Trends in upper urinary tract reconstruction surgery over a decade based on a multi-center database

  • Wei ZUO ,
  • Fei GAO ,
  • Chang-wei YUAN ,
  • Sheng-wei XIONG ,
  • Zhi-hua LI ,
  • Lei ZHANG ,
  • Kun-lin YANG ,
  • Xin-fei LI ,
  • Liang LIU ,
  • Lai WEI ,
  • Peng ZHANG ,
  • Bing WANG ,
  • Ya-ming GU ,
  • Hong-jian ZHU ,
  • Zheng ZHAO ,
  • Xue-song LI
Expand
  • 1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
    2. Department of Urology, Beijing Jiangong Hospital, Beijing 100054, China
    3. Department of Urology, Emergency General Hospital, Beijing 100028, China
    4. Department of Urology, Miyun District Hospital (Miyun Hospital, Peking University First Hospital), Beijing 101599, China

Received date: 2022-03-29

  Online published: 2022-08-11

Abstract

Objective: To study the trend of surgical type, surgical procedure and etiological distribution of upper urinary tract repair in recent 10 years. Methods: The preoperative and perioperative variables and follow-up data of upper urinary tract reconstruction surgery in RECUTTER (Reconstruction of Urinary Tract: Technology, Epidemiology and Result) database from 2010 to 2021 were searched, collected and analyzed. The surgical type, surgical procedure, duration of hospitalization, time of operation, incidence of short-term complications, and proportion of the patients undergoing reoperations were compared between the two groups of 2010-2017 period and 2018-2021 period. Results: A total of 1 072 patients were included in the RECUTTER database. Congenital factors and iatrogenic injuries were the main causes of upper urinary tract repair. Among them, 129 (12.0%) patients had open operation, 403 (37.6%) patients had laparoscopic surgery, 322 (30.0%) patients had robot-assisted laparoscopic surgery and 218 (20.3%) patients had endourological procedure. In the last decade, the total number of surgeries showed a noticeable increasing annual trend and the proportion of robot-assisted laparoscopic surgery in 2018-2021 was significantly higher than that in 2010-2017 (P < 0.001). The 1 072 patients included 124 (11.6%) cases of ileal ureter replacements, 440 (41.1%) cases of pyeloplasty, 229 (21.4%) cases of balloon dilation, 109 (10.2%) cases of ureteral reimplantation, 49 (4.6%) cases of boari flap-Psoas hitch surgery, 60 (5.6%) cases of uretero-ureteral anastomosis, 61 (5.7%) cases of lingual mucosal onlay graft ureteroplasty or appendiceal onlay flap ureteroplasty. Pyeloplasty and balloon dilatation had been the main types of surgery, while the proportion of lingual mucosal onlay graft ureteroplasty plus appendiceal onlay flap ureteroplasty had increased significantly in recent years (P < 0.05). In addition, the time of operation was significantly increased (P < 0.05) after 2018, which was considered to be related to the sharp increase in the proportion of robot-assisted laparoscopic surgery. We found that minimally invasive surgery (endourological procedure and robot-assisted laparoscopic surgery) as an independent risk factor (P=0.050, OR=0.472) could reduce the incidence of short-term post-operative complications. Conclusion: We have justified the value of the RECUTTER database, created by the Institute of Urology, Peking University in data support for clinical research work, and provided valuable experience for the construction of other multi-center databases at home and abroad. In recent 10 years, we have observed that, in upper urinary tract reconstruction surgery, the surgery type tends to be minimally invasive and the surgery procedure tends to be complicated, suggesting the superiority of robot-assisted laparoscopic surgery.

Cite this article

Wei ZUO , Fei GAO , Chang-wei YUAN , Sheng-wei XIONG , Zhi-hua LI , Lei ZHANG , Kun-lin YANG , Xin-fei LI , Liang LIU , Lai WEI , Peng ZHANG , Bing WANG , Ya-ming GU , Hong-jian ZHU , Zheng ZHAO , Xue-song LI . Trends in upper urinary tract reconstruction surgery over a decade based on a multi-center database[J]. Journal of Peking University(Health Sciences), 2022 , 54(4) : 692 -698 . DOI: 10.19723/j.issn.1671-167X.2022.04.018

