The Experts below are selected from a list of 2052 Experts worldwide ranked by ideXlab platform
Demetrius H. Bagley - One of the best experts on this subject based on the ideXlab platform.
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the minimally invasive treatment of Ureteropelvic Junction Obstruction a review of our experience during the last decade
The Journal of Urology, 2008Co-Authors: Brent V Yanke, Costas D Lallas, Christopher Pagnani, David E Mcginnis, Demetrius H. BagleyAbstract:Purpose: The minimally invasive treatment of Ureteropelvic Junction Obstruction has evolved during the last decade from endoscopic to laparoscopic and robotic. We review our 10-year experience with Ureteropelvic Junction Obstruction, and report on our experience and followup.Materials and Methods: We reviewed all patients treated during the last 10 years. There were 294 procedures performed with complete records on 273 patients including 128 retrograde endopyelotomies, 116 laparoscopic pyeloplasties and 29 robotic pyeloplasties. Technique for each procedure is reviewed. Statistical analysis was performed on all results. Variables evaluated were gender, age (younger than 41 vs 41 years or older), side (right or left), presence of crossing vessels, presence of a high insertion, primary or secondary procedure and whether prior endopyelotomy or pyeloplasty had been performed.Results: Mean followup for endopyelotomy, laparoscopic pyeloplasty and robotic pyeloplasty was 20, 20 and 19 months, respectively, with ...
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ureteroscopic treatment of Ureteropelvic Junction Obstruction
The Journal of Urology, 1998Co-Authors: Ehab R Tawfiek, Jibin Liu, Demetrius H. BagleyAbstract:AbstractPurpose: Endopyelotomy has increasingly become well accepted as the optimal management for primary and secondary Ureteropelvic Junction Obstruction. We report our experience with ureteroscopic endopyelotomy guided by endoluminal ultrasound.Materials and Methods: Ureteroscopic endopyelotomy was attempted in 27 patients with primary and 10 with secondary Ureteropelvic Junction Obstruction. Retrograde pyelogram and endoluminal ultrasound were performed at the start of the procedure in all patients. Based on sonographic findings 5 patients were not considered candidates for the procedure. The remaining 13 men and 19 women were treated ureteroscopically with a rigid ureteroscope in 5 (15.6%), flexible in 20 (62.5%), and rigid and flexible in 7 (21.9%) patients. Stents were placed postoperatively for 6 to 10 weeks. The patients were followed for a mean duration of 10 months.Results: The procedure was completed in all patients. Average operating time was 95 minutes including the time for imaging. Sonogra...
Thomas W Jarrett - One of the best experts on this subject based on the ideXlab platform.
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management of secondary Ureteropelvic Junction Obstruction after failed primary laparoscopic pyeloplasty
The Journal of Urology, 2004Co-Authors: Ioannis M Varkarakis, Albert M Ong, Louis R Kavoussi, Sam B Bhayani, Mohamad E Allaf, Takeshi Inagaki, Thomas W JarrettAbstract:Purpose: Laparoscopic pyeloplasty has been established as a minimally invasive alternative to open pyeloplasty. However, little is known about the treatment of patients in whom this technique fails. We present our experience with treating Ureteropelvic Junction Obstruction after failed primary laparoscopic pyeloplasty. Materials and Methods: From August 1993 to September of 2003, 227 patients underwent laparoscopic pyeloplasty for primary Ureteropelvic Junction Obstruction. Of these patients 10 (4.4%), including 6 females and 4 males 24 to 62 years old (mean age 42.1), underwent secondary treatment after laparoscopic pyeloplasty failed. The type of secondary intervention varied by anatomical factors, and patient and surgeon preference. Success was defined as symptomatic relief and improved radiographic imaging at latest followup. Results: Secondary interventions were repeat laparoscopic pyeloplasty in 1 patient, retrograde endoscopic balloon dilation in 2 and endopyelotomy in 7 (laser, cold knife and cutting balloon endopyelotomy in 3, 2, and 2, respectively). No postoperative complications were seen. Patients were followed for a mean of 25.5 months (range 3 to 96) after the second procedure. Seven of 10 secondary interventions (70%) were successful with no Obstruction on followup imaging. Three of 10 interventions (30%) failed, namely 1 laparoscopic pyeloplasty, 1 endoscopic balloon dilation and 1 laser endopyelotomy. Failure of the second procedure occurred at a mean of 9.3 months. Conclusions: When given the choice, most patients select endoscopic management after failed primary laparoscopic pyeloplasty due to its minimally invasive nature and low complication rate. Success rates are 70% with repeat intervention. Some patients require a third intervention.
