Minimally invasive surgeries for pelviureteric junction obstruction have become more
popular in the past decade than open surgery. This is to decrease the morbidity for
patients and attain better patient satisfaction especially for having a significantly
smaller incisions compared to open flank and midline abdominal incisions.
Minimally invasive surgery is a term used to describe surgeries that would spare the
patient a long incision and hence spares him also the pain and risk of wound infection
associated with it. In this study the investigators will focus only on laparoscopy and
robot-assisted surgeries.
Pelviureteric junction obstruction is a disease that is not uncommon with an incidence of
1 in 1000-1500. Although usually it is diagnosed in the pediatric population, it is not
uncommon in adults. PUJO (Pelviureteric junction obstruction) could have it's impact on
the patient's quality of life as if it is not treated it could decrease the split
glomerular filtration rate due to impaired drainage. It also could present with secondary
renal stones, pain, recurrent upper urinary tract infection, fever and urosepsis.
Management of PUJO (Pelviureteric junction obstruction) starts with the proper assessment
of the patient regarding his age and careful history taking and physical examination,
evaluation of laboratory investigations such as urine culture and sensitivity, serum
creatinine, total leucocytic count. Also, evaluation of the pelviabdominal ultrasound,
intravenous pyelography, and diuretic renogram.
Treatment of PUJO (Pelviureteric junction obstruction) ranges from active surveillance,
endopyelotomy and ureteral stenting, and pyeloplasty whether it is open, laparoscopic or
robot-assisted.
Traditionally, absorbable polyglactin sutures is used for dismembered pyeloplasty. Yet
recently barbed sutures have gained popularity within urologists especially in minimally
invasive surgeries.
Barbed knotless uni-directional sutures have the benefit of being knotless and evenly
distributes tension so there is no need for the assistant to follow the surgeon and
stretch the suture, this significantly decreases the operative time and frees the
assistant's port to be able to do other steps.
Barbed sutures have been well established in other surgical fields such as bariatric
surgery, gynecology, and skin closure previously, and recently it has been populated in
the urological community especially in the vesicourethral anastomosis in Radical
prostatectomy.
Sparse yet promising articles have been published regarding the use of barbed sutures in
pyeloplasty which could change the way surgeons approach the disease.