Blockage between the kidney and the ureter in infants can be successfully repaired with minimally invasive surgical approaches, according to a Children’s Hospital of Pittsburgh of UPMC study.
Ureteropelvic junction (UPJ) obstruction is the most common obstructive urinary system disease in infants, according to senior investigator Michael Ost, M.D. (pictured), chief, Division of Pediatric Urology at Children’s Hospital. The problem typically has been repaired with a procedure called pyeloplasty, in which an incision is made in the infant’s side to reach and remove scar tissue where the kidney meets the ureter, the tube that carries urine to the bladder.
The minimally invasive approach – called transperitoneal laparoscopic pyeloplasty, which can also be done with robot assistance – has emerged as a safe, effective alternative to the standard open pyeloplasty. Both laparoscopic and open pyeloplasty have comparable effectiveness in pediatric patients, but the role of infants is less well defined.
“This population can be challenging to treat laparascopically because of the small size of the abdomen and caliber of the ureter,” Dr. Ost said.
His team reviewed records of 29 children younger than 12 months old treated with transperitoneal laparoscopic pyeloplasty for UPJ obstruction from May 2005 to February 2012. Of the 24 patients for whom follow-up data was available, 22 (92 percent) had successful repairs. Two patients required a second, open procedure to correct the obstruction.
“Our results show the laparoscopic approach is a safe and effective option for the surgical management of UPJ obstruction in the infant population,” said Dr. Ost. “Our early experience reveals a developing success rate comparable to that of other treatment modalities with minimal morbidity.”
Illustration: Children’s Hospital of Pittsburgh of UPMC.
University of Pittsburgh Schools of Health Sciences News Release (04/10/13)
Children’s Hospital of Pittsburgh of UPMC News Release (04/10/13)
Abstract (The Journal of Urology; Vol. 189, Issue 4, 1503-1507 (04/2013))