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laparoscopic management of Ureteropelvic Junction Obstruction in patients with upper urinary tract anomalies
The Journal of Urology, 2004Co-Authors: P Bove, Albert M Ong, Koon Ho Rha, Peter A Pinto, Thomas W Jarrett, Louis R KavoussiAbstract:ABSTRACTPurpose: We report our experience with the laparoscopic management of Ureteropelvic Junction Obstruction in patients with upper urinary tract abnormalities.Materials and Methods: Between July 1994 and May 2002, 7 men and 4 women with upper urinary tract anatomical abnormalities were referred to our institution for management of symptomatic Ureteropelvic Junction Obstruction. Anomalies included horseshoe kidneys in 5 cases, pelvic kidneys in 3, a pancake kidney in 1, a malrotated kidney in 1 and a duplicated collecting system in 1. Three patients had associated renal stones that were extracted during reconstruction. Mean patient age was 37.4 years (range 25 to 60). One patient had undergone a previously unsuccessful endopyelotomy and 2 had a history of abdominal surgery.Results: Mean operative time was 195 minutes (range 85 to 403) and mean estimated blood loss was 122 cc (range 20 to 300). No patient in this series required transfusion. Average length of hospital stay was 3.2 days (range 2 to 5). ...
Louis R Kavoussi - One of the best experts on this subject based on the ideXlab platform.
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management of secondary Ureteropelvic Junction Obstruction after failed primary laparoscopic pyeloplasty
The Journal of Urology, 2004Co-Authors: Ioannis M Varkarakis, Albert M Ong, Louis R Kavoussi, Sam B Bhayani, Mohamad E Allaf, Takeshi Inagaki, Thomas W JarrettAbstract:Purpose: Laparoscopic pyeloplasty has been established as a minimally invasive alternative to open pyeloplasty. However, little is known about the treatment of patients in whom this technique fails. We present our experience with treating Ureteropelvic Junction Obstruction after failed primary laparoscopic pyeloplasty. Materials and Methods: From August 1993 to September of 2003, 227 patients underwent laparoscopic pyeloplasty for primary Ureteropelvic Junction Obstruction. Of these patients 10 (4.4%), including 6 females and 4 males 24 to 62 years old (mean age 42.1), underwent secondary treatment after laparoscopic pyeloplasty failed. The type of secondary intervention varied by anatomical factors, and patient and surgeon preference. Success was defined as symptomatic relief and improved radiographic imaging at latest followup. Results: Secondary interventions were repeat laparoscopic pyeloplasty in 1 patient, retrograde endoscopic balloon dilation in 2 and endopyelotomy in 7 (laser, cold knife and cutting balloon endopyelotomy in 3, 2, and 2, respectively). No postoperative complications were seen. Patients were followed for a mean of 25.5 months (range 3 to 96) after the second procedure. Seven of 10 secondary interventions (70%) were successful with no Obstruction on followup imaging. Three of 10 interventions (30%) failed, namely 1 laparoscopic pyeloplasty, 1 endoscopic balloon dilation and 1 laser endopyelotomy. Failure of the second procedure occurred at a mean of 9.3 months. Conclusions: When given the choice, most patients select endoscopic management after failed primary laparoscopic pyeloplasty due to its minimally invasive nature and low complication rate. Success rates are 70% with repeat intervention. Some patients require a third intervention.
