Uretero-pelvic junction obstruction (UPJO) is the most common congenital ureteral anomaly. Traditionally open pyeloplasty has been the standard treatment for UPJO for several years. However, in the last two decades, minimally-invasive surgery (MiS) has gained popularity either in the adult’s and pediatrics feld due to its technical feasibility and decreased morbidity with an overall success rate over 90%.
However, the risk of recurrence exists with a reported percentage of 3-10% with all of the techniques. Management of UPJO recurrence is more challenging due to scar tissue formation, fibrosis, and decreased vascularization of the ureter tract which necessitate extended resections to find healthy and well-vascularized tissue. For these reasons, only expert surgeons can manage these cases. Similarly, children with congenital anatomical anomalies, such as ectopic kidneys, horseshoe kidneys, or double districts due to the narrower space and fewer landmarks are required high experience. Last but not the least, high experience is needed in infants under 1 year or 15 kilograms.
Although in these 3 fields MIS approaches start to spread out in literature no evidence of superior laparoscopic or robotic surgeries has been clearly demonstrated and open approaches still might play a role. The aim of this Research Topic is to review the outcomes of challenging pyeloplasties by all three approaches. Monocentric experience, multicentric studies, retrospective paper only focusing on one technique or comparison of two approaches and review or meta analysis on this topic are welcome.
Uretero-pelvic junction obstruction (UPJO) is the most common congenital ureteral anomaly. Traditionally open pyeloplasty has been the standard treatment for UPJO for several years. However, in the last two decades, minimally-invasive surgery (MiS) has gained popularity either in the adult’s and pediatrics feld due to its technical feasibility and decreased morbidity with an overall success rate over 90%.
However, the risk of recurrence exists with a reported percentage of 3-10% with all of the techniques. Management of UPJO recurrence is more challenging due to scar tissue formation, fibrosis, and decreased vascularization of the ureter tract which necessitate extended resections to find healthy and well-vascularized tissue. For these reasons, only expert surgeons can manage these cases. Similarly, children with congenital anatomical anomalies, such as ectopic kidneys, horseshoe kidneys, or double districts due to the narrower space and fewer landmarks are required high experience. Last but not the least, high experience is needed in infants under 1 year or 15 kilograms.
Although in these 3 fields MIS approaches start to spread out in literature no evidence of superior laparoscopic or robotic surgeries has been clearly demonstrated and open approaches still might play a role. The aim of this Research Topic is to review the outcomes of challenging pyeloplasties by all three approaches. Monocentric experience, multicentric studies, retrospective paper only focusing on one technique or comparison of two approaches and review or meta analysis on this topic are welcome.
