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V576 RETROPERITONEOSCOPIC MINIPORT PYELOPLASTY IN CHILDREN: A SINGLE-CENTER EXPERIENCE
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THE JOURNAL OF UROLOGY姞
Source of Funding: None
V575
Vol. 189, No. 4S, Supplement, Sunday, May 5, 2013
is comparable to open pyeloplasty regarding success rates. Experience with miniport LPP however remains limited. We aim to present our outcomes for retroperitoneoscopic miniport LPP for UPJO. METHODS: Between April 2011 and October 2012 a total of 16 patients were operated for UPJO using the miniport LPP technique. After the retrograde pyelography, retroperitoneal access was achieved under the vision of a 5mm 30° telescope at the 90° flank position, with the aid of balloon dilatation. One 5mm trocar for telescope and a pair of 3.5mm trocars were applied. The proximal ureter was dissected with bluntly, and the ureter was spatulated without being separated from the kidney pelvis. Pyeloplasty was performed by Anderson-Hynes technique using 5/0 vicryl. After pyeloplasty, a JJ stent was placed and the drain was left in situ in the retroperitoneal space. RESULTS: Ten boys and six girls with an average age of 8.57⫾5.62 (1-17) years were evaluated. 11 cases were on the left and 5 were on the right side. Mean operation time was 123.4⫾32.1 (80-190) minutes, blood loss was minimal and hospital stay was 2.93⫾1.9(2-9) days. One minor complication (Clavien classification) was present. By the end of 3 months, no obstruction was observed in 15 cases scintigraphically. In the remaining one case while there were improvement both clinically and ultrasonographically however no change was observed on MAG-3 scintigraphy. CONCLUSIONS: Retroperitoneoscopic miniport pyeloplasty is a feasable technique to be preferred in terms of functional and cosmetic aspect.
TWO STAGE COMPLEX HYPOSPADIA REPAIR WHEN URETHRAL PLATE HAS TO BE DIVIDED: VENTRAL CORPOROPLASTY USING A TUNICA VAGINALIS FLAP Antonio Macedo Jr*, Herick Bacelar, Luis Branda˜o, Ricardo Mattos, Sergio Ottoni, Riberto Liguori, Gilmar Garrone, Bruno Leslie, Valdemar Ortiz, Sa˜o Paulo, Brazil INTRODUCTION AND OBJECTIVES: Treatment of posterior hypospadia is an ongoing debate. One stage repair is still our preference but in some circumstances, penile curvature remains even after urethral plate division. We wanted to demonstrate our strategy of ventral corporoplasty associated with tunica vaginalis flap to reconstruct the corporal body in a two-stage strategy for proximal hypospadia surgery. METHODS: We present the video of a 4 years old boy referred for primary repair. We degloved the penis and defined the urethral plate before deciding to section it. The assessment of residual curvature after complete urethral plate division and transverse superficial cuts in albuginea forced us to perform a ventral incision of corporal body to elongate the ventral surface of the penis. We gained access to the scrotum and defined a tunica vaginalis flap. This flap was then used to reconstruct the defect in corpora and penile skin was remodelled to cover the penis, keeping the meatus in proximal place. A second surgery was scheduled for s 6 months interval. RESULTS: Patient had an uneventful follow-up, we left an indwelling catheter for 7 days. Penile aspect is very satisfactory with no residual curvature. CONCLUSIONS: The tunica vaginalis is an attractive alternative for ventral corporoplasty in hypospadia repair and has the advantage of prompt disposability, autologous use and does not represent a extra cost for treatment. We acknowledge the need of long term follow-up in adolescence to evaluate sexual function and quality of erections in the long setting. Source of Funding: None
V576 RETROPERITONEOSCOPIC MINIPORT PYELOPLASTY IN CHILDREN: A SINGLE-CENTER EXPERIENCE Ender Ozden*, Yakup Bostanci, Fatih Atac, Gurkan Genc, Yarkin Kamil Yakupoglu, Aykut Sy´rtbas, Ozan Ozkaya, Saban Sarikaya, Samsun, Turkey INTRODUCTION AND OBJECTIVES: Laparoscopic pyeloplasty (LPP) for treatment of ureteropelvic junction obstruction (UPJO)
Source of Funding: None
V577 PEDIATRIC ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY IN HORSESHOE KIDNEY Candace F. Granberg*, Rochester, MN; Daniel DaJusta, Louisville, KY; Patricio Gargollo, Dallas, TX INTRODUCTION AND OBJECTIVES: The surgical approach to ureteropelvic junction obstruction (UPJO) in horseshoe kidneys is challenging secondary to the inherent aberrant anatomy. Historically, some have recommended division of the isthmus, while others have advocated transection of crossing vessels, both of which carry risk of nephron damage or loss. With the advent of minimally-invasive surgery, robotic-assisted laparoscopic pyeloplasty (RALP) has become routine in otherwise anatomically normal kidneys; however, there is limited data on the robotic approach to UPJO in children with horseshoe kidneys. Thus, the objective of this video is to detail the surgical approach to RALP in the horseshoe kidney. METHODS: Hidden incision endoscopic surgery (HIdES) was developed at our institution, and is applied in all RALP cases. One robotic port is placed infraumbilically, while all remaining ports are hidden below the level of a Pfannensteil incision, thus rendering them nonvisibile when wearing a bathing suit. A 5mm assist port is optional.