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laparoscopic management of Ureteropelvic Junction Obstruction in patients with upper urinary tract anomalies
The Journal of Urology, 2004Co-Authors: P Bove, Albert M Ong, Koon Ho Rha, Peter A Pinto, Thomas W Jarrett, Louis R KavoussiAbstract:ABSTRACTPurpose: We report our experience with the laparoscopic management of Ureteropelvic Junction Obstruction in patients with upper urinary tract abnormalities.Materials and Methods: Between July 1994 and May 2002, 7 men and 4 women with upper urinary tract anatomical abnormalities were referred to our institution for management of symptomatic Ureteropelvic Junction Obstruction. Anomalies included horseshoe kidneys in 5 cases, pelvic kidneys in 3, a pancake kidney in 1, a malrotated kidney in 1 and a duplicated collecting system in 1. Three patients had associated renal stones that were extracted during reconstruction. Mean patient age was 37.4 years (range 25 to 60). One patient had undergone a previously unsuccessful endopyelotomy and 2 had a history of abdominal surgery.Results: Mean operative time was 195 minutes (range 85 to 403) and mean estimated blood loss was 122 cc (range 20 to 300). No patient in this series required transfusion. Average length of hospital stay was 3.2 days (range 2 to 5). ...
Robert L Lebowitz - One of the best experts on this subject based on the ideXlab platform.
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fibroepithelial polyps causing Ureteropelvic Junction Obstruction in children
The Journal of Urology, 2003Co-Authors: Gregory S Adey, Sara O Vargas, Alan B Retik, Joseph G Borer, James Mandell, Hardy W Hendren, Robert L Lebowitz, Stuart B BauerAbstract:ABSTRACTPurpose: Fibroepithelial polyps are benign mucosal projections that can be found throughout the urinary system. We review our experience with fibroepithelial polyps of the Ureteropelvic Junction in children to define more clearly this entity and its outcome following treatment.Methods: We reviewed the records of all children with fibroepithelial polyps causing Ureteropelvic Junction Obstruction treated at our institution between December 1967 and February 2002.Results: Nine patients 6 weeks to 9 years old had 11 Ureteropelvic Junction Obstructions secondary to fibroepithelial polyps, representing a 0.5% incidence of all Ureteropelvic Junction Obstructions seen during that period. The majority of the patients were male (89%) and had Obstruction on the left side (78%). Only 22% of the patients had a diagnosis of obstructing polyps suggested preoperatively. All patients underwent dismembered pyeloplasty but 1 required subsequent nephrectomy due to progressive loss of renal function. All lesions were ...
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complete duplication of the ureter with Ureteropelvic Junction Obstruction of the lower pole of the kidney imaging findings
American Journal of Roentgenology, 1995Co-Authors: Sandra K Fernbach, J K Zawin, Robert L LebowitzAbstract:The purpose of our study was to identify the radiographic signs that aid in the diagnosis of Obstruction of the Ureteropelvic Junction of the lower pole (or moiety) of the kidney in children with complete duplication of the ureter and to describe the imaging appearance of this unusual cause of lower-pole hydronephrosis.We reviewed the medical records and imaging studies of 16 children (11 boys and five girls) with complete ureteral duplication and Ureteropelvic Junction Obstruction of the lower pole of the kidney over a 5-year period. standard criteria for determining urinary tract Obstruction were used.Sonograms showed a lower-pole abnormality (hydronephrosis or cystic mass) in all 15 children who underwent sonography. Voiding cystourethrography, performed for all children, showed vesicoureteral reflux into the lower pole in addition to Ureteropelvic Junction Obstruction in eight children (seven boys and one girl). For the other eight, the diagnosis of lower-pole Ureteropelvic Junction Obstruction was ma...
Christopher S Saigal - One of the best experts on this subject based on the ideXlab platform.
