Wang Yanze,Xu Hongye,Wu Rongde,et al.Surgical managements and risk factors of restenosis after pyeloplasty for ureteropelvic junction obstruction in children[J].Journal of Clinical Pediatric Surgery,,():750-756.[doi:10.3760/cma.j.cn101785-202312065-009]
Surgical managements and risk factors of restenosis after pyeloplasty for ureteropelvic junction obstruction in children
- Keywords:
- Ureteropelvic Junction Obstruction; Treatment Outcome; Postoperative Complications; Ureteral Obstruction; Surgical Procedures; Operative; Risk Factors; Child
- Abstract:
- Objective To explore the causes and surgical managements of restenosis after pyeloplasty for ureteropelvic junction obstruction (UPJO) in children and examine the potential risk factors for restenosis.Methods From January 2013 to February 2023,the relevant clinical data were retrospectively reviewed for 326 UPJO children (332 sides) undergoing primary and redo pyeloplasties.The causes,diagnoses,surgical procedures and outcomes of restenosis after primary pyeloplasty were summarized.They were assigned into two groups of restenosis and non-restenosis according to follow-up results.The relevant clinical data of two groups were compared for examining the risk factors of recurrence.Results There were 11 sides in restenosis group and 321 sides in non-restenosis group.Postoperative restenosis was confirmed by ultrasonography,computed tomography (CT) and retrograde pyelography.Laparoscopic redo pyeloplasty (n=10) and open surgery (n=1) were performed.Interval between two operations was (9.68±2.71) month.The intraoperative findings included local stenosis of ureteropelvic junction (n=4,36.36%),adhesion & compression around ureteropelvic junction (n=5,45.45%) and compression of anterior crossing vessel (n=2,18.18%).During a follow-up period after redo pyeloplasty of (46.90±43.75) month,hydronephrosis improved in all cases. In the restenosis group,27.27%(3/11)cases underwent the percutoneaus nephrostomies before pyeloplasty and 45.45%(5/11)underwent miniature pyeloplasty via a dorsal paravertebral transverse incision.which were significant more than those in non-restenosis group(6.85%(22/321)and 17.76%(57/321).Multivariate Logistic regression analysis revealed that preoperative percutaneous nephrostomy (P=0.009,OR=7.226,95%CI:1.628-32.082) and dorsal mini-incision (P=0.015,OR=5.038,95%CI:1.376-18.440) were independent risk factors for recurrent UPJO.Conclusions The common causes of restenosis include local stricture of anastomosis,adhesion and compression around ureteropelvic junction and anterior crossing vessels.Laparoscopic redo pyeloplasty is both safe and effective for recurrent UPJO.Preoperative percutaneous nephrostomy should be adopted cautiously with definite indications.Surgeons should be vigilant for handling anterior crossing vessels within a confined dorsal field.
References:
[1] 杨平,李康明,邹兵,等.机器人辅助腹腔镜与传统腹腔镜肾盂成形术治疗小儿肾盂输尿管连接处梗阻的Meta分析[J].临床小儿外科杂志,2022,21(5):482-489.DOI:10.3760/cma.j.cn101785-202011015-015. Yang P,Li KM,Zou B,et al.Robotic-assisted laparoscopic pyeloplasty versus laparoscopic pyeloplasty for children with ureteropelvic junction obstruction:a Meta-analysis[J].DOI:10.3760/cma.j.cn101785-202011015-015.
[2] Szavay P,Zundel S.Surgery of uretero-pelvic junction obstruction (UPJO)[J].Semin Pediatr Surg,2021,30(4):151083.DOI:10.1016/j.sempedsurg.2021.151083.
[3] Huang YD,Wu Y,Shan W,et al.An updated meta-analysis of laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children[J].Int J Clin Exp Med,2015,8(4):4922-4931.
[4] Tanash MA,Bollu BK,Naidoo R,et al.Laparoscopic versus open pyeloplasty in paediatric pelvi-ureteric junction obstruction[J].J Paediatr Child Health,2023,59(8):974-978.DOI:10.1111/jpc.16443.
[5] Braga LHP,Lorenzo AJ,B?gli DJ,et al.Comparison of flank,dorsal lumbotomy and laparoscopic approaches for dismembered pyeloplasty in children older than 3 years with ureteropelvic junction obstruction[J].J Urol,2010,183(1):306-311.DOI:10.1016/j.juro.2009.09.008.
[6] Chow AK,Rosenberg BJ,Capoccia EM,et al.Risk factors and management options for the adult failed ureteropelvic junction obstruction repair in the era of minimally invasive and robotic approaches:a comprehensive literature review[J].J Endourol,2020,34(11):1112-1119.DOI:10.1089/end.2019.0737.
