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Gunshot Injury of Pelvi-Ureteric Junction: Management by the Rendezvous Technique.

ABSTRACT: Background: Gunshot injury of ureter is common, but isolated injury of pelvi-ureteric junction (PUJ) has not been reported. Moreover, its management is evolving from the traditional urinary diversion, stenting followed later by definitive surgical repair to a more upfront minimally invasive endourologic approach. Case Presentation: An adolescent boy presented with gunshot laceration injury of left PUJ with associated small intestinal injury. Radiological investigations confirmed a contained urinary leak. Retrograde stenting was not effective. The same guidewire was retained into the urinoma and an antegrade percutaneous access was obtained. A snare was used to retrieve the guidewire and obtain a through and through access. A ureteropelvic drainage catheter was inserted over this guidewire and secured in the upper ureter, bypassing the region of injury. Three weeks later, the drainage tube was removed and the same tract was used for antegrade stenting. A retrograde pyelogram done 3 months later during stent removal demonstrated no leak. The patient is asymptomatic for urinary symptoms on 6 months of follow-up. Conclusion: Rendezvous technique is a feasible alternative to open repair of gunshot pelvi-ureteric junction injury. Long-term follow-up is awaited.

SUBMITTER: Sekhon V

PROVIDER: S-EPMC5561446 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description:BackgroundUnilateral ureteric-pelvic junction obstruction (UPJO) is the most common cause of obstructive uropathy and may lead to renal impairment and loss of renal function. The current diagnostic approach with renal imaging cannot reliably determine which newborns and infants less than two years of age have a significant obstruction and are at risk for permanent kidney damage. There is therefore no consensus on optimal therapeutic management of unilateral UPJO.ObjectivesTo assess the effects of surgical versus non-surgical treatment options for newborns and infants less than two years of age with unilateral UPJO.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 6, 2016), MEDLINE/Ovid, and EMBASE/Ovid databases from their inception to 13 June 2016. We searched the reference lists of potentially relevant studies without using any language restriction. We also searched the following trial registers for relevant registered studies: www.clinicaltrials.gov/; ISRCTN registry (controlled-trials.com/); www.trialscentral.org/; apps.who.int/trialsearch/; www.drks.de/; and www.anzctr.org.au/trialSearch.aspx.Selection criteriaWe selected randomised and quasi-randomised controlled trials comparing surgical with non-surgical interventions for the treatment of unilateral UPJO.Data collection and analysisTwo review authors independently assessed study eligibility and risk of bias of included studies and extracted data. In case of disagreements we consulted a third review author. The data reported in the two included studies did not allow us to perform a meta-analysis.Main resultsWe found only two studies at high risk of bias that were eligible for inclusion in this review. The total sample size, including both trials, was small (n = 107 participants less than six months of age from the UK and USA), and not all prespecified outcome measures were assessed. Reported measures only accounted for the short-term follow-ups. The mean split renal function was not statistically different between the surgical and non-surgical group at the six-month or one-year time point (very low-quality evidence). The surgical group showed a significantly less obstructed drainage pattern and a lower urinary tract dilatation than the non-surgical group (very low-quality evidence). Transfer from the non-surgical group to the surgical group was reported for about one out of five participants. Split renal function after secondary surgical intervention was reported with variable results, but most of the participants reverted to pre-deteriorated values. The studies either provided no or insufficient data on the following outcome measures: postoperative complications, UPJO-associated clinical symptoms, costs of interventions, radiation exposure, quality of life, and adverse effects.Authors' conclusionsWe found limited evidence assessing the benefits and harms of surgical compared to non-surgical treatment options for newborns and infants less than two years of age with unilateral UPJO. The majority of participants in the non-surgical treatment group did not experience any significant deterioration of split renal function, and only about 20% of them underwent secondary surgical intervention, with minor risk of permanent deteriorated split renal function. The study follow-up period was too short to assess the long-term effects on split renal function in both treatment groups. We need further randomised controlled trials with sufficient statistical power and an adequate follow-up period to determine the optimal therapy for newborns and infants less than two years of age with unilateral UPJO.

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Gunshot Injury of Pelvi-Ureteric Junction: Management by the Rendezvous Technique.

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