Multicenter comparative study of open, laparoscopic, and robotic pyeloplasty in the pediatric population for the treatment of ureteropelvic junction obstruction (UPJO)
Por:
Gonzalez, ST, Rosito, TE, Tur, AB, Ruiz, J, Gozalbez, R, Maiolo, A, Tavares, PM, Gorgen, ARH, de Kencht, EL, Madarriaga, YQ, Weller, S, Tobia, IP, Castellan, M, Corbetta, JP
Publicada:
1 nov 2022
Resumen:
Introduction: Dismembered open pyeloplasty described by Anderson and Hynes is the "gold standard" for the treatment of ureteropelvic junction obstruction. The aim of our study was to compare the results of open (OP) vs laparoscopic (LP) vs robotic (RALP) pyeloplasty.
Material and Methods: A multicenter prospective review was conducted of pyeloplasty surgeries performed at five high-volume centers between 2014 and 2018. Demographic data, history of prenatal hydronephrosis, access type, MAG3 renogram and differential renal function, surgery time, length of hospital stay, and complication rate (Clavien-Dindo) were recorded. Access type was compared using the Kruskal-Wallis, Chi-square, or Fisher's exact tests.
Results: A total of 322 patients were included: 62 OP, 86 LP, and 174 RALP. The mean age was 8.13 (r: 1-16) years, with a statistically significant lower age (mean 5 years) in OP (p < 0.001). There were no significant differences in the distribution of the side affected. Operative time was 110.5 min for OP, 140 min for LP, and 179 min for RALP (p < 0.0001). Hospital stay was significantly shorter in the RALP group than in the other groups (p < 0.0001). There were no differences in postoperative complications and reoperations between the three groups.
Conclusions: Minimally invasive surgery for the management of UPJO in children is gaining more acceptance, even in patients younger than 1-year-old. Operative time continues to be significantly shorter in OP than in LP and RALP. Hospital stay was shorter in RALP compared to the other techniques. No differences were found in complication rates, type of complications, and reoperation rate.
Filiaciones:
Gonzalez, ST:
Univ Nacl la Plata UNLP, Dept Urol, La Plata, Buenos Aires, Argentina
Hosp Interzonal Especializado Pediat Sor Maria Lu, Dept Urol, La Plata, Buenos Aires, Argentina
Rosito, TE:
Hosp Clin Porto Alegre, Dept Urol, Grp Urol Reconstrut & Infantil GURI, Rua Ramiro Barcelos 2350, BR-90035903 Porto Alegre, RS, Brazil
Univ Fed Rio Grande do Sul, Programa Posgrad Ginecol & Obstet, Porto Alegre, RS, Brazil
Tur, AB:
Fundacio Puigvert, Dept Pediat Urol, Barcelona, Catalunya, Spain
Ruiz, J:
Hosp Pediat Prof Dr Juan P Garrahan, Dept Urol, Buenos Aires, DF, Argentina
Gozalbez, R:
Nicklaus Childrens Hosp, Div Pediat Urol, Miami, FL USA
Maiolo, A:
Hosp Interzonal Especializado Pediat Sor Maria Lu, Dept Urol, La Plata, Buenos Aires, Argentina
Tavares, PM:
Hosp Clin Porto Alegre, Dept Urol, Grp Urol Reconstrut & Infantil GURI, Rua Ramiro Barcelos 2350, BR-90035903 Porto Alegre, RS, Brazil
Univ Fed Rio Grande do Sul, Programa Posgrad Ginecol & Obstet, Porto Alegre, RS, Brazil
Gorgen, ARH:
Hosp Clin Porto Alegre, Dept Urol, Grp Urol Reconstrut & Infantil GURI, Rua Ramiro Barcelos 2350, BR-90035903 Porto Alegre, RS, Brazil
de Kencht, EL:
Fundacio Puigvert, Dept Pediat Urol, Barcelona, Catalunya, Spain
Madarriaga, YQ:
Fundacio Puigvert, Dept Pediat Urol, Barcelona, Catalunya, Spain
Weller, S:
Hosp Pediat Prof Dr Juan P Garrahan, Dept Urol, Buenos Aires, DF, Argentina
Tobia, IP:
Univ Nacl la Plata UNLP, Dept Urol, La Plata, Buenos Aires, Argentina
Castellan, M:
Nicklaus Childrens Hosp, Div Pediat Urol, Miami, FL USA
Corbetta, JP:
Hosp Pediat Prof Dr Juan P Garrahan, Dept Urol, Buenos Aires, DF, Argentina
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