THE JOURNAL OF UROLOGY姞
Source of Funding: None
V575
Vol. 189, No. 4S, Supplement, Sunday, May 5, 2013
is comparable to open pyeloplasty regarding success rates. Experience with miniport LPP however remains limited. We aim to present our outcomes for retroperitoneoscopic miniport LPP for UPJO. METHODS: Between April 2011 and October 2012 a total of 16 patients were operated for UPJO using the miniport LPP technique. After the retrograde pyelography, retroperitoneal access was achieved under the vision of a 5mm 30° telescope at the 90° flank position, with the aid of balloon dilatation. One 5mm trocar for telescope and a pair of 3.5mm trocars were applied. The proximal ureter was dissected with bluntly, and the ureter was spatulated without being separated from the kidney pelvis. Pyeloplasty was performed by Anderson-Hynes technique using 5/0 vicryl. After pyeloplasty, a JJ stent was placed and the drain was left in situ in the retroperitoneal space. RESULTS: Ten boys and six girls with an average age of 8.57⫾5.62 (1-17) years were evaluated. 11 cases were on the left and 5 were on the right side. Mean operation time was 123.4⫾32.1 (80-190) minutes, blood loss was minimal and hospital stay was 2.93⫾1.9(2-9) days. One minor complication (Clavien classification) was present. By the end of 3 months, no obstruction was observed in 15 cases scintigraphically. In the remaining one case while there were improvement both clinically and ultrasonographically however no change was observed on MAG-3 scintigraphy. CONCLUSIONS: Retroperitoneoscopic miniport pyeloplasty is a feasable technique to be preferred in terms of functional and cosmetic aspect.
TWO STAGE COMPLEX HYPOSPADIA REPAIR WHEN URETHRAL PLATE HAS TO BE DIVIDED: VENTRAL CORPOROPLASTY USING A TUNICA VAGINALIS FLAP Antonio Macedo Jr*, Herick Bacelar, Luis Branda˜o, Ricardo Mattos, Sergio Ottoni, Riberto Liguori, Gilmar Garrone, Bruno Leslie, Valdemar Ortiz, Sa˜o Paulo, Brazil INTRODUCTION AND OBJECTIVES: Treatment of posterior hypospadia is an ongoing debate. One stage repair is still our preference but in some circumstances, penile curvature remains even after urethral plate division. We wanted to demonstrate our strategy of ventral corporoplasty associated with tunica vaginalis flap to reconstruct the corporal body in a two-stage strategy for proximal hypospadia surgery. METHODS: We present the video of a 4 years old boy referred for primary repair. We degloved the penis and defined the urethral plate before deciding to section it. The assessment of residual curvature after complete urethral plate division and transverse superficial cuts in albuginea forced us to perform a ventral incision of corporal body to elongate the ventral surface of the penis. We gained access to the scrotum and defined a tunica vaginalis flap. This flap was then used to reconstruct the defect in corpora and penile skin was remodelled to cover the penis, keeping the meatus in proximal place. A second surgery was scheduled for s 6 months interval. RESULTS: Patient had an uneventful follow-up, we left an indwelling catheter for 7 days. Penile aspect is very satisfactory with no residual curvature. CONCLUSIONS: The tunica vaginalis is an attractive alternative for ventral corporoplasty in hypospadia repair and has the advantage of prompt disposability, autologous use and does not represent a extra cost for treatment. We acknowledge the need of long term follow-up in adolescence to evaluate sexual function and quality of erections in the long setting. Source of Funding: None
V576 RETROPERITONEOSCOPIC MINIPORT PYELOPLASTY IN CHILDREN: A SINGLE-CENTER EXPERIENCE Ender Ozden*, Yakup Bostanci, Fatih Atac, Gurkan Genc, Yarkin Kamil Yakupoglu, Aykut Sy´rtbas, Ozan Ozkaya, Saban Sarikaya, Samsun, Turkey INTRODUCTION AND OBJECTIVES: Laparoscopic pyeloplasty (LPP) for treatment of ureteropelvic junction obstruction (UPJO)
Source of Funding: None
V577 PEDIATRIC ROBOTIC-ASSISTED LAPAROSCOPIC PYELOPLASTY IN HORSESHOE KIDNEY Candace F. Granberg*, Rochester, MN; Daniel DaJusta, Louisville, KY; Patricio Gargollo, Dallas, TX INTRODUCTION AND OBJECTIVES: The surgical approach to ureteropelvic junction obstruction (UPJO) in horseshoe kidneys is challenging secondary to the inherent aberrant anatomy. Historically, some have recommended division of the isthmus, while others have advocated transection of crossing vessels, both of which carry risk of nephron damage or loss. With the advent of minimally-invasive surgery, robotic-assisted laparoscopic pyeloplasty (RALP) has become routine in otherwise anatomically normal kidneys; however, there is limited data on the robotic approach to UPJO in children with horseshoe kidneys. Thus, the objective of this video is to detail the surgical approach to RALP in the horseshoe kidney. METHODS: Hidden incision endoscopic surgery (HIdES) was developed at our institution, and is applied in all RALP cases. One robotic port is placed infraumbilically, while all remaining ports are hidden below the level of a Pfannensteil incision, thus rendering them nonvisibile when wearing a bathing suit. A 5mm assist port is optional.