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• W3187130896 abstract "You have accessJournal of UrologyUpper Tract Reconstruction (V09)1 Sep 2021V09-06 A NOVEL TECHNIQUE OF CONISATION OF THE URETERO-PELVIC RECONSTRUCTION DURING LAPAROSCOPIC AND ROBOTIC ASSISTED PYELOPLASTY IN CASES OF URETEROPELVIC JUNCTION OBSTRUCTION Wael Khoder, Jacob Michaelis, Markus Grabbert, Christian Gratzke, Alexander Kretschmer, and Christian Stief Wael KhoderWael Khoder More articles by this author , Jacob MichaelisJacob Michaelis More articles by this author , Markus GrabbertMarkus Grabbert More articles by this author , Christian GratzkeChristian Gratzke More articles by this author , Alexander KretschmerAlexander Kretschmer More articles by this author , and Christian StiefChristian Stief More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002052.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anderson-Hynes technique is the most popular surgical technique for pyeloplasty in patients with ureteropelvic junction obstruction (UPJO). Besides transperitoneal approaches, the retroperitoneoscopic approach is emerging. We present a modified dismembered pyeloplasty technique through retroperitoneoscopic laparoscopic (RLP) and robotic (RRP) approach in a single surgeon series. METHODS: The diagnosis of UPJO was confirmed preoperatively with imaging (retrograde pyelography or computed tomography), as well as functional mercaptoacetyltriglycine renal scans (MAGIII). The renal pelvis was resected in a fish mouth pattern, with app. ¾ of the ureteric circumference at UPJ. Stenotic ureteric part was excised and the ureter was spatulated longitudinally (V-shaped flap). Anastomosis begins with 3 to 5 stitches using 4/0 monocryl sited at the edge of spatulation transversally to widen the lumen with conisation of UPJ. These sutures were set under enough tension to straighten the ureter. The anastomosis at the base of ureteric-flap with the upper pelvic part (upper fish mouth) followed in same manner. Finally, reconstruction is completed with closure of anterior and posterior walls using 5/0 monocryl continuous sutures. All patients had a DJ-stent for 6–8 weeks postoperatively. RESULTS: 176 patients underwent the described pyeloplasty technique. Mean patients’ age was 28years (14-82), Mean BMI was 23.5 kg/m2 (10.2% (18/176 patients) classified as obese). Preoperatively, 36.9% (65/176) reported urinary tract infections, pain 70.5 % (124/176) or urinary stones 27.3% (24/176). All procedures were successfully completed without conversion or revision. Mean operative time was 137 minutes, blood loss was 68 ml with a mean hospital stay of 8days. There was no significant change between pre- and postoperative creatinine levels with a mean change of 0.0 (-0.4, +0.9) mg/dl. Postoperatively, one patient had small pulmonary embolism, transient fever in 4patients, otherwise uneventful. The Dj was removed after successful postoperative retrograde pyelography at a mean of 56days. MAG III after 3 months showed stable to improved function with a mean of 1.1% (-34%, +24%) more partial renal function assigned to the treated kidney. CONCLUSIONS: The presented modified technique of RRP has favorable morbidity and functional outcomes in comparison to known standard techniques. It is an easy to learn technique for surgeons already practicing dismembered pyeloplasty. Source of Funding: No Funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e689-e689 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wael Khoder More articles by this author Jacob Michaelis More articles by this author Markus Grabbert More articles by this author Christian Gratzke More articles by this author Alexander Kretschmer More articles by this author Christian Stief More articles by this author Expand All Advertisement Loading ..." @default.
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• W3187130896 title "V09-06 A NOVEL TECHNIQUE OF CONISATION OF THE URETERO-PELVIC RECONSTRUCTION DURING LAPAROSCOPIC AND ROBOTIC ASSISTED PYELOPLASTY IN CASES OF URETEROPELVIC JUNCTION OBSTRUCTION" @default.
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