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Principles of paediatric surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
In many infants, prenatally diagnosed mild to moderate hydronephrosis resolves spontaneously. Those with more significant pelviureteric junction obstruction may be asymptomatic or present in later childhood with urinary tract infection or loin pain. Pyeloplasty is indicated for symptoms or impaired renal function. In boys, partial membranous obstruction in the posterior urethra (valves) can cause a severe prenatal obstructive uropathy. This condition demands urgent investigation and treatment soon after birth to preserve bladder and kidney function. Renal failure develops in about one- third of affected boys despite early endoscopic ablation of the obstructing valves. Other congenital urinary tract malformations include ureteric abnormalities (e.g. duplex, uret- erocoele, vesicoureteric reflux), multicystic dysplastic kidney and bladder exstrophy.
Management of antenatal hydronephrosis
Published in Prem Puri, Newborn Surgery, 2017
The anomaly is corrected by performing a pyeloplasty, in which the stenotic segment is excised and the normal ureter and renal pelvis are reattached. Success rates are 91%–98%. Lesser degrees of UPJ narrowing may cause mild hydronephrosis, which is usually non-obstructive, and typically these kidneys function normally. Another cause of mild hydronephrosis is fetal folds of the upper ureter (Figure 100.5), which also are non-obstructive. The spectrum of non-obstructive UPJ abnormalities often is termed “anomalous UPJ.”
Complications of Open Renal Surgery
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Brian K. McNeil, Robert C. Flanigan
Complications of open pyeloplasty include devascularization of the ureter, persistent obstruction, anastomotic stricture formation, prolonged leakage with subsequent urinoma and fistula formation, and all other complications associated with renal exposure. Some have debated the utility of internal stenting as a way to minimize complications after open pyeloplasty. Smith et al. found similar outcomes in children undergoing stented versus nonstented repair with complication rates of 12% and 14%, respectively (67).
Management of ‘forgotten’ encrusted JJ stents using extracorporeal shockwave lithotripsy: A single-centre experience
Published in Arab Journal of Urology, 2019
Hasan El-Tatawy, Ahmed S. El-Abd, Tarek A. Gameel, Ahmed R. Ramadan, Mohamed O. Abo Farha, Magdy A. Sabaa, Shawky A. El-Abd
The preoperative site and burden of encrustation evaluated by KUB and non-enhanced spiral CT was important to decide the treatment plane after initial ESWL. The reasons for JJ placement were identified from the reports as: post-pyeloplasty (16 patients), endoscopic dilatation of the ureter (nine), obstructive uropathy during pregnancy (six), open ureterolithotomy (20), post uretero-vesical re-implantation (five), and in the majority of patients (77) the stent was inserted for ureterorenoscopy and stone extraction. Patients with the encrusted stent in the upper coil only and of <10 mm, the mean encrustation size was 9.13 mm, whilst it was 17.3 mm in 26 patients with encrustation size of 10–20 mm, and 22 mm in one patient with encrustation burden of >20 mm.
Fibrin glue as a sealant in stentless laparoscopic pyeloplasty: A randomised controlled trial
Published in Arab Journal of Urology, 2019
Ahmed Farouk, Ahmed Tawfick, Mahmoud Reda, Ahmed M. Saafan, Waleed Mousa, Ahmed M. Tawfeek, Hassan Shaker
Although Anderson and Hynes [12] first described dismembered pyeloplasty for the treatment of an obstructed retrocaval ureter in 1949, since then open pyeloplasty has been viewed as the ‘gold standard’ surgery for PUJO, with a success rate of >90% [13].