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Arthur D. Smith - One of the best experts on this subject based on the ideXlab platform.
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Percutaneous Surgery for Ureteropelvic Junction Obstruction (Endopyelotomy): Technique and Early Results
The Journal of Urology, 2017Co-Authors: Gopal H Badlani, Majid Eshghi, Arthur D. SmithAbstract:AbstractWe incised Ureteropelvic Junction obstruction in 31 patients with a cold knife direct-vision urethrotome inserted through a percutaneous nephrostomy tract. In 12 patients renal calculi were removed endourologically during the same session. There were no immediate complications and nephrostograms showed adequate drainage in all cases. Of these patients 8 had previously undergone open pyeloplasty without success. The longest followup is almost 2 years. There have been 4 failures and, thus, the success rate is 87.1 per cent.
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Ureteropelvic Junction obstruction repair when how what
Current Opinion in Urology, 2004Co-Authors: Beng Jit Tan, Arthur D. SmithAbstract:Purpose of reviewTo review factors that affect the success of Ureteropelvic Junction obstruction repair and recent developments in minimally invasive procedures for the repair of Ureteropelvic Junction obstruction.Recent findingsRecent reports and studies further confirm earlier findings that the su
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a multicenter clinical trial investigating the use of a fluoroscopically controlled cutting balloon catheter for the management of ureteral and Ureteropelvic Junction obstruction
The Journal of Urology, 1997Co-Authors: Glenn M Preminger, Ralph V Clayman, Stephen Y Nakada, Richard K Babayan, David M Albala, Gerhard J Fuchs, Arthur D. SmithAbstract:AbstractPurpose: We assessed the efficacy of a fluoroscopically controlled cutting balloon catheter for the treatment of Ureteropelvic Junction and ureteral strictures.Materials and Methods: A multicenter trial was performed that included66 endopyelotomies and 49 endoureterotomies. To our knowledge this study represents the largest number of patients with Ureteropelvic Junction obstruction and ureteral strictures tested with this device to date.Results: With a mean followup of 7.8 months (range 1 to 17.9) the patency rate was 77% for endopyelotomy, with 72% of the primary and 100% of the secondary Ureteropelvic Junction obstructions remaining patent. The endoureterotomy patients were followed for an average of 8.7 months (range 1.2 to 17.0), with a patency rate of 55%.Conclusions: A cutting balloon endoscopic incision is effective in the majority of cases, with patency rates for endopyelotomies and endoureterotomies that mirror current endourological reports using other, albeit more time intensive and mor...
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new technique in managing Ureteropelvic Junction obstruction percutaneous endoscopic pyeloplasty
Journal of Endourology, 1996Co-Authors: Gary S Oshinsky, Thomas W Jarrett, Arthur D. SmithAbstract:Endopyelotomy is currently advocated for management of the obstructed Ureteropelvic Junction (UPJ). Healing of the stented UPJ occurs by secondary intention. Regardless of the method employed, success rates approach 85%. In order to increase the rate of success, we have devised a method of performing endopyelotomy in conJunction with endoscopic suturing of the incised UPJ. Two methods were developed to allow for the placement of a single absorbable monofilament suture. In the first method, endopyelotomy is carried out in the standard antegrade manner, and endoscopic suturing is performed with the use of a second retroperitoneal access sheath at the UPJ. In the second method, endoscopic placement of the suture is carried out through the standard renal access sheath, with suturing performed via the nephroscope. We have performed endoscopic pyeloplasty in eight patients. With a mean follow-up of 12 months, the procedure was successful in seven of these patients. Endoscopic suturing of the UPJ is technically demanding, but once sufficient expertise is gained, it may be utilized for immediate tissue coaptation, possibly decreasing urinary extravasation and, it is hoped, maximizing the caliber of the UPJ.
Ralph V Clayman - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic pyeloplasty for secondary Ureteropelvic Junction obstruction
The Journal of Urology, 2003Co-Authors: Chandru P Sundaram, Elspeth M Mcdougall, Robert L Grubb, Jamil Rehman, Yan Yan, Cathy Chen, Jaime Landman, Ralph V ClaymanAbstract:ABSTRACTPurpose: Laparoscopic pyeloplasty has become a viable option for the treatment of select patients with primary Ureteropelvic Junction obstruction with success rates similar to those of open surgery. However, little has been written on the application of this technique for secondary Ureteropelvic Junction obstruction. We report the largest series of secondary Ureteropelvic Junction obstruction managed by laparoscopic pyeloplasty.Materials and Methods: Between March 1994 and March 2001, 36 patients underwent laparoscopic transperitoneal pyeloplasty for secondary Ureteropelvic Junction obstruction. The patients had undergone an average of 1.3 Ureteropelvic Junction procedures (range 1 to 4) prior to presentation, including cutting balloon retrograde endopyelotomy in 28, antegrade endoscopic endopyelotomy in 7, retrograde endoscopic endopyelotomy in 4, retrograde balloon dilation in 4 and open pyeloplasty in 3. A preoperative diagnosis of recurrent obstruction was confirmed by renal scan in 31 cases, ...
