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INTRODUCTION: Anderson-Hynes pyeloplasty is the technique of choice for the treatment of pyeloureteral junction obstruction (PUJO) with an excellent success rate. Minimally invasive surgery has become the standard of care for the management of PUJO in children. Although it has been comparable to the open approach at all levels, its diffusion or employment in younger children has not been widely adopted. Our aim is to evaluate laparoscopic pyeloplasty outcomes from international academic centers in children under 1 year of age, focusing on feasibility and outcomes including possible complications. MATERIALS AND METHODS: This is review of consecutive infants under 1 year of age who underwent laparoscopic pyeloplasty between 2009 and 2018 with more than 12 months of follow-up. Seven different training centers with different backgrounds participated in this study. Evaluation was carried out with ultrasound and renogram before and after surgery. Demographic data, perioperative characteristics, complications, and results are described and analyzed. RESULTS: Over 9 years, 124 transperitoneal laparoscopic Anderson-Hynes pyeloplasties were performed on 123 children under 1 year of age; 88 males and 35 females, with 1 case of bilateral PUJO. Of the 124 renal units, 86 were left-sided. Mean age at surgery was 6.6 months (1 week-12 months), with 56% (n = 70) done before 6 months of age. Mean weight at surgery was 6.8 kg (3-12 kg), with 59% (n = 73) weighing less than 8 kg. Mean operative time (skin-to-skin) was 150 min (75-330 min). After a mean follow-up of 46 months (12-84 months), 12 (9%) patients developed complications, with only 1 needing a redo pyeloplasty also done laparoscopically. One child, with deterioration in renal function, underwent nephrectomy. CONCLUSION: Laparoscopic pyeloplasty under 1 year of age and/or less than 12 kilos is feasible with lower complication rate. Furthermore, age younger than 6 months and weight less than 8 kg are no longer limiting factors for a successful pyeloplasty as shown by this multicentre study.

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PURPOSE: The Anderson-Hynes technique has been the treatment of choice for primary ureteropelvic junction obstruction in children. Laparoscopic approach has shown similar outcomes to open, with advantages of shorter hospital stay and less pain. We reviewed the experience of 11 geographically diverse, tertiary pediatric urology institutions focusing on the outcomes and complications of laparoscopic pyeloplasty. MATERIALS AND METHODS: A descriptive, retrospective study was conducted evaluating patients undergoing Anderson-Hynes dismembered laparoscopic pyeloplasty. Centers from four different continents participated. Demographic data, perioperative management, results, and complications are described. RESULTS: Over a 9-year period, 744 laparoscopic pyeloplasties were performed in 743 patients. Mean follow-up was 31 months (6-120m). Mean age at surgery was 82 months (1 w-19 y). Median operative time was 177 min. An internal stent was placed in 648 patients (87%). A catheter was placed for bladder drainage in 702 patients (94%). Conversion to open pyeloplasty was necessary in seven patients. Average length of hospital stay was 2.8 days. Mean time of analgesic requirement was 3.2 days. Complications, according to Clavien-Dindo classification, were observed in 56 patients (7.5%); 10 (1%) were Clavien-Dindo IIIb. Treatment failure occurred in 35 cases with 30 requiring redo pyeloplasty (4%) and 5 cases requiring nephrectomy (0.6%). CONCLUSION: We have described the laparoscopic pyeloplasty experience of institutions with diverse cultural and economic backgrounds. They had very similar outcomes, in agreement with previously published data. Based on these findings, we conclude that laparoscopic pyeloplasty is safe and successful in diverse geographics areas of the world.

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ABSTRACT We describe a step by step technique for open distal ureteroureterostomy (UU) in infants less than 6 months presenting with duplex collecting system and upper pole ectopic ureter in the absence of vesicoureteral reflux (VUR).

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We describe a step by step technique for open distal ureteroureterostomy (UU) in infants less than 6 months presenting with duplex collecting system and upper pole ectopic ureter in the absence of vesicoureteral reflux (VUR).