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the comparative effectiveness of treatments for Ureteropelvic Junction Obstruction
Urology, 2018Co-Authors: Bruce L Jacobs, Rachana Seelam, Janet M Hanley, Stuart J Wolf, Brent K Hollenbeck, John M Hollingsworth, Andrew W Dick, Claude Messan Setodji, Julie C Lai, Christopher S SaigalAbstract:Objective To examine the effectiveness of the 3 primary treatments for Ureteropelvic Junction Obstruction (ie, open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy) as assessed by failure rates. Materials and Methods Using MarketScan data, we identified adults (ages 18-64 years) who underwent treatment for Ureteropelvic Junction Obstruction between 2002 and 2010. Our primary outcome was failure (ie, need for a secondary procedure). We fit a Cox proportional hazards model to examine the effects of different patient, regional, and provider characteristics on treatment failure. We then implemented a survival analysis framework to examine the failure-free probability for each treatment. Results We identified 1125 minimally invasive pyeloplasties, 775 open pyeloplasties, and 1315 endopyelotomies with failure rates of 7%, 9%, and 15%, respectively. Compared with endopyelotomy, minimally invasive pyeloplasty was associated with a lower risk of treatment failure (adjusted hazards ratio [aHR] 0.52; 95% confidence interval [CI], 0.39-0.69). Minimally invasive and open pyeloplasties had similar failure rates. Compared with open pyeloplasty, endopyelotomy was associated with a higher risk of treatment failure (aHR 1.78; 95% CI, 1.33-2.37). The average length of stay was 2.7 days for minimally invasive pyeloplasty and 4.2 days for open pyeloplasty (P Conclusion Endopyelotomy has the highest failure rate, yet it remains a common treatment for Ureteropelvic Junction Obstruction. Future research should examine to what extent patients and physicians are driving the use of endopyelotomy.
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cost analysis of treatments for Ureteropelvic Junction Obstruction
Journal of Endourology, 2017Co-Authors: Bruce L Jacobs, Rachana Seelam, Julie Lai, Janet M Hanley, Stuart J Wolf, Brent K Hollenbeck, John M Hollingsworth, Andrew W Dick, Claude Messan Setodji, Christopher S SaigalAbstract:Abstract Background and Purpose: Ureteropelvic Junction Obstruction is a common urologic condition that accounts for approximately $12 million in inpatient spending annually. Few studies have assessed the costs related to treatment. We sought to examine the cost of care for patients treated for Ureteropelvic Junction Obstruction. Patients and Methods: We used the MarketScan® database to identify adults from 18 to 64 years old treated with minimally invasive pyeloplasty, open pyeloplasty, and endopyelotomy for Ureteropelvic Junction Obstruction between 2002 and 2010. Our primary outcome was total expenditures related to the surgical episode, defined as the period from 30 days prior until 30 days after the index surgery. We fit a multinomial linear regression model to evaluate cost of the surgical episode, adjusting for age, gender, comorbidity, benefit plan type, and region of residence. Results: We identified 1251 endopyelotomies, 717 open pyeloplasties, and 1048 minimally invasive pyeloplasties. The adju...
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variation in the use of open pyeloplasty minimally invasive pyeloplasty and endopyelotomy for the treatment of Ureteropelvic Junction Obstruction in adults
Journal of Endourology, 2017Co-Authors: Bruce L Jacobs, Rachana Seelam, Janet M Hanley, Stuart J Wolf, Brent K Hollenbeck, John M Hollingsworth, Andrew W Dick, Claude Messan Setodji, Julie C Lai, Christopher S SaigalAbstract:Abstract Background and Purpose: Ureteropelvic Junction Obstruction is a common condition that can be treated with open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy. While all these treatments are effective, the extent to which they are used is unclear. We sought to examine the dissemination of these treatments. Patients and Methods: Using the MarketScan® database, we identified adults 18 to 64 years old who underwent treatment for Ureteropelvic Junction Obstruction between 2002 and 2010. Our primary outcome was Ureteropelvic Junction Obstruction treatment (i.e., open pyeloplasty, minimally invasive pyeloplasty, endopyelotomy). We fit a multilevel multinomial logistic regression model accounting for patients nested within providers to examine several factors associated with treatment. Results: Rates of minimally invasive pyeloplasty increased 10-fold, while rates of open pyeloplasty decreased by over 40%, and rates of endopyelotomy were relatively stable. Factors associated with receivin...
