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Failed Pyeloplasty in Children: Comparative Analysis of Retrograde Endopyelotomy Versus Redo Pyeloplasty

2007; Lippincott Williams & Wilkins; Volume: 178; Issue: 6 Linguagem: Inglês

10.1016/j.juro.2007.08.050

1527-3792

Luis H. Braga, Armando J. Lorenzo, Sean Skeldon, Sumit Davé, Darius Bägli, Antoine E. Khoury, João L. Pippi Salle, Walid A. Farhat,

Kidney Stones and Urolithiasis Treatments

No AccessJournal of UrologyPediatric urology1 Dec 2007Failed Pyeloplasty in Children: Comparative Analysis of Retrograde Endopyelotomy Versus Redo Pyeloplasty Luis H.P. Braga, Armando J. Lorenzo, Sean Skeldon, Sumit Dave, Darius J. Bagli, Antoine E. Khoury, Joao L. Pippi Salle, and Walid A. Farhat Luis H.P. BragaLuis H.P. Braga , Armando J. LorenzoArmando J. Lorenzo , Sean SkeldonSean Skeldon , Sumit DaveSumit Dave , Darius J. BagliDarius J. Bagli , Antoine E. KhouryAntoine E. Khoury , Joao L. Pippi SalleJoao L. Pippi Salle , and Walid A. FarhatWalid A. Farhat View All Author Informationhttps://doi.org/10.1016/j.juro.2007.08.050AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We compared retrograde endopyelotomy to redo pyeloplasty for the treatment of failed pyeloplasty in children. Materials and Methods: Of 32 patients with recurrent ureteropelvic junction obstruction retrograde endopyelotomy was performed in 18 and redo pyeloplasty was performed in 14. Patient age, gender, side, stent placement at initial pyeloplasty, presentation of secondary ureteropelvic junction obstruction, hospital stay, complications and success rates were compared. Success was defined as radiographic relief of obstruction as determined by ultrasound or diuretic renography at latest followup. Results: Median patient age was 6 years (range 2 to 14) at retrograde endopyelotomy and 7.2 years (1 to 17) at redo pyeloplasty. Retrograde endopyelotomy technique consisted of holmium laser in 10 patients and cautery/balloon dilation in 8. Redo pyeloplasty was performed through a flank incision in 12 patients and by laparoscopy in 2. Retrograde endopyelotomy was successful in 39% of the patients, while redo pyeloplasty had a 100% success rate (p = 0.002). Of the patients with failed retrograde endopyelotomy 5 had a stricture greater than 1 cm and 7 were younger than 4 years. Mean length of the narrowed ureteral segment was 10.1 mm in the failed retrograde endopyelotomy group vs 5.8 mm in the successful group (p <0.01). Only 1 of 8 children (13%) had a successful retrograde endopyelotomy using cautery followed by balloon dilation. Hospital stay was 1.3 days for the retrograde endopyelotomy group and 2.9 days for the redo pyeloplasty group (p <0.01). Mean followup was 47 months (range 15 to 132) after retrograde endopyelotomy and 33.1 months (12 to 78) after redo pyeloplasty. Conclusions: Retrograde endopyelotomy had a significantly lower success rate than redo pyeloplasty for correction of recurrent ureteropelvic junction obstruction after failed pyeloplasty in children. Patient age less than 4 years and narrowed ureteral segment greater than 10 mm were associated with a poor outcome after retrograde endopyelotomy. 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Link, Google Scholar Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada© 2007 by American Urological AssociationFiguresReferencesRelatedDetailsCited byJacobson D, Shannon R, Johnson E, Gong E, Liu D, Flink C, Meyer T, Cheng E and Lindgren B (2019) Robot-Assisted Laparoscopic Reoperative Repair for Failed Pyeloplasty in Children: An Updated SeriesJournal of Urology, VOL. 201, NO. 5, (1005-1011), Online publication date: 1-May-2019.Cadeddu J (2017) Re: Pediatric Robot-Assisted Redo Pyeloplasty with Buccal Mucosa Graft: A Novel TechniqueJournal of Urology, VOL. 198, NO. 6, (1191-1191), Online publication date: 1-Dec-2017.Moscardi P, Barbosa J, Andrade H, Mello M, Cezarino B, Oliveira L, Srougi M, Dénes F and Lopes R (2016) Reoperative Laparoscopic Ureteropelvic Junction Obstruction Repair in Children: Safety and Efficacy of the TechniqueJournal of Urology, VOL. 197, NO. 3 Part 1, (798-804), Online publication date: 1-Mar-2017.Dy G, Hsi R, Holt S, Lendvay T, Gore J and Harper J (2016) National Trends in Secondary Procedures Following Pediatric PyeloplastyJournal of Urology, VOL. 195, NO. 4 Part 2, (1209-1214), Online publication date: 1-Apr-2016.Parente A, Angulo J, Burgos L, Romero R, Rivas S and Ortiz R (2015) Percutaneous Endopyelotomy over High Pressure Balloon for Recurrent Ureteropelvic Junction Obstruction in ChildrenJournal of Urology, VOL. 194, NO. 1, (184-189), Online publication date: 1-Jul-2015.Kim E, Tanagho Y, Traxel E, Austin P, Figenshau R and Coplen D (2012) Endopyelotomy for Pediatric Ureteropelvic Junction Obstruction: A Review of our 25-Year ExperienceJournal of Urology, VOL. 188, NO. 4S, (1628-1633), Online publication date: 1-Oct-2012.Lindgren B, Hagerty J, Meyer T and Cheng E (2012) Robot-Assisted Laparoscopic Reoperative Repair for Failed Pyeloplasty in Children: A Safe and Highly Effective Treatment OptionJournal of Urology, VOL. 188, NO. 3, (932-937), Online publication date: 1-Sep-2012. Volume 178Issue 6December 2007Page: 2571-2575 Advertisement Copyright & Permissions© 2007 by American Urological AssociationKeywordskidney pelvischildpostoperative complicationsureteral obstructionurologic surgical proceduresMetricsAuthor Information Luis H.P. Braga More articles by this author Armando J. Lorenzo More articles by this author Sean Skeldon More articles by this author Sumit Dave More articles by this author Darius J. Bagli More articles by this author Antoine E. Khoury More articles by this author Joao L. Pippi Salle More articles by this author Walid A. Farhat More articles by this author Expand All Advertisement PDF downloadLoading ...