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OBJECTIVE: To compare the efficacy and safety of lidocaine gel vs nonanesthetic gel (NAG) in reducing transurethral bladder catheterization (TUBC) procedural pain in children. STUDY DESIGN: A systematic literature search was done using electronic medical databases and trial registries up to September 2016 with no language restrictions. Randomized controlled trials (RCTs) that assessed the efficacy and safety of lidocaine gel vs NAG in reducing TUBC-associated pain in children were screened, identified, and appraised. Risks of bias and study quality of the eligible trials were assessed according to the Cochrane Collaboration recommendations. Various pain assessment scales from the included studies were extracted as mean differences and standard deviations for each treatment group. Standardized mean differences (SMDs) were generated with 95% CIs for between-group difference estimation. Effect estimates were pooled using the inverse variance method with a random-effects model. Subgroup analysis was performed for different age groups. RESULTS: Five RCTs (with a total of 369 children) were included. Overall pooled effect estimates showed that compared with NAG, lidocaine gel has no significant benefit in decreasing TUBC-associated pain in children (SMD, -0.22; 95% CI, -0.65 to 0.21). Effect estimates from 4 studies revealed no difference in pain reduction between the lidocaine gel and NAG in children aged <4 years (SMD, 0.01; 95% CI, -0.22 to 0.24). No serious adverse events from the lidocaine gel use were reported in any of the studies. CONCLUSIONS: Lidocaine gel does not appear to reduce TUBC pain compared with NAG, specifically in children aged <4 years. PROSPERO REGISTRATION NUMBER: CRD42016050018.

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OBJECTIVE: To compare the characteristics of prenatally and postnatally diagnosed ureteropelvic junction obstruction (UPJO) in children. PATIENTS AND METHODS: We reviewed the records of 74 children who underwent pyeloplasty or nephrectomy for UPJO between 1995 and 2000. The patients were divided into 2 groups: prenatally and postnatally diagnosed UPJO. In each group, we compared age at surgery, gender, affected side, anteroposterior diameter (APD) of the renal pelvis, surgical findings, and renal function as determined by creatinine clearance. RESULTS: Of the 74 children, 44 (59.4 percent) had a prenatal diagnosis of UPJO and 30 (40.6 percent) had a postnatal diagnosis despite the fact that all had had a fetal ultrasonography. Median age at the time of surgery was 6.3 years (4 months to 16 years) for children with postnatal UPJO and 3.6 months (1 month to 4 years) for the prenatal group. Forty-three percent of the children in the postnatal group and 25 percent in the prenatal group were females. Clinical manifestations in children with postnatal UPJO included abdominal pain in 13 (43 percent) patients, pyelonephritis in 7 (23 percent), urinary tract infection in 5 (16.6 percent), and occasional findings upon ultrasound in 5 (16.6 percent). Excretory urography suggested obstruction in most children. The surgical findings included ureteral kinks due to adhesions in 93.3 percent of postnatally diagnosed UPJO cases and in 27.3 percent of prenatal cases (p < 0.01). A reduction in mean creatinine clearance of hydronephrotic kidneys was observed for both groups when compared to reference values for the respective ages, but this difference was not statistically significant. CONCLUSIONS: Postnatally diagnosed UPJO may be considered, at least in part, an entity different from prenatally detected obstruction due to its peculiar characteristics, i.e., postnatal UPJO more frequently affects females, manifests later in life with urinary infection or abdominal pain, and is frequently associated with ureteral kinking.

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OBJECTIVE: To compare the characteristics of prenatally and postnatally diagnosed ureteropelvic junction obstruction (UPJO) in children. PATIENTS AND METHODS: We reviewed the records of 74 children who underwent pyeloplasty or nephrectomy for UPJO between 1995 and 2000. The patients were divided into 2 groups: prenatally and postnatally diagnosed UPJO. In each group, we compared age at surgery, gender, affected side, anteroposterior diameter (APD) of the renal pelvis, surgical findings, and renal function as determined by creatinine clearance. RESULTS: Of the 74 children, 44 (59.4%) had a prenatal diagnosis of UPJO and 30 (40.6%) had a postnatal diagnosis despite the fact that all had had a fetal ultrasonography. Median age at the time of surgery was 6.3 years (4 months to 16 years) for children with postnatal UPJO and 3.6 months (1 month to 4 years) for the prenatal group. Forty-three percent of the children in the postnatal group and 25% in the prenatal group were females. Clinical manifestations in children with postnatal UPJO included abdominal pain in 13 (43%) patients, pyelonephritis in 7 (23%), urinary tract infection in 5 (16.6%), and occasional findings upon ultrasound in 5 (16.6%). Excretory urography suggested obstruction in most children. The surgical findings included ureteral kinks due to adhesions in 93.3% of postnatally diagnosed UPJO cases and in 27.3% of prenatal cases (p < 0.01). A reduction in mean creatinine clearance of hydronephrotic kidneys was observed for both groups when compared to reference values for the respective ages, but this difference was not statistically significant. CONCLUSIONS: Postnatally diagnosed UPJO may be considered, at least in part, an entity different from prenatally detected obstruction due to its peculiar characteristics, i.e., postnatal UPJO more frequently affects females, manifests later in life with urinary infection or abdominal pain, and is frequently associated with ureteral kinking.