Laparoendoscopic single-site surgery(LESS) has been developed to benefit patients by enabling surgeons to perform scarless surgery. In this review we aimed to summarize and critically analyze the available evidence on...Laparoendoscopic single-site surgery(LESS) has been developed to benefit patients by enabling surgeons to perform scarless surgery. In this review we aimed to summarize and critically analyze the available evidence on the current status and future prospects for LESS in pediatric urology, with special emphasis on our experience with LESS in children. The clinical data available clearly demonstrate that LESS can safely and effectively be performed in a variety of pediatric urology settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low; mostly being small case series or case-control studies from selected centers. Thus, the only objective benefit of LESS remains improved cosmetic outcome. Prospective randomized studies are awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technological advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics may be a driving force in the development of LESS.展开更多
Introduction:The main goal of managing an obstructed megaureter(OMU)is to preserve the function of the affected kidney.To preserve the upper urinary tract,end cutaneous ureterostomy(ECU)seems to be a promising tempori...Introduction:The main goal of managing an obstructed megaureter(OMU)is to preserve the function of the affected kidney.To preserve the upper urinary tract,end cutaneous ureterostomy(ECU)seems to be a promising temporizing option.We aimed to evaluate our experience with ECU in patients with primary and secondary OMU and to demonstrate an efficacy of robot-assisted laparoscopic takedown ureterostomy and subsequent extravesical ureteric reimplantation.Materials and methods:Retrospective analysis of patients that underwent ECU due to primary or secondary megaureter between 2003 and 2020.Nineteen patients(12 males,7 females)with a mean age of 4.2±3.5 months(mean±standard deviation)underwent ECU of 27 renal units.Of those,11(57.9%)had primary OMU and 8(42.1%)had secondary OMU.Undiversion was performed in 16(84%)out of 19 patients(20 renal units out of 27[74%]).Results:In the vast majority of the cases,we have observed improvement in the hydronephrosis and renal function after ureterostomy.After reimplantation ultrasonography showed either stable or further improvement in hydronephrosis in 80%of patients.Robot-assisted laparoscopic patients had shorter admission period and indwelling catheter time after the surgery.Conclusions:End cutaneous ureterostomy is a safe and effective temporary procedure for the treatment of progressive primary and secondary megaureters.Robot-assisted laparoscopic takedown of ureterostomy with subsequent reimplantation seems to be a good alternative for undiversion and subsequent reimplantation in these patients.展开更多
Background:The aim of this prospective randomized study was to evaluate the impact of visual guidelines(picture book)and parents tutoring on pediatric urological surgery on parent's stress and anxiety,the number o...Background:The aim of this prospective randomized study was to evaluate the impact of visual guidelines(picture book)and parents tutoring on pediatric urological surgery on parent's stress and anxiety,the number of postoperative contacts,and complications.Materials and methods:Following institutional ethical committee approval,a special picture book reflecting different stages of the convalescent period following multiple types of pediatric urological surgery was developed.Parents were randomly divided into 2 groups in which 33 parents in Group 1 received the picture book in addition to routine instructions prior to the surgery and 31 in Group 2 received only routine postoperative instructions.The parents were asked to answer a questionnaire(Amsterdam Preoperative Anxiety and Information Scale)regarding the level of anxiety before surgery and immediately after surgery in the recovery room.The number of postoperative parent's calls,nonplaned emergency room visits,and complications were recorded.Results:No statistically significant difference in perioperative parental anxiety was found(p=0.88).The visual tutoring group had a significantly lower rate of emergency room admissions(6.6%vs.18.6%,p=0.0433),however parents from this group made a higher number of postoperative calls(9.9%vs.3.1%,p=0.38).Two(6.6%)from the tutoring group expressed their desire to omit visual counseling in future surgical preparation and 4(13.2%)did not have an opinion.Overall satisfaction with regards to the preoperative counseling and information and the number of postoperative complications was similar in both groups.Conclusions:Visual tutoring does not add any value to parental anxiety but seems helpful in reducing postoperative emergency room visits.Some parents preferred to exclude visual information from future preoperative counseling.展开更多
Purpose:To summarize our experience in the management of congenital anomalies in the kidney and urinary tract(CAKUT)in adults.Materials and methods:We conducted a retrospective chart review of all adult patients who u...Purpose:To summarize our experience in the management of congenital anomalies in the kidney and urinary tract(CAKUT)in adults.Materials and methods:We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021.Results:The study included 102 patients with a median age of 25(interquartile range,23-36.5).Of these,85(83.3%)patients reported normal prenatal ultrasound,and the remaining 17(16.7%)patients were diagnosed with antenatal hydronephrosis.These patients were followed-up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care.All studied adult patients presented with the following pathologies:67 ureteropelvic junction obstructions,14 ectopic ureters,9 ureteroceles,and 6 primary obstructive megaureters,and the remaining 6 patients were diagnosed with vesicoureteral reflux.Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles.Notably,67%of patients underwent pyeloplasty,9%underwent endoscopic puncture of ureterocele,3%underwent ureteral reimplantation,6%underwent endoscopic correction of reflux,7%underwent partial nephrectomy of non-functioning moiety,and the remaining 9%underwent robotic-assisted laparoscopic ureteroureterostomy.The median follow-up period after surgery was 33 months(interquartile range,12-54).Post-operative complications occurred in 5 patients(Clavien-Dindo 1-2).Conclusions:Patients with CAKUT present clinical symptoms later in life.Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility,and children should be appropriately counseled when they enter adolescence.Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.展开更多
文摘Laparoendoscopic single-site surgery(LESS) has been developed to benefit patients by enabling surgeons to perform scarless surgery. In this review we aimed to summarize and critically analyze the available evidence on the current status and future prospects for LESS in pediatric urology, with special emphasis on our experience with LESS in children. The clinical data available clearly demonstrate that LESS can safely and effectively be performed in a variety of pediatric urology settings. As clinical experience increases, expanding indications are expected to be documented and the efficacy of the procedure to improve. So far, the quality of evidence of all available studies remains low; mostly being small case series or case-control studies from selected centers. Thus, the only objective benefit of LESS remains improved cosmetic outcome. Prospective randomized studies are awaited to determine which LESS procedures will be established and which are unlikely to stand the test of time. Technological advances hold promise to minimize the challenging technical nature of scarless surgery. In this respect, robotics may be a driving force in the development of LESS.
