Subadventitial dismembered pyeloureteroplasty – new surgical technique for correction of uretero-pelvic junction stenosis

Akif Memmedoglu Bagirov 1 *
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1 Department of Urology, Azerbaijan Medical University, Baku, Azerbaijan
* Corresponding Author
J CLIN MED KAZ, In press.
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ABSTRACT

Objective: Open or laparoscopic dismembered pyeloplasty has been the gold standard for the correction of ureteropelvic junction obstruction (UPJO) with a success rate of about 90%. Main insufficient feature of dismembered pyeloureteroplasty is interfering ureteral blood supply, which creates the prerequisites for the deterioration of the regeneration of the ureter and the possibility of developing restenosis.
Methods: We offered and applied the new method – subadventitial resection of ureteropelvic junction (UPJ) to prevent damage to vessels of the distal part of pelvis and proximal part of the ureter. The protection of blood supply in this area should improve anastomosis regeneration and prevent fibrotic changes for long time, simultaneously providing better condition for the kinetic ability of the ureter. 
Results: Retrospective analysis of 106 patients with hydronephrosis, whom performed 108 open dismembered pyeloplasty (two patients were operated bilaterally) with subadventitial resection of UPJ from 1998-2020 years with a mean follow-up of 36 month shows that this technique has advantages over analogues.
Conclusion: Our 22 years of experience shows that the technique of subadventitial resection of the ureter, allows us to save the ureteral blood circulation and thus creates conditions for better regeneration of the anastomosis and prevent later complications of dismembered pyelouretereroplasty.

CITATION

Bagirov AM. Subadventitial dismembered pyeloureteroplasty – new surgical technique for correction of uretero-pelvic junction stenosis. J Clin Med Kaz. 2021.

REFERENCES

  • Klingler HC, Remzi M, Janetschek G, Kratzik C, Marberger MJ. Comparison of open versus laporoscopic pyeloplasty techniques in treatment of uretero-pelvic junction obstruction. European Urology 44, 2003, 340-345. doi: 10.1016/s0302-2838(03)00297-5.
  • O’Reilly PH, Brooman PJ, Mak S, Jones M, Pickup C, Atkinson C, et al. The long-term results of Anderson-Hynes pyeloplasty. BJU Int. 2001; 87: 287–9. doi: 10.1046/j.1464-410x.2001.00108.x.
  • Jacobs BL, Lai JC, Seelam R2, Hanley JM, Wolf JS Jr, Hollenbeck BK, Hollingsworth JM, Dick AW, Setodji CM, Saigal CS. The Comparative Effectiveness of Treatments for Ureteropelvic Junction Obstruction. Urology. 2018 Jan; 111: 72-77. DOI: 10.1016/j.urology.2017.09.002
  • Anderson JK, Kabalin JN, Cadeddu JA. Surgical anatomy of the retroperitoneum, adrenals, kidneys, and ureters. İn Campbell’s Urology: 33-96, 2008
  • Kogan BA. Disorders of the ureter and ureteropelvic junction. In Smith´s General Urology, Edited by Tanagho FA, McAninch JW. XVII edition. 2012, 559-573 DOI:10/1036/0071457372
  • Tan HJ, Ye Z, Roberts WW, Wolf JS. Failure after laparoscopic pyeloplasty: prevention and management. J Endourol. 2011 Sep;25(9):1457-62. doi.org/10.1089/end.2010.0647.
  • Blanc T, Muller C, Abdoul H, Peev S, Paye-Jaouen, Peycelon M. et al. Retroperitoneal laparoscopic pyeloplasty in chilfren: long-term outcome and critical analysis of 10-year experience in a teaching center. European Urology 63, 2013, 565-572. doi: 10.1016/j.eururo.2012.07.051
  • Salih EM. Morphological and functional outcome of dismembered pyeloplasty in children with unilateral ureteropelvic junction obstruction. African Journal of Urology, Volume 21, Issue 3, September 2015, Pages 174-180 https://doi.org/10.1016/j.afju.2015.04.003
  • Maheshwari R, Ansari M S, Mandhani A, Srivastava A, Kapoor R. Laparoscopic pyeloplasty in pediatric patients: The SGPGI experience. Indian J Urol. 2010;26:36-40. doi: 10.4103/0970-1591.60441.
  • Panda SS, Bajpai M, Jana M, Baidya DK, Kumar R. Anderson-Hynes pyeloplasty with isthmotomy and lateropexy in horseshoe kidneys with pelviureteric junction obstruction in children. Indian J Urol. 2014 Apr;30(2):161-3. doi: 10.4103/0970-1591.126897