Mini incision open pyeloplasty - Improvement in patient outcome

Singh, Vishwajeet; Garg, Manish; Sharma, Pradeep; Sinha, Rahul Janak; Kumar, Manoj

doi:10.1590/S1677-5538.IBJU.2014.0024

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Original Article • Int. braz j urol. 41 (5) • Sep-Oct 2015 • https://doi.org/10.1590/S1677-5538.IBJU.2014.0024 copy

Mini incision open pyeloplasty - Improvement in patient outcome

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

To assess the subjective and objective outcomes of mini-incision dismembered Anderson-Hynes pyeloplasty in the treatment of primary ureteropelvic junction obstruction (UPJO).

Materials and Methods:

Between January 2008 to January 2013, Anderson-Hynes pyeloplasty was performed in 71 patients diagnosed with primary UPJO. Small subcostal muscle splitting incision was used in all cases. Sixteen patients with renal calculi underwent concomitant pyelolithotomy. Subjective outcome was assessed using visual pain analogue score (VAS). For objective assessment, the improvement in differential renal function (DRF) and radio-tracer wash out time (T1/2) on Tc-99m DTPA scan and decrease in hydronephrosis (HDN) on renal ultrasound (USG) and urography (IVU) were assessed.

Results:

Mean incision length was 5.2 cm. The average operating time and postoperative hospital stay was 63 (52-124) minutes and 2.5 (²2. Klingler HC, Remzi M, Janetschek G, Kratzik C, Marberger MJ. Comparison of open versus laparoscopic pyeloplasty techniques in treatment of uretero-pelvic junction obstruction. Eur Urol. 2003;44:340-5.–⁶6. Baldwin DD, Dunbar JA, Wells N, McDougall EM. Single-center comparison of laparoscopic pyeloplasty, Acucise endopyelotomy, and open pyeloplasty. J Endourol. 2003;17:155-60.) days respectively. Concomitant renal calculi were successfully removed in all the patients. Overall complication rates were 8.4% and overall success rate was 98.6% at median follow-up of 16 months. There was significant improvement in pain score (p=0.0001) and significant decrease in HDN after the procedure. While preoperative mean T1/2 was 26.7±6.4 minutes, postoperative half-time decreased to 7.8±4.2 minutes at 6 months and to 6.7±3.3 minutes at 1 year. Mean pre-operative DRF was 26.45% and it was 31.38% and 33.19% at 6 months and 1 year respectively.

Conclusions:

Mini-incision pyeloplasty is a safe and effective technique with combined advantage of high success rates of standard open pyeloplasty with decreased morbidity of laparoscopic approach. Excellent functional and objective outcomes can be achieved without extra technical difficulty.

Key words:
Laparoscopy; Minimally Invasive Surgical Procedures; Postoperative Period

Total No of patients		71
Mean (range) (years)		23(07-42)
No. M/F		44/27
Mean BMI (kg/m2)		23.6 (18-27)
Mean (range) S. Creatnine		1.1 (0.3-1.5)
No. Rt/Lt side of involvement		23/48
Symptoms
	Lumbar pain	59
	Abdominal mass	10
	Asymptomatic	2
No. of pts with associated stones		16
Horse-shoe kidney with UPJO		2
No. of pts with
	pre-op PCN	4
No. of pts with co-morbidity
	DM	4
	HT	6

Mean (range) operative time (mints)	63 (52-124)
Mean±SD VAS pre-operatively	2.6±0.46
Incision length (cm)	5.2 (3.8-7.4)
Mean±SD VAS on day 1	3.8±0.73
Mean±SD VAS on day 2	1.2±0.26
Mean±SD VAS post- operatively at 6 months after surgery	0.27±0.43
No. of pts with anterior crossing vessels	27
Mean (range) blood loss (mL)	41.23(27-78)
Mean (range) days of drain removal	2.1 (2 to 5)
Mean(range) hosp stay (days)	2.5 (2-6)
Median Follow-up (months)	16(9-22)
Overall complications (%)	5(8.4%)
Overall Success rate (%)	98.6

Clavien Grading	Complication	No. of pts in open group
I	Wound infection	1
II	Febrile UTI	3
IIIa	Displaced stent in post op period	1
IIIb	Re- surgery	1

Subjective outcome	Pre-operatively	On post op day 1	6 months after surgery	P value blw pre-op and at 6 months
Pain Score (VAS)	2.6±0.46	3.8±0.73	0.27±0.43	0.0001
Objective outcome	Pre-operatively	At 6 months of follow-up	At 1 Year Follow-Up	P value blw pre-op and at 1 year
Mean DRF (%)	26.45±10.32	31.38±8.74	33.19±06.13	0.0001
T1/2 (min)	26.7±6.4	7.8±4.2	6.7±3.3	0.0001

HDN Grades on Renal USG	Pre-operatively (no. of pts)	At 6 month follow up (no. of pts)	At 1 year follow up(no. of pts)
Grade IV	59	10	3
Grade III	10	14	2
Grade II	2	17	9
Grade I	—	27	16
No HDN	—	3	41

IVP Grading of HDN	Pre-operatively (no. of pts)	At 6 month follow up (no. of pts)	At 1 year follow-up (no. of pts)
Severe	58	11	2
Moderate	13	17	5
Mild	—	39	13
NO HDN	—	4	51

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[1] Correspondence address: Manish Garg, MD, Senior Resident, Department of Urology, King George Medical University, Lucknow, India, Telephone: + 91 760 7333618, E-mail: dr_manugarg@yahoo.co.in