No surgical dissection is done in proximity to the obliterated um

No surgical dissection is done in proximity to the obliterated umbilical artery, nor is the artery ligated. Patients

follow a strict postoperative critical pathway, and parents receive extensive preoperative and postoperative education. The child is required to fulfill strict criteria to be discharged home.

Results: A total of 51 girls and 9 boys 0.9 to 10.5 years old (mean age 5.1) were evaluated. A total of 24 unilateral and 36 bilateral procedures were performed with and without ureteral tapering, and for single systems, duplex systems and an associated Hutch diverticulum. Overall 54 children (90%) were discharged home the same day, while only 6 (10%) went home the next day. All patients who under-went selleck kinase inhibitor a unilateral procedure and 83% who underwent a

bilateral procedure were outpatients. However, when evaluating the last 40 consecutive patients, including 14 with a unilateral and 26 with a bilateral procedure, PD0332991 ic50 all (100%) were discharged home the day of surgery without increased morbidity or an additional analgesic requirement. All outpatients were discharged within 5 hours after surgery. All patients tolerated the procedure well without major complications and without any patients requiring an emergency department visit or hospitalization after discharge home. After the urinary catheter was removed all patients were able to spontaneously void postoperatively without any acute or chronic urinary retention.

Conclusions: This

study demonstrates that implementation of a strict critical pathway and a unilateral or bilateral extravesical ureteral reimplantation surgical technique with limited dissection can consistently result in same day discharge from the hospital within a few hours postoperatively without increased morbidity or rehospitalization.”
“Purpose: Standard treatment for ureterovascular Metabolism inhibitor ureteropelvic junction obstruction has been dismembered pyeloplasty. We previously reported the alternative technique of laparoscopic transposition of lower pole vessels (the vascular hitch) in pediatric patients. This report is an update of this select group of pediatric patients with intermediate followup.

Materials and Methods: Patients underwent diagnostic renal sonography and (99m)technetium-mereaptoacetyltriglycine diuretic renography with additional magnetic resonance angiography in candidate patients. Radiographic criteria included moderate hydronephrosis with no caliceal dilatation and a well preserved cortex, poor renal drainage with preserved split function and lower pole crossing vessels. Intraoperative criteria included a normal ureter and ureteropelvic junction with peristalsis. Postoperatively patients were followed clinically, and with renal sonography and (99m)technetium-mercaptoacetyl-triglycine renography at 1 and 2 months, respectively.

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