ofmother and child. Since the adoption of theconcept of reproductive health at the CairoICPD meeting and the Beijing Women WorldCongress, maternal and child health care hasbeen more emphasized as one of the essentialcomponent of reproductive health care. Safemotherhood is on the top priority of MCH programme.Decline of Maternal …     

Does delaying pyeloplasty affect renal function in children with a prenatal diagnosis of pelvi-ureteric junction obstruction?

OBJECTIVE: To evaluate retrospectively children with an antenatal diagnosis of pelvi-ureteric junction (PUJ) obstruction who required pyeloplasty for deteriorating renal function during the follow-up, specifically assessing the recovery of function after surgery. PATIENTS AND METHODS: Between 1988 and 2000, 44 consecutive patients with a prenatal diagnosis of PUJ obstruction who were initially treated by observation underwent pyeloplasty because their renal function deteriorated during the follow-up. Patients with bilateral disease, a single kidney or vesico-ureteric reflux were excluded from the study. The mean (sd) age of the patients was 13.3 (4.5) months and their mean (range) initial renal function 39.7 (30.4-45)%. In all patients the diagnostic criteria and indications for surgery were identical. The main indication for surgery was deteriorating renal function of >5%, confirmed by renal scintigraphy. Of 44 patients, 35 (77%) had severe dilatation of the renal pelvis by >3 cm. The mean (sd) deterioration in renal function during the follow-up, just before surgery, was 8.2 (2.4)%, and the mean time between the last acceptable renogram and the study showing deterioration was 8.3 (1.3) months; the mean follow-up was 5.1 (1.6) years. The results were assessed statistically using the unpaired nonparametric Mann-Whitney U-test. RESULTS: An improvement in hydronephrosis was confirmed in all patients, with renal function returning to the initial levels in 36 of 44 (81%) patients 6-12 months after surgery, although in two patients renal function did not improve after surgery. There was no significant difference between the preoperative characteristics and the degree of hydronephrosis, renal function or patient age with the level of renal functional improvement after surgery. CONCLUSION: In patients with an antenatal diagnosis of PUJ obstruction, expectant management is recommended and spares the children unnecessary surgery. Even if renal function deteriorates, delayed pyeloplasty recovers the initial functional level.     

Value of urinary carbohydrate antigen 19–9 to predict failure of conservative management in children with ureteropelvic junction obstruction

ObjectiveTo assess the role of urinary carbohydrate antigen 19–9 (CA19–9) measurement in determining optimal management of ureteropelvic junction obstruction (UPJO) and predicting failure of conservative management.Patients and methodsChildren with UPJO diagnosed between December 2012 and April 2015 were included. Depending on clinical and para-clinical findings, patients were divided into three groups: Group 1 consisted of patients who were considered for non-operative management with improvement of the condition during the course of follow-up. Group 2 were suitable for observation; however due to deterioration of condition pyeloplasty was indicated after a period of observation. Group 3 patients required immediate pyeloplasty. Urinary CA19–9 was measured in all patients at baseline and compared between the study groups.ResultsA total of 112 children (115 affected kidneys) with UPJO and mean age of 18.6 ± 3.3 months were assessed. Group 1, 2, and 3 consisted of 54(48.2%), 24(21.4%), and 34(30.4%) patients, respectively. Mean baseline urinary CA19–9 was 37.83 ± 5.20, 145.45 ± 18.38 and 244.62 ± 41.42 in groups 1, 2 and 3, respectively. Multivariate analysis showed that both CA19–9 and APD are independent predictors of need for surgery in patients on observation. ROC curve analysis revealed that urinary CA19–9 level at cut off value of 52.6 U/mL had sensitivity of 92.0% and specificity of 70.9% in predicting failure of non-operative management.ConclusionHigher urinary CA19–9 level is associated with failure of non-operative management in patients with UPJO. Such patients may require close follow-up and assessments to prevent irreversible damage to the kidney.Type of StudyStudy of Diagnostic Test.Level of EvidenceLevel II.     

Complications of laparoscopic incisional–ventral hernia repair: the experience of a single institution

Background Laparoscopic incisional–ventral hernia repair (LIVH) is used with increasing frequency for the morbidly obese and for complex and recurrent hernias. The experience of a single institution with this technique is reviewed and the findings and complications are presented.Methods Data were collected retrospectively for a single surgeons series of patients undergoing LIVH at the institution described in this report.Results The review showed a complication rate of 15.2%, a recurrence rate of 2%, and a prosthetic infection rate of 2%. Patients with a body mass index greater than 30 cm/m² accounted for 73% of the complications and made up 62.2% of the patients.Conclusions The LIVH procedure may be safely performed with low complication and recurrence rates even for the obese, allowing ventral hernia repair to be performed safely with good results. The LIVH technique should be considered for the repair of all incisional and ventral hernias requiring repair with a mesh prosthesis.     

Totally laparoscopic right colectomy with transvaginal specimen extraction: the authors’ initial institutional experience

Background  

The persistence of early and delayed wound complications related to both open and laparoscopic colectomy remains a significant health burden. Furthermore, as interest in natural orifice translumenal endosurgery (NOTES) continues to grow, bridging techniques may help to attenuate the learning curve associated with NOTES. The authors present their technique and short-term outcomes for totally laparoscopic right colectomy with transvaginal specimen extraction in a series of four patients.     

The use of the acucise technique for ureteropelvic junction obstruction: A trade-off between efficacy and invasiveness?

Open pyeloplasty is traditionally the recommended treatment for ureteropelvic junction obstruction. In the past decades, several less invasive procedures emerged with the advantages of lower morbidity and better patient tolerance. In 1993, an electrosurgical cutting balloon device called the Acucise (Applied Medical Resources Corp., Laguna Hills, CA) was introduced. It was presented as a straightforward, safe procedure that can be performed in a complete retrograde fashion under fluoroscopic guidance. Despite these advantages; however, it is not yet a generally excepted procedure. This is mainly due to the fact that specific patient selection is needed, and success rates are comparable with other already established endoscopic procedures. Considering the large variety of minimally invasive procedures available, treatment of choice must be based on several factors such as success rate, morbidity, cost, and surgeon’s experience. Acucise is considered a good alternative for the treatment of ureteropelvic junction obstruction in selected patients. However, the efficacy is significantly lower than the reference standard.