References

1 Stief CG , Jonas U , Petry KU , et al. Ureteric reconstruction[J]. BJU international, 2003, 91 (2): 138- 142.
2 Zhu W , Xiong S , Xu C , et al. Initial experiences with preoperative three-dimensional image reconstruction technology in laparoscopic pyeloplasty for ureteropelvic junction obstruction[J]. Transl Androl Urol, 2021, 10 (11): 4142- 4151.
3 Yuan C , Wang J , Cheng S , et al. Robotic ureteral reimplantation for the management of ureterovaginal fistula: Four cases at a single center[J]. Transl Androl Urol, 2021, 10 (10): 3705- 3713.
4 Yang K , Fan S , Wang J , et al. Robotic-assisted lingual mucosal graft ureteroplasty for the repair of complex ureteral strictures: Technique description and the medium-term outcome[J]. Eur Urol, 2022, 81 (5): 533- 540.
5 Wang J , Xiong S , Fan S , et al. Appendiceal onlay flap ureteroplasty for the treatment of complex ureteral strictures: Initial experience of nine patients[J]. J Endourol, 2020, 34 (8): 874- 881.
6 Fan S , Yin L , Yang K , et al. Posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts for long proximal ureteral strictures: 10 cases of experience[J]. J Endourol, 2021, 35 (2): 192- 199.
7 Li X , Wang X , Li T , et al. Cine magnetic resonance urography and whitaker test: Dynamic visualized and quantified tools in ileal ureter replacement[J]. Transl Androl Urol, 2021, 10 (11): 4110- 4119.
8 Li X , Yang K , Zhu W , et al. The whitaker test in the follow-up of complex upper urinary tract reconstruction: Is it clinical useful or not[J]. Urol J, 2021, 19 (1): 56- 62.
9 Ding G , Li X , Fang D , et al. Etiology and ureteral reconstruction strategy for iatrogenic ureteral injuries: A retrospective single-center experience[J]. Urol Int, 2021, 105 (5/6): 470- 476.
10 de Onis M , Bl?ssner M . The world health organization global database on child growth and malnutrition: Methodology and applications[J]. Int J Epidemiol, 2003, 32 (4): 518- 526.
11 Jacobs JP , Lacour-Gayet FG , Jacobs ML , et al. Initial application in the sts congenital database of complexity adjustment to evaluate surgical case mix and results[J]. Ann Thorac Surg, 2005, 79 (5): 1635- 1649.
12 Kakeji Y , Yamamoto H , Ueno H , et al. Development of gastroenterological surgery over the last decade in japan: Analysis of the national clinical database[J]. Surg Today, 2021, 51 (2): 187- 193.
13 Bowdish ME , D'Agostino RS , Thourani VH , et al. Sts adult car-diac surgery database: 2021 update on outcomes, quality, and research[J]. Ann Thorac Surg, 2021, 111 (6): 1770- 1780.
14 Kwoh YS , Hou J , Jonckheere EA , et al. A robot with improved absolute positioning accuracy for ct guided stereotactic brain surgery[J]. IEEE Trans Biomed Eng, 1988, 35 (2): 153- 160.
15 Binder J , Kramer W . Robotically-assisted laparoscopic radical prostatectomy[J]. BJU Int, 2001, 87 (4): 408- 410.
16 Rosero EB , Kho KA , Joshi GP , et al. Comparison of robotic and laparoscopic hysterectomy for benign gynecologic disease[J]. Obstet Gynecol, 2013, 122 (4): 778- 786.
17 Yates DR , Vaessen C , Roupret M . From leonardo to da vinci: The history of robot-assisted surgery in urology[J]. BJU Int, 2011, 108 (11): 1708- 1713.
18 Autorino R , Porpiglia F , Dasgupta P , et al. Precision surgery and genitourinary cancers[J]. Eur J Surg Oncol, 2017, 43 (5): 893- 908.
19 Leal Ghezzi T , Campos Corleta O . 30 years of robotic surgery[J]. World J Surg, 2016, 40 (10): 2550- 2557.
20 Andolfi C , Adamic B , Oommen J , et al. Robot-assisted laparoscopic pyeloplasty in infants and children: Is it superior to conventional laparoscopy?[J]. World J Urol, 2020, 38 (8): 1827- 1833.
21 Crocerossa F , Carbonara U , Cantiello F , et al. Robot-assisted radical nephrectomy: A systematic review and meta-analysis of comparative studies[J]. Eur Urol, 2021, 80 (4): 428- 439.
22 Deng T , Liu B , Luo L , et al. Robot-assisted laparoscopic versus open ureteral reimplantation for pediatric vesicoureteral reflux: A systematic review and meta-analysis[J]. World J Urol, 2018, 36 (5): 819- 828.
Outlines

/