@misc{Panek_Wojciech_Outcomes_2020,
 author={Panek, Wojciech},
 address={Kraków},
 howpublished={online},
 year={2020},
 school={Rada Dyscypliny Nauki medyczne},
 language={pol; eng},
 abstract={Background Intrinsic pathology of the ureter as well as various extrinsic factors can impair emptying of the collecting system. Uretero-pelvic junction obstruction (UPJO) can lead to deterioration of the renal function. Mild hydronephrosis in the majority of neonates tends to disappear during the first year of life. Progressive dilation and/or symptomatic hydronephrosis require surgical treatment. A number of methods has been described to relive the UPJO. It has been shown that videosurgical techniques are safe regardless the age of the patient and surgical treatment is effective in 90-96% of cases. Furthermore, the short-term complications appear in 10-14% of patients. In many centers laparoscopic pyeloplasty (LP) has become the treatment of choice. A lot of clinical trials has been committed to identify risk factor of failure. However, no relationship has been found between the approach (trans- vs retroperitoneal), the way of completing anastomosis (running vs interrupted), the suture material (poly- vs monofilament) and the postoperative course. Neither the manner of stenting (internal vs external) nor the duration of temporary diversion influence the outcome. The goal of this thesis was to identify the risk factors for complications after laparoscopic pyeloplasty, in particular: - to find out whether children with lower urinary tract (LUT) anomalies are at greater risk f},
 abstract={or postoperative complications when stented with a double-J catheter (DJ), - to evaluate the outcome of the laparoscopic dismembered pyeloplasty with transposition of the CVs in children and adults, - to assess the long-term outcome of paediatric LP in relation to surgeon’s experience. Study 1: Short-term complications after pyeloplasty in children with lower urinary tract anomalies. Material and Methods: the clinical data of children operated on between 2006 and 2015 were analyzed. The inclusion criteria were: 1) toilet-trained child and 2) unilateral dismembered pyeloplasty stented with a (DJ) done by the same surgeon. Cystoscopy and retrograde pyelography were done in all patients. The JJC is removed 2-3 weeks after LP. Asymptomatic patients with infravesical LUT anomalies (a-LUTA) and those with history of LUT symptoms (LUTS) were identified. Any short-term complication was classified according to Clavien-Dindo. Fisher’s exact test was used for statistical analysis. Results: Fifty-four children (mean 9.8 years) were included. 10/54 patients had LUTS. In 4 of those 10, anatomical infravesical anomaly was found during cystoscopy. Accidental urethral anomaly was found in 11 patients (a-LUTA). The control group (CG) consisted of 33 patients. Postoperative hospital stay ranged from 1 to 8 days (mean 2 days). Overall complication rate was 8/54 (14%). Grade 1 complications occu},
 abstract={rred in 3 patients in the CG. Five patients had grade 3 complications (2 needed replacement of CAD, and 3 had diversion of the upper tract). Those problems occurred in 1/10 patients with LUTS and 3/11 patients with a-LUTA compared to 1/33 in the CG. This difference was statistically significant (p<0.05). Study 2: Management of crossing vessels in children and adults: a mulit-center experience with the transperitoneal laparoscopic approach. Material and Methods: The data from 3 departments were reviewed. The inclusion criteria were: 1) a transperitoneal laparoscopic approach; 2) dismembered pyeloplasty; and 3) the same operating paediatric urologist (RC) or urologist (TS); 4) postoperative internal drainage – DJ stent. In the case of crossing vessels (CVs), pyeloplasty with vessels transposition or pyeloplasty with cephalad translocation of CVs was performed. Forty-eight children and 41 adults met these criteria. Patients were divided into 4 groups: children with (group 1A) and without (group 1B) CVs and adults with (group 2A) and without (group 2B) CVs. Any surgical re-intervention at the uretero-pelvic junction was defined as failure. Fisher’s exact test was used for the statistical analysis. Results: The overall re-intervention rate was 3/48 (6.25%) in children and 2/41 (4.9%) in adults (p>0.05), and involved the following: 4 endopyelotomies and 1 re-do pyeloplasty. CVs wer},
 abstract={e identified in 28/48 (58%) children and 12/41 (29%) adults. The mean operation time was 152 min in group 1A vs. 161 min in group 2A (p>0.05). Re-intervention was needed in 2/28 in group 1A vs. 1/12 patient in group 2A (p>0.05). There was no difference in the failure rate between group 1A vs. group 1B, nor between group 2A vs. group 2B (p>0.05). Study 3: Learning curve or experience-related outcome: what really matters in paediatric laparoscopic pyeloplasty. Materials and methods: Retrospective analysis of the consecutive LPs. The inclusion criteria: (1) children aged <18 years, (2) transperitoneal approach; and (3) the same operating paediatric urologist (RC). Patients with a history of any procedure on the upper urinary tract were excluded. Any surgical reintervention during follow up was defined as a failure. The outcomes of LPs performed before 2012 (G1) were compared to those conducted between 2012 and 2016 (G2). Fisher’s exact test was used for statistical analysis. Results: Ninety patients met the inclusion criteria, and a total of 95 LPs were performed. The mean operation time was 155 min, and the mean hospitalisation period was 2.4 days. In G1, 19 patients underwent Anderson-Hynes LP, 16 had Fenger non-dismembered LP and two underwent vascular hitch. In G2, 54, 2 and 2 patients underwent these procedures, respectively. The overall success rate was 91.5%. There were},
 abstract={six failures in G1 and three in G2 (p = 0.147). Of the Anderson-Hynes LPs, 1/19 in G1 and 3/58 in G2 required reintervention (p = 1). For Fenger LPs, this was 4/16 and 0/2, respectively (p = 1). Only one patient required reoperation after vascular hitch. Conclusions Medical history focusing on the function of the LUT should be taken in all toiled-trained children before pyeloplasty. If case of LUTD or if any infravesical abnormality is found, internal diversion should probably be avoided. Special attention must be paid to bladder function in the postoperative period. Crossing vessels should be meticulously looked for during pyeloplasty in older children and adults. Dismembered LP with dorsal transposition and cephalad translocation are comparable methods in terms of success rate for treatment of UPJ obstruction in those patients. Critical internal analysis is essential to improve the overall outcomes of LP. The surgeons’ learning curve reflects their experience with regard to the entire therapeutic process, but not their manual skills.},
 title={Outcomes of surgical treatment of ureteropelvic junction obstruction in children and adults},
 type={Praca doktorska},
 keywords={uretero-pelvic junction obstruction, hydronephrosis, laparoscopic pyeloplasty, complications, outcomes},
}