文摘Introduction:The main goal of managing an obstructed megaureter(OMU)is to preserve the function of the affected kidney.To preserve the upper urinary tract,end cutaneous ureterostomy(ECU)seems to be a promising temporizing option.We aimed to evaluate our experience with ECU in patients with primary and secondary OMU and to demonstrate an efficacy of robot-assisted laparoscopic takedown ureterostomy and subsequent extravesical ureteric reimplantation.Materials and methods:Retrospective analysis of patients that underwent ECU due to primary or secondary megaureter between 2003 and 2020.Nineteen patients(12 males,7 females)with a mean age of 4.2±3.5 months(mean±standard deviation)underwent ECU of 27 renal units.Of those,11(57.9%)had primary OMU and 8(42.1%)had secondary OMU.Undiversion was performed in 16(84%)out of 19 patients(20 renal units out of 27[74%]).Results:In the vast majority of the cases,we have observed improvement in the hydronephrosis and renal function after ureterostomy.After reimplantation ultrasonography showed either stable or further improvement in hydronephrosis in 80%of patients.Robot-assisted laparoscopic patients had shorter admission period and indwelling catheter time after the surgery.Conclusions:End cutaneous ureterostomy is a safe and effective temporary procedure for the treatment of progressive primary and secondary megaureters.Robot-assisted laparoscopic takedown of ureterostomy with subsequent reimplantation seems to be a good alternative for undiversion and subsequent reimplantation in these patients.
文摘Background:The aim of this prospective randomized study was to evaluate the impact of visual guidelines(picture book)and parents tutoring on pediatric urological surgery on parent's stress and anxiety,the number of postoperative contacts,and complications.Materials and methods:Following institutional ethical committee approval,a special picture book reflecting different stages of the convalescent period following multiple types of pediatric urological surgery was developed.Parents were randomly divided into 2 groups in which 33 parents in Group 1 received the picture book in addition to routine instructions prior to the surgery and 31 in Group 2 received only routine postoperative instructions.The parents were asked to answer a questionnaire(Amsterdam Preoperative Anxiety and Information Scale)regarding the level of anxiety before surgery and immediately after surgery in the recovery room.The number of postoperative parent's calls,nonplaned emergency room visits,and complications were recorded.Results:No statistically significant difference in perioperative parental anxiety was found(p=0.88).The visual tutoring group had a significantly lower rate of emergency room admissions(6.6%vs.18.6%,p=0.0433),however parents from this group made a higher number of postoperative calls(9.9%vs.3.1%,p=0.38).Two(6.6%)from the tutoring group expressed their desire to omit visual counseling in future surgical preparation and 4(13.2%)did not have an opinion.Overall satisfaction with regards to the preoperative counseling and information and the number of postoperative complications was similar in both groups.Conclusions:Visual tutoring does not add any value to parental anxiety but seems helpful in reducing postoperative emergency room visits.Some parents preferred to exclude visual information from future preoperative counseling.
文摘Purpose:To summarize our experience in the management of congenital anomalies in the kidney and urinary tract(CAKUT)in adults.Materials and methods:We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021.Results:The study included 102 patients with a median age of 25(interquartile range,23-36.5).Of these,85(83.3%)patients reported normal prenatal ultrasound,and the remaining 17(16.7%)patients were diagnosed with antenatal hydronephrosis.These patients were followed-up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care.All studied adult patients presented with the following pathologies:67 ureteropelvic junction obstructions,14 ectopic ureters,9 ureteroceles,and 6 primary obstructive megaureters,and the remaining 6 patients were diagnosed with vesicoureteral reflux.Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles.Notably,67%of patients underwent pyeloplasty,9%underwent endoscopic puncture of ureterocele,3%underwent ureteral reimplantation,6%underwent endoscopic correction of reflux,7%underwent partial nephrectomy of non-functioning moiety,and the remaining 9%underwent robotic-assisted laparoscopic ureteroureterostomy.The median follow-up period after surgery was 33 months(interquartile range,12-54).Post-operative complications occurred in 5 patients(Clavien-Dindo 1-2).Conclusions:Patients with CAKUT present clinical symptoms later in life.Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility,and children should be appropriately counseled when they enter adolescence.Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.