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a multicenter clinical trial investigating the use of a fluoroscopically controlled cutting balloon catheter for the management of ureteral and Ureteropelvic Junction obstruction
The Journal of Urology, 1997Co-Authors: Glenn M Preminger, Ralph V Clayman, Stephen Y Nakada, Richard K Babayan, David M Albala, Gerhard J Fuchs, Arthur D. SmithAbstract:AbstractPurpose: We assessed the efficacy of a fluoroscopically controlled cutting balloon catheter for the treatment of Ureteropelvic Junction and ureteral strictures.Materials and Methods: A multicenter trial was performed that included66 endopyelotomies and 49 endoureterotomies. To our knowledge this study represents the largest number of patients with Ureteropelvic Junction obstruction and ureteral strictures tested with this device to date.Results: With a mean followup of 7.8 months (range 1 to 17.9) the patency rate was 77% for endopyelotomy, with 72% of the primary and 100% of the secondary Ureteropelvic Junction obstructions remaining patent. The endoureterotomy patients were followed for an average of 8.7 months (range 1.2 to 17.0), with a patency rate of 55%.Conclusions: A cutting balloon endoscopic incision is effective in the majority of cases, with patency rates for endopyelotomies and endoureterotomies that mirror current endourological reports using other, albeit more time intensive and mor...
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). ...
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comparison of open and endourologic approaches to the obstructed Ureteropelvic Junction
Urology, 1995Co-Authors: Louis R Kavoussi, Glenn M Preminger, James D Brooks, William W SchuesslerAbstract:Abstract Objectives To compare open pyeloplasty with three minimally invasive modalities: antegrade endopyelotomy, Acucise endopyelotomy (Applied Medical, Laguna Hills, Calif), and laparoscopic pyeloplasty. Methods Forty-five adult patients with Ureteropelvic Junction obstruction were managed by one of the above four techniques. Success rates, analgesic use, length of hospital stay, recovery time, and complications were compared between each of the four groups. Results Successful relief of obstruction was achieved in 100% of patients undergoing open and laparoscopic dismembered pyeloplasty, 78% undergoing Acucise endopyelotomy, and 77% undergoing antegrade percutaneous endopyelotomy. Acucise endopyelotomy results in shorter convalescence (1 week) than antegrade endopyelotomy (4.7 weeks), laparoscopic pyeloplasty (2.3 weeks) or open pyeloplasty (10.3 weeks). Complication rates appear to be similar among all groups. Conclusions Our limited data imply that Acucise endopyelotomy offers low morbidity with success rates comparable to antegrade pyeloplasty, whereas laparoscopic pyeloplasty is as effective as open pyeloplasty with diminished morbidity.
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...
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). ...
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new technique in managing Ureteropelvic Junction obstruction percutaneous endoscopic pyeloplasty
Journal of Endourology, 1996Co-Authors: Gary S Oshinsky, Thomas W Jarrett, Arthur D. SmithAbstract:Endopyelotomy is currently advocated for management of the obstructed Ureteropelvic Junction (UPJ). Healing of the stented UPJ occurs by secondary intention. Regardless of the method employed, success rates approach 85%. In order to increase the rate of success, we have devised a method of performing endopyelotomy in conJunction with endoscopic suturing of the incised UPJ. Two methods were developed to allow for the placement of a single absorbable monofilament suture. In the first method, endopyelotomy is carried out in the standard antegrade manner, and endoscopic suturing is performed with the use of a second retroperitoneal access sheath at the UPJ. In the second method, endoscopic placement of the suture is carried out through the standard renal access sheath, with suturing performed via the nephroscope. We have performed endoscopic pyeloplasty in eight patients. With a mean follow-up of 12 months, the procedure was successful in seven of these patients. Endoscopic suturing of the UPJ is technically demanding, but once sufficient expertise is gained, it may be utilized for immediate tissue coaptation, possibly decreasing urinary extravasation and, it is hoped, maximizing the caliber of the UPJ.