[7] Dy GW,Hsi RS,Holt SK,et al.National trends in secondary procedures following pediatric pyeloplasty[J].J Urol,2016,195(4 Pt 2):1209-1214.DOI:10.1016/j.juro.2015.11.010.
[8] Romao RLP,Koyle MA,Pippi Salle JL,et al.Failed pyeloplasty in children:revisiting the unknown[J].Urology,2013,82(5):1145-1147.DOI:10.1016/j.urology.2013.06.049.
[9] Ceyhan E,Dogan HS,Tekgul S.Our experience on management of failed pediatric pyeloplasty[J].Pediatr Surg Int,2020,36(8):971-976.DOI:10.1007/s00383-020-04699-9.
[10] Thomas JC,DeMarco RT,Donohoe JM,et al.Management of the failed pyeloplasty:a contemporary review[J].J Urol,2005,174(6):2363-2366.DOI:10.1097/01.ju.0000180420.11915.31.
[11] Abdrabuh AM,Salih EM,Aboelnasr M,et al.Endopyelotomy versus redo pyeoloplasty for management of failed pyeloplasty in children:a single center experience[J].J Pediatr Surg,2018,53(11):2250-2255.DOI:10.1016/j.jpedsurg.2018.06.002.
[12] Hammady A,Elbadry MS,Rashed EN,et al.Laparoscopic repyeloplasty after failed open repair of ureteropelvic junction obstruction:a case-matched multi-institutional study[J].Scand J Urol,2017,51(5):402-406.DOI:10.1080/21681805.2017.1347819.
[13] Alhazmi HH.Redo laparoscopic pyeloplasty among children:a sy-stematic review and meta-analysis[J].Urol Ann,2018,10(4):347-353.DOI:10.4103/UA.UA_100_18.
[14] Chung DY,Hong CH,Im YJ,et al.Delayed redo pyeloplasty fails to recover lost renal function after failed pyeloplasty:early sonographic changes that correlate with a loss of differential renal function[J].Korean J Urol,2015,56(2):157-163.DOI:10.4111/kju.2015.56.2.157.
[15] Ceyhan E,Ileri F,Ceylan T,et al.Predictors of recurrence and complications in pediatric pyeloplasty[J].Urology,2019,126:187-191.DOI:10.1016/j.urology.2019.01.014.
[16] Braga LHP,Lorenzo AJ,B?gli DJ,et al.Risk factors for recurrent ureteropelvic junction obstruction after open pyeloplasty in a large pediatric cohort[J].J Urol,2008,180(4 Suppl):1684-1688.DOI:10.1016/j.juro.2008.03.086.
[17] Comploj E,Koen M,Becker T,et al.Does a preoperative percutaneous nephrostomy influence the outcome of pyeloplasty in infants and children?[J].J Pediatr Urol,2009,5(Supplement 1):S62.DOI:10.1016/j.jpurol.2009.02.101.
[18] Rehman J,Landman J,Sundaram C,et al.Missed anterior crossing vessels during open retroperitoneal pyeloplasty:laparoscopic transperitoneal discovery and repair[J].J Urol,2001,166(2):593-596.DOI:10.1016/S0022-5347(05)65990-3.
[19] Abdel-Karim AM,Fahmy A,Moussa A,et al.Laparoscopic pyeloplasty versus open pyeloplasty for recurrent ureteropelvic junction obstruction in children[J].J Pediatr Urol,2016,12(6):401.e1-401.e6.DOI:10.1016/j.jpurol.2016.06.010.
[20] Zouari M,Dghaies R,Rhaiem W,et al.Risk factors for adverse outcomes after pediatric pyeloplasty:a retrospective cohort study[J].Int J Urol,2024,31(1):45-50.DOI:10.1111/iju.15305.
[21] Grimsby GM,Jacobs MA,Gargollo PC.Success of laparoscopic robot-assisted approaches to ureteropelvic junction obstruction based on preoperative renal function[J].J Endourol,2015,29(8):874-877.DOI:10.1089/end.2014.0876.
[22] Li LJ,Qiu MX,Gong BS,et al.Systematic review and meta-analysis of ureteral stent for risk factors of restenosis after laparoscopic pyeloplasty[J].Ann Palliat Med,2021,10(10):10527-10534.DOI:10.21037/apm-21-2228.
[23] Bowen DK,Mittal S,Aghababian A,et al.Pyeloplasty is a safe and effective surgical approach for low functioning kidneys with ureteropelvic junction obstruction[J].J Pediatr Urol,2021,17(2):233.e1-233.e7.DOI:10.1016/j.jpurol.2020.12.018.
Memo
收稿日期:2023-12-28。
基金项目:山东省立医院医疗技术创新激励项目(CXJL:ZQN-202208)
通讯作者:刘伟,Email:lemontree1119@126.com