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Re: The Management of Secondary Pelvi-Ureteric Junction Obstruction—A Comparison of Pyeloplasty and Endopyelotomy
Urological Survey 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57
Laparoscopy/New Technology Re: The Management of Secondary Pelvi-Ureteric Junction ObstructiondA Comparison of Pyeloplasty and Endopyelotomy M. Vannahme, S. Mathur, K. Davenport, A. G. Timoney and F. X. Keeley, Jr. Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, Gloucestershire, United Kingdom BJU Int 2014; 113: 108e112.
Abstract available at http://jurology.com/ Editorial Comment: Management of secondary ureteropelvic junction obstruction is challenging, given the presence of extensive fibrotic tissue and likely an ischemic ureteral segment. The authors reviewed their experience with 58 cases (41 failed pyeloplasties and 17 failed endopyelotomies) and reported significantly better results with salvage pyeloplasty (87.5% vs 44% for secondary endopyelotomy). They conclude that pyeloplasty (specifically a laparoscopic technique) is the preferred approach for secondary ureteropelvic junction obstruction regardless of prior intervention. However, for failed primary pyeloplasty I still believe that endopyelotomy is a reasonable first approach that has minimal morbidity and a reasonable expectation of success. In fact, in this scenario the authors reported an improved and acceptable success rate of 66% for endopyelotomy. Jeffrey A. Cadeddu, MD
Re: Unfavorable Outcomes of Laparoscopic Pyeloplasty Using Barbed Sutures: A Multi-Center Experience E. Liatsikos, T. Knoll, I. Kyriazis, I. Georgiopoulos, P. Kallidonis, P. Honeck and J. U. Stolzenburg Department of Urology, University of Patras Medical School, Rion, Patras, Greece World J Urol 2013; 31: 1441e1444.
Abstract available at http://jurology.com/ Editorial Comment: This is a small series of 6 dismembered pyeloplasty cases where a 4-zero monofilament barbed suture was used for the anastomosis. Five of the 6 cases failed, requiring salvage endurological or open intervention. The surgeons are highly experienced, with the only change in technique being the barbed suture. Early publication of such a high failure rate should serve as a warning to others. If others have a different experience, then publication is strongly encouraged. I, for one, have not used the barbed sutures for the pelviureteral anastomosis, given concerns that if the suture is pulled too tightly, it could inadvertently render the anastomosis ischemic. I have advocated these sutures for renorrhaphy during robotic partial nephrectomy and
0022-5347/14/1921-0001/0 THE JOURNAL OF UROLOGY® © 2014 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2014.04.031 Vol. 192, 1-2, July 2014 Printed in U.S.A.
www.jurology.com Dochead: Urological Survey
LIT 5.2.0 DTD JURO11405_proof 16 April 2014 2:35 pm EO:
j
58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 1 113 114
LAPAROSCOPY/NEW TECHNOLOGY
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for urethrovesical anastomosis during robotic prostatectomy but the tissue bulk in these procedures likely minimizes the risk of complete tissue ischemia. Until other publications are available, barbed sutures for pyeloplasty should be used cautiously. Jeffrey A. Cadeddu, MD
Dochead: Urological Survey
LIT 5.2.0 DTD JURO11405_proof 16 April 2014 2:35 pm EO:
177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238
Laparoscopy/New Technology Re: The Management of Secondary Pelvi-Ureteric Junction ObstructiondA Comparison of Pyeloplasty and Endopyelotomy M. Vannahme, S. Mathur, K. Davenport, A. G. Timoney and F. X. Keeley, Jr. Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, Gloucestershire, United Kingdom BJU Int 2014; 113: 108e112.
Abstract available at http://jurology.com/ Editorial Comment: Management of secondary ureteropelvic junction obstruction is challenging, given the presence of extensive fibrotic tissue and likely an ischemic ureteral segment. The authors reviewed their experience with 58 cases (41 failed pyeloplasties and 17 failed endopyelotomies) and reported significantly better results with salvage pyeloplasty (87.5% vs 44% for secondary endopyelotomy). They conclude that pyeloplasty (specifically a laparoscopic technique) is the preferred approach for secondary ureteropelvic junction obstruction regardless of prior intervention. However, for failed primary pyeloplasty I still believe that endopyelotomy is a reasonable first approach that has minimal morbidity and a reasonable expectation of success. In fact, in this scenario the authors reported an improved and acceptable success rate of 66% for endopyelotomy. Jeffrey A. Cadeddu, MD
Re: Unfavorable Outcomes of Laparoscopic Pyeloplasty Using Barbed Sutures: A Multi-Center Experience E. Liatsikos, T. Knoll, I. Kyriazis, I. Georgiopoulos, P. Kallidonis, P. Honeck and J. U. Stolzenburg Department of Urology, University of Patras Medical School, Rion, Patras, Greece World J Urol 2013; 31: 1441e1444.
Abstract available at http://jurology.com/ Editorial Comment: This is a small series of 6 dismembered pyeloplasty cases where a 4-zero monofilament barbed suture was used for the anastomosis. Five of the 6 cases failed, requiring salvage endurological or open intervention. The surgeons are highly experienced, with the only change in technique being the barbed suture. Early publication of such a high failure rate should serve as a warning to others. If others have a different experience, then publication is strongly encouraged. I, for one, have not used the barbed sutures for the pelviureteral anastomosis, given concerns that if the suture is pulled too tightly, it could inadvertently render the anastomosis ischemic. I have advocated these sutures for renorrhaphy during robotic partial nephrectomy and
0022-5347/14/1921-0001/0 THE JOURNAL OF UROLOGY® © 2014 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2014.04.031 Vol. 192, 1-2, July 2014 Printed in U.S.A.
www.jurology.com Dochead: Urological Survey
LIT 5.2.0 DTD JURO11405_proof 16 April 2014 2:35 pm EO:
j
58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 1 113 114
LAPAROSCOPY/NEW TECHNOLOGY
2
115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176
for urethrovesical anastomosis during robotic prostatectomy but the tissue bulk in these procedures likely minimizes the risk of complete tissue ischemia. Until other publications are available, barbed sutures for pyeloplasty should be used cautiously. Jeffrey A. Cadeddu, MD
Dochead: Urological Survey
LIT 5.2.0 DTD JURO11405_proof 16 April 2014 2:35 pm EO:
177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238